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Arentson-Lantz EJ, Deer RR, Kokonda M, Wen CL, Pecha TA, Carreon SA, Ngyen TM, Volpi E, Nowakowski S. Improvements in sleep quality and fatigue are associated with improvements in functional recovery following hospitalization in older adults. FRONTIERS IN SLEEP 2022; 1:1011930. [PMID: 37251511 PMCID: PMC10217784 DOI: 10.3389/frsle.2022.1011930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Study objectives Poor sleep quality, a frequent problem in older adults, has been shown to be associated with reduced physical function and wellbeing. However, little is known about the relationship between sleep quality and the recovery of physical function following hospitalization. Thus, we conducted this study to examine the association between sleep quality and functional recovery after an acute hospitalization in community dwelling older adults. Methods Older adult patients (N = 23, mean age = 74 ± 9 years) were recruited during an acute hospitalization (average length of stay 3.9 days) with a cardiovascular (56%), pulmonary (22%), or metabolic (13%) admission diagnosis. Objective physical function was measured using the Short Physical Performance Battery (SPPB) and self-reported function was assessed with Katz Index of Independence in Activities of Daily Living (ADL) and Lawton Instrumental Activities of Daily Living Scale (IADL). Sleep quality was measured using Pittsburgh Sleep Quality Index (PSQI) global score and Iowa Fatigue Score (IFS). Testing was performed prior to discharge (baseline) and 4-weeks post-discharge (follow-up). Results Regression models showed PSQI Subjective Sleep Quality change scores from baseline to 4-week follow-up predicted a change in ADL (β = -0.22); PSQI Use of Sleep Medications change scores predicted a change in SPPB Total (β = 1.62) and SPPB Chair Stand (β = 0.63); IFS change scores predicted SPPB Total (β = -0.16) and SPPB Chair Stand performance (β = -0.07) change scores. Conclusions For older adults, changes in sleep medication use, daytime dysfunction, and fatigue were associated with improvements in functional recovery (including physical performance and independence) from acute hospitalization to 4-week follow-up. These results suggest that interventions focused on improving sleep quality, daytime consequences, and fatigue might help enhance physical functioning following hospitalization. Clinical trial registration ClinicalTrials.gov, identifier: NCT02203656.
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Affiliation(s)
- Emily J. Arentson-Lantz
- Department of Nutrition, Metabolism, and Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, United States
| | - Rachel R. Deer
- Department of Nutrition, Metabolism, and Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, United States
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, United States
| | - Manasa Kokonda
- Center for Innovation in Quality, Effectiveness, and Safety, Michael DeBakey VA Medical Center, Houston, TX, United States
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Chelsey L. Wen
- School of Public Health, University of Texas Health Science Center, Houston, TX, United States
| | - Thomas A. Pecha
- School of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Samantha A. Carreon
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Trung M. Ngyen
- School of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Elena Volpi
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, United States
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, United States
| | - Sara Nowakowski
- Department of Nutrition, Metabolism, and Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, United States
- Center for Innovation in Quality, Effectiveness, and Safety, Michael DeBakey VA Medical Center, Houston, TX, United States
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
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2
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Sharma Y, Avina P, Ross E, Horwood C, Hakendorf P, Thompson C. Validity of the Malnutrition Universal Screening Tool for Evaluation of Frailty Status in Older Hospitalised Patients. Gerontol Geriatr Med 2022; 8:23337214221107817. [PMID: 35832095 PMCID: PMC9272176 DOI: 10.1177/23337214221107817] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/25/2022] [Accepted: 05/31/2022] [Indexed: 11/16/2022] Open
Abstract
The malnutrition-universal-screening-tool (MUST) is commonly used for screening malnutrition in hospitalised patients but its utility in the detection of frailty is unknown. This study determined the utility of MUST in detection of frailty in older hospitalised patients. This prospective-study enrolled 243 patients ⩾65 years in a tertiary-teaching hospital in Australia. Patients with a MUST score of ⩾1 were classified as at-risk of malnutrition. Frailty status was determined by the Edmonton-Frail-Scale (EFS) and patients with an EFS score of >8 were classified as frail. We validated the MUST against the EFS by plotting a receiver-operating-characteristic-curve (ROC) curve and area-under-the-curve (AUC) was determined. The mean (SD) age was 83.9 (6.5) years and 126 (51.8%) were females. The EFS determined 149 (61.3%) patients as frail, while 107 (44.1%) patients were at-risk of malnutrition according to the MUST. There was a positive linear but weak association between the MUST and the EFS scores (Pearson's correlation coefficient= .22, 95% CI .12- .36, p < .001). The sensitivity, specificity, positive and negative predictive value of MUST in the detection of frailty was 51%, 67%, 78.5% and 37%, respectively and the AUC was .59 (95% CI .53-.65, p < .001). The MUST is moderately sensitive in detection of frailty in older-hospitalised patients.
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Affiliation(s)
- Yogesh Sharma
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia,Flinders Medical Centre, Adelaide, SA, Australia,Yogesh Sharma, MBBS, MD, FRACP, PhD, College of Medicine and Public Health, Flinders University, Division of Medicine, Cardiac & Critical Care, Flinders Medical Centre, Flinders Drive, Bedford Park, Adelaide, SA 5002, Australia.
| | - Peter Avina
- Queen Elizabeth Hospital, Adelaide, SA, Australia
| | - Emelie Ross
- Flinders Medical Centre, Adelaide, SA, Australia
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Deer RR, Hosein E, Mera A, Howe K, Goodlett S, Robertson N, Volpi E. Dietary Intake Patterns of Community-Dwelling Older Adults after Acute Hospitalization. J Gerontol A Biol Sci Med Sci 2021; 77:140-147. [PMID: 34410002 DOI: 10.1093/gerona/glab232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Malnutrition and sarcopenia are a growing concern in community-dwelling older adults. Hospitalization increases the risk of malnutrition and leads to a decline in functional and nutritional status at discharge. Persistent malnutrition after hospital discharge may worsen post-hospital outcomes, including readmissions. The aim of this study was to determine dietary intakes and nutrient distribution patterns of community-dwelling older adults after acute hospitalization. METHODS Participants (≥65 yrs old, n=85) were enrolled during acute hospitalization and dietary 24-hour recalls were collected weekly for one month post-discharge. Analysis included: change in dietary intake over recovery timeframe; daily intake of energy, protein, fruit, vegetables, and fluids; comparison of intake to recommendations; distribution of energy and protein across mealtimes; and analysis of most common food choices. RESULTS Most participants did not meet current recommendations for energy, fruit, vegetables, or fluids. Average protein consumption was significantly higher than the current recommendation of 0.8g/kg/day; however only 55% of participants met this goal and less than 18% met the 1.2 g/kg/day proposed optimal protein intake for older adults. The protein distribution throughout the day was skewed and no one met the 0.4 g/meal protein recommendation at all meals. CONCLUSIONS Our findings indicate that community-dwelling older adults did not meet their nutritional needs during recovery after hospitalization. These data highlight the need for better nutritional evaluation and support of geriatric patients recovering from hospitalization.
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Affiliation(s)
- Rachel R Deer
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, USA.,Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA.,Department of Nutrition and Metabolism, University of Texas Medical Branch, Galveston, TX, USA
| | - Erin Hosein
- Department of Nutrition and Metabolism, University of Texas Medical Branch, Galveston, TX, USA
| | - Alejandra Mera
- Department of Nutrition and Metabolism, University of Texas Medical Branch, Galveston, TX, USA
| | - Kristen Howe
- Department of Nutrition and Metabolism, University of Texas Medical Branch, Galveston, TX, USA
| | - Shawn Goodlett
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA
| | - Nicole Robertson
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA
| | - Elena Volpi
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA.,Department of Nutrition and Metabolism, University of Texas Medical Branch, Galveston, TX, USA.,Department of Internal Medicine, Division of Geriatrics, University of Texas Medical Branch, Galveston, TX, USA
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Peyrusqué E, Buckinx F, Bolduc A, Law C, Kergoat MJ, Aubertin-Leheudre M. Potential Efficacy of Pragmatic Exercise Program (SPRINT) during Hospitalization in Older Adults on Health Care and Physical Performance: A Pilot Study. J Nutr Health Aging 2021; 25:126-133. [PMID: 33367473 DOI: 10.1007/s12603-020-1483-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Immobilization contribute to iatrogenic decline in hospitalized older adult. Implementing physical activity (PA) seems to be one of the best and easy solution. However, PA interventions are poorly integrated into usual care and those available are either non-specific, need supervision or requested human/material resources. Thus, we aimed to assess the effect of a pragmatic, unsupervised, and specific PA program (SPRINT) on health care practice and functional capacities in hospitalized older patients. DESIGN Single arm interventional pragmatic pilot study. SETTING Geriatric Assessment Unit (GAU). PARTICIPANTS Of the 39 patients (> 65 years) hospitalized in a GAU and eligible, 19 agreed to participate (AP) and 20 declined (N-AP). INTERVENTION One of the 4 PA programs, developed by our team, was allocated according to mobility profile. Individual functional capacities (i.e. balance, walking speed, functional mobility profile (PFMP)), active time (METS> 1.5: min), length of hospitalization (LOS), discharge orientation were assessed at admission and discharge of GAU. RESULTS Baseline characteristics of the 2 groups were comparable. At discharge, the AP group improved more on walking speed (0.57 ± 0.21 vs. 0.64 ± 0.19; p = 0.013), Berg balance scale (41.8 ± 13.7 vs. 45.1 ± 9.7; p = 0.017) and PFMP (54.0 ± 7.1 vs 55.1 ± 5.5; p = 0.042) than the N-AP group. The LOS was significantly shorter in AP group compared to the N-AP group (5 vs. 36 days; p = 0.026) and more subjects in the AP group were oriented at home without health or social services (89.5 vs. 60%; p=0.065). CONCLUSION SPRINT appears effective to counteract iatrogenic decline and decreased the LOS. Moreover, this simple pragmatic PA tool seems to improve the life trajectory and healthcare practice in aging population. Further researches are needed to confirm these promising pragmatic results.
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Affiliation(s)
- E Peyrusqué
- Mylène Aubertin-Leheudre, PhD, Département des Sciences de l'Activité Physique, Université du Québec à Montréal (UQAM), Pavillon des sciences biologiques (SB), 4th floor, 141 avenue Président-Kennedy, SB-4615, Montreal, Quebec, Canada H3C 3P8, E-mail address:
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Yao S, Zheng P, Ji L, Ma Z, Wang L, Qiao L, Wan Y, Sun N, Luo Y, Yang J, Wang H. The effect of comprehensive assessment and multi-disciplinary management for the geriatric and frail patient: A multi-center, randomized, parallel controlled trial. Medicine (Baltimore) 2020; 99:e22873. [PMID: 33181655 PMCID: PMC7668452 DOI: 10.1097/md.0000000000022873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND A comprehensive geriatric assessment (CGA) of elderly patients is useful for detecting the patients vulnerabilities. Exercise and early rehabilitation, nutritional intervention, traditional Chinese medicine (TCM), standardized medication guidance, and patient education can, separately, improve and even reverse the physical frailty status. However, the effect of combining a CGA and multi-disciplinary management on frailty in elderly patients remains unclear. The present study assessed the effects of a CGA and multi-disciplinary management on elderly patients with frailty in China. METHODS In this study, 320 in patients with frailty ≥70 years old will be randomly divided into an intervention group and a control group. The intervention group will be given routine management, a CGA and multi-disciplinary management involving rehabilitation exercise, diet adjustment, multi-drug evaluation, acupoint massage in TCM and patient education for 12 months, and the control group will be followed up with routine management for basic diseases. The primary outcomes are the Fried phenotype and short physical performance battery (SPPB). The secondary outcomes are the clinical frailty scale (CFS), non-elective hospital readmission, basic activities of daily living (BADL), 5-level European quality of life 5 dimensions index (EQ-5D), nutrition risk screening-2002 (NRS-2002), medical insurance expenses, fall events, and all-cause mortality. In addition, a cost-effectiveness study will be carried out. DISCUSSION This paper outlines the protocol for a randomized, single-blind, parallel multi-center clinical study. This protocol, if beneficial, will demonstrate the interaction of various intervention strategies, will help improve elderly frailty patients, and will be useful for clinicians, nurses, policymakers, public health authorities, and the general population. TRIAL REGISTRATION Chinese Clinical Trials Register, ChiCTR1900022623. Registered on April 19, 2019, http://www.chictr.org.cn/showproj.aspx?proj=38141.
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Affiliation(s)
- Simin Yao
- Department of Cardiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences
- Peking University Fifth School of Clinical Medicine, Dong Dan, Beijing
| | - Peipei Zheng
- Department of Cardiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences
- Peking University Fifth School of Clinical Medicine, Dong Dan, Beijing
| | | | - Zhao Ma
- Department of Rehabilitation
| | | | - Linlin Qiao
- Department of TCM, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, PR China
| | - Yuhao Wan
- Department of Cardiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences
| | - Ning Sun
- Department of Cardiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences
| | - Yao Luo
- Department of Cardiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences
| | - Jiefu Yang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences
| | - Hua Wang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences
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6
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Deer RR, Dickinson JM, Baillargeon J, Fisher SR, Raji M, Volpi E. A Phase I Randomized Clinical Trial of Evidence-Based, Pragmatic Interventions to Improve Functional Recovery After Hospitalization in Geriatric Patients. J Gerontol A Biol Sci Med Sci 2020; 74:1628-1636. [PMID: 30906944 DOI: 10.1093/gerona/glz084] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Physical function declines during hospitalization in geriatric patients, increasing the risk of loss of independence. There is a need for evidence-based, pragmatic interventions to improve functional recovery of older adults following acute hospitalization. Here, we report the results of a Phase I randomized clinical trial designed to determine safety and effect size of protein supplementation, exercise, and testosterone interventions on 30-day post-discharge functional recovery and readmissions in geriatric patients. METHODS A total of 100 patients admitted to the University of Texas Medical Branch hospital for an acute medical illness were randomized to one of five intervention groups: isocaloric placebo, whey protein supplement, in-home rehabilitation + placebo, in-home rehabilitation + whey protein, or testosterone. Primary outcome measure was the change from baseline in short physical performance battery score at 1 and 4 weeks post-discharge. Secondary outcomes were changes in body composition, activities of daily living, and 30-day readmissions. Comparisons were made across study groups and between placebo and all active intervention groups. RESULTS Four weeks post-discharge, the short physical performance battery total score and balance score increased more in active intervention groups than placebo group (p < .05). There were no significant differences in change in body composition or activities of daily living across groups or between active intervention groups and placebo group. Readmission rates were highest in placebo (28%), followed by rehabilitation + placebo (15%), whey protein (12%), rehabilitation + whey protein (11%), and testosterone (5%). There was a trend for lower readmission rates in all active intervention groups (11%) versus placebo group (28%). CONCLUSIONS Findings from this Phase I clinical trial suggest that pragmatic, evidence-based interventions may accelerate recovery from acute hospitalization in geriatric patients. These data provide essential information to design larger randomized controlled trials to test the effectiveness of these interventions.
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Affiliation(s)
- Rachel R Deer
- Sealy Center on Aging, The University of Texas Medical Branch, Galveston.,Division of Rehabilitation Sciences, The University of Texas Medical Branch, Galveston
| | - Jared M Dickinson
- Sealy Center on Aging, The University of Texas Medical Branch, Galveston.,School of Nutrition and Health Promotion, Healthy Lifestyles Research Center, Arizona State University, Phoenix
| | - Jacques Baillargeon
- Department of Preventive Medicine and Community Health, The University of Texas Medical Branch, Galveston
| | - Steven R Fisher
- Sealy Center on Aging, The University of Texas Medical Branch, Galveston.,Department of Physical Therapy, The University of Texas Medical Branch, Galveston
| | - Mukaila Raji
- Sealy Center on Aging, The University of Texas Medical Branch, Galveston.,Department of Internal Medicine, Division of Geriatrics, The University of Texas Medical Branch, Galveston
| | - Elena Volpi
- Sealy Center on Aging, The University of Texas Medical Branch, Galveston.,Department of Internal Medicine, Division of Geriatrics, The University of Texas Medical Branch, Galveston
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7
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Echeverria I, Amasene M, Urquiza M, Labayen I, Anaut P, Rodriguez-Larrad A, Irazusta J, Besga A. Multicomponent Physical Exercise in Older Adults after Hospitalization: A Randomized Controlled Trial Comparing Short- vs. Long-Term Group-Based Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17020666. [PMID: 31968573 PMCID: PMC7013692 DOI: 10.3390/ijerph17020666] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/16/2020] [Accepted: 01/17/2020] [Indexed: 01/04/2023]
Abstract
Multicomponent physical exercise is effective in curbing the effect of hospitalization in older adults. However, it is not well established which characteristics of the exercise interventions would optimize intervention sustainability and efficacy. This study compared the effects of two group-based multicomponent exercise interventions of different lengths in older adults after hospitalization. Fifty-five participants were randomly assigned to a short-term group-based branch (SGB, n = 27) or to a long-term group-based branch (LGB, n = 28). The SGB participated in a six-week multicomponent group-based exercise-training program followed by 18 weeks of home-based exercise. The LGB completed 12 weeks of each phase. Physical function, physical activity, quality of life, anthropometrics, and nutritional status were assessed at baseline, after 12 weeks, and after 24 weeks of intervention. Both groups improved physical function and nutritional status and increased physical activity after 12 weeks of intervention (paired student’s t-test, p < 0.01), and maintained the positive effects during the following 12 weeks. No group-by-time interaction was observed in any of the studied variables using mixed-model ANOVA. Based on these findings, we determined that 6 weeks of a group-based exercise intervention caused similar functional and nutritional benefits to a longer group-based intervention of 12 weeks when both are continued at home until 24 weeks.
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Affiliation(s)
- Iñaki Echeverria
- Department of Physiology, University of the Basque Country, UPV/EHU, 48940 Leioa, Spain; (M.U.); (A.R.-L.); (J.I.)
- Department of RMSB, UMR 5536, Université Bordeaux/CNRS, 33000 Bordeaux, France
- Correspondence: ; Tel.: +34-626-504-080
| | - Maria Amasene
- Department of Pharmacy and Food Science, University of the Basque Country UPV/EHU, 01006 Vitoria-Gasteiz, Spain;
| | - Miriam Urquiza
- Department of Physiology, University of the Basque Country, UPV/EHU, 48940 Leioa, Spain; (M.U.); (A.R.-L.); (J.I.)
| | - Idoia Labayen
- Institute for Innovation & Sustainable Development in Food Chain (IS-FOOD), Public University of Navarra, 31006 Pamplona, Spain;
| | - Pilar Anaut
- Department of Medicine, Araba University Hospital, Bioaraba Research Institute, OSI Araba, CIBERSAM, University of the Basque Country (UPV/EHU), 01004 Vitoria-Gasteiz, Spain; (P.A.); (A.B.)
| | - Ana Rodriguez-Larrad
- Department of Physiology, University of the Basque Country, UPV/EHU, 48940 Leioa, Spain; (M.U.); (A.R.-L.); (J.I.)
| | - Jon Irazusta
- Department of Physiology, University of the Basque Country, UPV/EHU, 48940 Leioa, Spain; (M.U.); (A.R.-L.); (J.I.)
| | - Ariadna Besga
- Department of Medicine, Araba University Hospital, Bioaraba Research Institute, OSI Araba, CIBERSAM, University of the Basque Country (UPV/EHU), 01004 Vitoria-Gasteiz, Spain; (P.A.); (A.B.)
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Deer RR, Akhverdiyeva L, Kuo YF, Volpi E. Developing a screening tool for sarcopenia in hospitalized geriatric patients: Estimation of appendicular skeletal muscle mass using bioelectrical impedance. Clin Nutr 2019; 39:2233-2237. [PMID: 31676257 DOI: 10.1016/j.clnu.2019.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 09/06/2019] [Accepted: 10/07/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND & AIMS Sarcopenia is now a billable ICD-10 geriatric condition characterized by low appendicular skeletal muscle mass (ASMM) and low function. There is an increasing need for portable, provider-friendly, cost-effective methods for estimating ASMM. The overall goal of this project was to create and validate a regression model for obtaining ASMM from Bioelectrical Impedance Analysis (BIA) measurements using Dual-energy X-ray Absorptiometry (DXA) as the reference. METHODS Geriatric patients (≥65 years of age) were enrolled during an acute hospitalization. Body composition measurements were obtained through DXA and BIA devices. The ASMM prediction model was derived using stepwise multiple regression modeling. The model was 10 fold validated and tested as a screening tool (sensitivity, specificity, positive and negative predictive values) using the Foundation for the NIH Sarcopenia Project (FNIH) definition. RESULTS The following variables were selected by stepwise regression modeling: sex, body mass index, max grip strength, and fat mass derived by BIA. The model was internally validated with 10 fold cross validation. Using the FNIH definition, the model was found to have a sensitivity of 80%, a specificity of 91%, a positive predictive value of 73% and a negative predictive value of 93%. CONCLUSIONS We have developed a screening tool that can be easily used in geriatric patients to screen for sarcopenia. Once validated with a larger sample, the developed prediction model can be used to estimate ASMM using provider-friendly measurements and can be easily implemented as a sensitive screening tool for identifying patients at risk for sarcopenia. Those identified at risk would undergo further functional testing for diagnosis and treatment of sarcopenia.
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Affiliation(s)
- Rachel R Deer
- Sealy Center on Aging, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA; Division of Rehabilitation Sciences, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA.
| | - Leyla Akhverdiyeva
- School of Medicine, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA.
| | - Yong-Fang Kuo
- Sealy Center on Aging, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA; Dept. of Preventive Medicine and Population Health, Office of Biostatistics, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA.
| | - Elena Volpi
- Sealy Center on Aging, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA; Dept. of Internal Medicine, Division of Geriatrics, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA.
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Abstract
Prevalence of cardiovascular disease (CVD) increases with age and is endemic in the burgeoning population of older adults. Older adults with CVD are susceptible not only to high mortality but also to increased likelihood of disability, dependency, functional decline, and poor quality of life. Cardiac rehabilitation (CR) is a multidimensional and comprehensive treatment program that can potentially address many of the distinctive challenges of older adults with CVD. In this review, the wide range of potential benefits of CR for older adults with CVD is summarized.
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Affiliation(s)
- Deirdre O'Neill
- Department of Medicine and Mazankowski Heart Institute, Division of Cardiology, University of Alberta Hospital, 11220 83 Avenue, Edmonton, AB T6G 2J2, Canada
| | - Daniel E Forman
- Section of Geriatric Cardiology, Divisions of Geriatrics and Cardiology, University of Pittsburgh, Pittsburgh, PA, USA; Geriatric Research, Education, and Clinical Center (GRECC), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
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Beneficial Effects of Leucine Supplementation on Criteria for Sarcopenia: A Systematic Review. Nutrients 2019; 11:nu11102504. [PMID: 31627427 PMCID: PMC6835605 DOI: 10.3390/nu11102504] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 10/14/2019] [Accepted: 10/14/2019] [Indexed: 12/24/2022] Open
Abstract
Objective: Treating sarcopenia remains a challenge, and nutritional interventions present promising approaches. We summarize the effects of leucine supplementation in treating older individuals with sarcopenia associated with aging or to specific disorders, and we focus on the effect of leucine supplementation on various sarcopenia criteria, e.g., muscular strength, lean mass, and physical performance. Methods: A literature search for articles related to this topic was performed on the relevant databases, e.g., the PubMed/Medline, Embase, EBSCO, Cochrane, Lilacs, and Dialnet. The identified articles were reviewed according to Preferred Reporting Items for Systematic reviews and meta-analyses (PRISMA) guidelines. Results: Of the 163 articles we consulted, 23 met our inclusion criteria, analysing the effect of leucine or leucine-enriched protein in the treatment of sarcopenia, and 13 of these studies were based on randomized and placebo-controlled trials (RCTs). In overall terms, the published results show that administration of leucine or leucine-enriched proteins (range 1.2–6 g leucine/day) is well-tolerated and significantly improves sarcopenia in elderly individuals, mainly by improving lean muscle-mass content and in this case most protocols also include vitamin D co-administration. The effect of muscular strength showed mix results, and the effect on physical performance has seldom been studied. For sarcopenia-associated with specific disorders, the most promising effects of leucine supplementation are reported for the rehabilitation of post-stroke patients and in those with liver cirrhosis. Further placebo-controlled trials will be necessary to determine the effects of leucine and to evaluate sarcopenia with the criteria recommended by official Working Groups, thereby limiting the variability of methodological issues for sarcopenia measurement across studies.
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Deer RR, Goodlett SM, Fisher SR, Baillargeon J, Dickinson JM, Raji M, Volpi E. A Randomized Controlled Pilot Trial of Interventions to Improve Functional Recovery After Hospitalization in Older Adults: Feasibility and Adherence. J Gerontol A Biol Sci Med Sci 2019; 73:187-193. [PMID: 28591764 DOI: 10.1093/gerona/glx111] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Indexed: 12/28/2022] Open
Abstract
Background Hospitalization is a major risk factor for functional decline, disability, loss of independence, and mortality in older adults. Evidence-based interventions to improve functional recovery from hospitalization are difficult to evaluate and implement in geriatric patients. The goal of this pilot study was to test the feasibility of recruiting geriatric inpatients and implementing pragmatic interventions to improve physical function following hospitalization. Methods Enrolled subjects were randomized to one of five 30-day posthospitalization interventions: isocaloric placebo (P), whey protein supplement (W), in-home rehabilitation+placebo (R+P), rehabilitation+whey protein (R+W), or testosterone (T). Data were collected from a single-site university hospital to determine: (i) institution-based feasibility (nonmodifiable factors including number of patients screened, eligible, contacted) and (ii) patient-based feasibility (modifiable factors including number of patients refusing, enrolled, randomized, intervention adherence, and withdrawal). Results From January 2014 to July 2016, 4,533 patients were chart screened; 594 (13.1%) were eligible to participate; 384 eligible subjects were contacted; 113 were enrolled; and 100 were randomized. Supplement adherence was 75% and was not different by age, education, level of independence, depression, supplement type, or dual intervention, but was significantly higher in subjects who completed the intervention (p < .01). Rehabilitation session adherence was 77% and did not vary significantly by age, education, level of independence, depression, or supplement type, but was significantly higher for sessions directly supervised (p < .01). Adherence was 100% in the testosterone arm with 94.7% of injections given within 24 hours of discharge. Conclusions Findings from this clinical trial indicate that posthospitalization interventions in geriatric patients are feasible at both the institution and patient level.
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Affiliation(s)
- Rachel R Deer
- Sealy Center on Aging, The University of Texas Medical Branch, Galveston
| | - Shawn M Goodlett
- Sealy Center on Aging, The University of Texas Medical Branch, Galveston
| | - Steve R Fisher
- Sealy Center on Aging, The University of Texas Medical Branch, Galveston.,Department of Physical Therapy, The University of Texas Medical Branch, Galveston
| | - Jacques Baillargeon
- Department of Preventive Medicine and Community Health, The University of Texas Medical Branch, Galveston
| | - Jared M Dickinson
- School of Nutrition and Health Promotion, Healthy Lifestyles Research Center, Arizona State University, Phoenix
| | - Mukaila Raji
- Sealy Center on Aging, The University of Texas Medical Branch, Galveston.,Department of Internal Medicine, Division of Geriatrics, The University of Texas Medical Branch, Galveston
| | - Elena Volpi
- Sealy Center on Aging, The University of Texas Medical Branch, Galveston.,Department of Internal Medicine, Division of Geriatrics, The University of Texas Medical Branch, Galveston
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Wells EU, Williams CP, Kennedy RE, Sawyer P, Brown CJ. Factors That Contribute to Recovery of Community Mobility After Hospitalization Among Community-Dwelling Older Adults. J Appl Gerontol 2018; 39:435-441. [PMID: 29690809 DOI: 10.1177/0733464818770788] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
This study aimed to determine the proportion of older adults who recovered community mobility after hospitalization and identify factors associated with recovery. Using a random sample of 1,000 Medicare beneficiaries ≥65 years of age, we identified individuals with at least one hospitalization over 8.5 years of follow-up. Data were collected at baseline and every 6 months, including demographics, function, social support, community mobility measured by the UAB Life-Space Assessment (LSA), and overnight hospital admissions. Recovery was defined as a LSA score no more than five points lower than the prehospitalization LSA score at last follow-up. Overall, 339 participants (M age = 75.4 [SD = 6.6] years, 44% African American, 48% female) had at least one hospitalization. In the full logistic regression model, younger age (p = .007) and religious service attendance (p = .001) remained independently associated with recovery. An understanding of factors associated with recovery after hospitalization may provide a target for future interventions.
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Affiliation(s)
| | | | | | | | - Cynthia J Brown
- The University of Alabama at Birmingham, USA
- Birmingham/Atlanta Veterans Affairs Geriatric Research, Education, and Clinical Center, AL, USA
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13
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Protein Requirements in Critically Ill Older Adults. Nutrients 2018; 10:nu10030378. [PMID: 29558388 PMCID: PMC5872796 DOI: 10.3390/nu10030378] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 03/11/2018] [Accepted: 03/13/2018] [Indexed: 12/19/2022] Open
Abstract
Critically ill elderly patients' nutritional needs are not well understood and vary with the phase of illness and recovery. Patients' nutritional needs should be assessed early in hospitalization and re-assessed throughout the stay with additional attention during the transitions from critical illness, to severe illness, to post-hospital rehabilitation. In this review, we summarize recent findings and highlight recommendations for protein supplementation in critically ill geriatric patients throughout the stages of recovery. Future research specifically focusing on protein dose, its relationship with caloric needs, and delivery modality must be conducted to provide more specific guidelines for clinical practice.
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14
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Baldwin C, van Kessel G, Phillips A, Johnston K. Accelerometry Shows Inpatients With Acute Medical or Surgical Conditions Spend Little Time Upright and Are Highly Sedentary: Systematic Review. Phys Ther 2017; 97:1044-1065. [PMID: 29077906 DOI: 10.1093/ptj/pzx076] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 07/21/2017] [Indexed: 11/13/2022]
Abstract
BACKGROUND Physical inactivity and sedentary behaviors have significant and independent effects on health. The use of wearable monitors to measure these constructs in people who are hospitalized with an acute illness is rapidly expanding, but has not been systematically described. PURPOSE The purpose of this study was to review the use of accelerometer monitoring with inpatients who are acutely ill, including what activity and sedentary behaviors have been measured and how active or sedentary inpatients are. DATA SOURCES Databases used were MEDLINE, EMBASE, CINAHL, and Scopus. STUDY SELECTION Quantitative studies of adults with an acute medical or surgical hospital admission, on whom an accelerometer was used to measure a physical activity or sedentary behavior, were selected. DATA EXTRACTION AND DATA SYNTHESIS Procedures were completed independently by 2 reviewers, with differences resolved and cross-checked by a third reviewer. Forty-two studies were identified that recruited people who had medical diagnoses (n = 10), stroke (n = 5), critical illness (n = 3), acute exacerbations of lung disease (n = 7), cardiac conditions (n = 7), or who were postsurgery (n = 10). Physical activities or sedentary behaviors were reported in terms of time spent in a particular posture (lying/sitting, standing/stepping), active/inactive, or at a particular activity intensity. Physical activity was also reported as step count, number of episodes or postural transitions, and bouts. Inpatients spent 93% to 98.8% (range) of their hospital stay sedentary, and in most studies completed <1,000 steps/day despite up to 50 postural transitions/day. No study reported sedentary bouts. Many studies controlled for preadmission function as part of the recruitment strategy or analysis or both. LIMITATIONS Heterogeneity in monitoring devices (17 models), protocols, and variable definitions limited comparability between studies and clinical groups to descriptive synthesis without meta-analysis. CONCLUSIONS Hospitalized patients were highly inactive, especially those with medical admissions, based on time and step parameters. Accelerometer monitoring of sedentary behavior patterns was less reported and warrants further research.
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Affiliation(s)
- Claire Baldwin
- Sansom Institute of Health Research, School of Health Sciences, Division of Health Sciences, University of South Australia, City East Campus, Centenary Building, Adelaide, South Australia 5000, Australia
| | - Gisela van Kessel
- Sansom Institute of Health Research, School of Health Sciences, Division of Health Sciences, University of South Australia
| | - Anna Phillips
- Sansom Institute of Health Research, School of Health Sciences, Division of Health Sciences, University of South Australia
| | - Kylie Johnston
- Sansom Institute of Health Research, School of Health Sciences, Division of Health Sciences, University of South Australia
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Schopfer DW, Forman DE. Growing Relevance of Cardiac Rehabilitation for an Older Population With Heart Failure. J Card Fail 2016; 22:1015-1022. [PMID: 27769907 DOI: 10.1016/j.cardfail.2016.10.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 10/14/2016] [Accepted: 10/17/2016] [Indexed: 12/20/2022]
Abstract
Cardiac rehabilitation (CR) is a comprehensive lifestyle program that can have particular benefit for older patients with heart failure (HF). Prevalence of HF is increasingly common among older adults. Mounting effects of cardiovascular risk factors in older age as well as the added effects of geriatric syndromes such as multimorbidity, frailty, and sedentariness contribute to the high incidence of HF as well as to management difficulty. CR can play a decisive role in improving function, quality of life, symptoms, morbidity, and mortality, and also address the idiosyncratic complexities of care that often arise in old age. Unfortunately, the current policies and practices regarding CR for patients with HF are limited to HF with reduced ejection fraction and do not extend to HF with preserved ejection fraction, which is likely undercutting its full potential to improve care for today's aging population. Despite the strong rationale for CR on important clinical outcomes, it remains underused, particularly among older patients with HF. In this review, we discuss both the potential and the limitations of contemporary CR for older adults with HF.
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Affiliation(s)
- David W Schopfer
- Department of Medicine, University of California San Francisco, San Francisco, California; Department of Medicine, San Francisco VA Medical Center, San Francisco, California
| | - Daniel E Forman
- Section of Geriatric Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Geriatric, Research, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
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