Sarcopenia and frailty: a clinician's controversial point of view

ESPEN practical guideline on clinical nutrition in hospitalized patients with acute or chronic kidney disease

BACKGROUND AND AIMS

Hospitalized patients often have acute kidney disease (AKD) or chronic kidney disease (CKD), with important metabolic and nutritional consequences. Moreover, in case kidney replacement therapy (KRT) is started, the possible impact on nutritional requirements cannot be neglected. On this regard, the present guideline aims to provide evidence-based recommendations for clinical nutrition in hospitalized patients with KD.

METHODS

The standard operating procedure for ESPEN guidelines was used. Clinical questions were defined in both the PICO format, and organized in subtopics when needed, and in non-PICO questions for the more general topics. The literature search was from January 1st, 1999 until January 1st, 2020. Each question led to one or more recommendation/statement and related commentaries. Existing evidence was graded, as well as recommendations and statements were developed and agreed upon in a multistage consensus process.

RESULTS

The present guideline provides 32 evidence-based recommendations and 8 statements, defining how to assess nutritional status, how to define patients at risk, how to choose the route of feeding, and how to integrate nutrition with KRT. In the final online voting, a strong consensus was reached in 84% at least of recommendations and 100% of statements.

CONCLUSION

The presence of KD in hospitalized patients identifies a highly heterogeneous group of subjects with widely varying nutrient needs and intakes. Considering the high nutritional risk related with this clinical condition, an individualized approach consisting of nutritional status evaluation and monitoring, frequent evaluation of nutritional requirements, and careful integration with KRT should be planned to avoid both underfeeding and overfeeding. Practical recommendations and statements were developed, aiming at defining suggestions for everyday clinical practice in the individualization of nutritional support in this patient setting. Literature areas with scarce or without evidence were also identified, thus requiring further basic or clinical research.

Burden of frailty and its correlates among the elderly: a cross-sectional study in a rural community of West Bengal

Context

With the ageing of Indian society, providing a healthy life among older people is a public health precedence. Therefore, beforehand discovery and possible forestalment of frailty may help promote healthy ageing and dwindle the social, mental and financial burden of their families and caregivers.

Aims

The study aimed to assess the proportion of frailty and its associated factors among the elderly aged 65 years and above in a rural community of West Bengal.

Settings and Design

A community-based cross-sectional study was conducted among 270 elderlies selected from 15 villages out of a total 64 villages of Singur under the Hooghly District of West Bengal from January 2019 to February 2020.

Materials and Methods

Cluster sampling technique was used. Data was collected using a pre-designed, pre-tested structured schedule including Fried frailty phenotype (FFP), geriatric depression scale short form (GDS 15) and mini nutritional assessment (MNA) tool.

Statistical Analysis Used

Associated factors of frailty were assessed by univariate and multivariable logistic regression using SPSS version 16 software and MS Excel 2019.

Results

The proportion of frailty was observed to be 23.7% and that of prefrailty 40.7%. Frailty was significantly associated with increasing age [AOR(CI) 1.2(1.1-1.3)], decreasing years of schooling [AOR(CI) 1.3(1.1-1.5)], loss of spouse [AOR(CI) 4.2(1.2-15.2)], financial dependency [AOR(CI) 19.3(2.7-139.0)], staying at home [AOR(CI) 16.3(2.7-98.2)], presence of anaemia [AOR(CI) 3.6(1.3-9.5)], at risk of malnutrition [AOR(CI) 6.5(1.9-22.3)], increasing number of falls in the last 1 year [AOR(CI) 4.3(1.2-15.6)], presence of 3 or more chronic diseases [AOR(CI) 154.7(12.1-1981.9)] and depression [AOR(CI) 8.3(2.5-27.0)].

Conclusion

The burden of frailty among the study population is relatively high. It's an intimidating situation that needs bettered screening provisions for early discovery with special stress on nutritive upliftment. Screening for depression should also be done regularly.

The relationship between self-perceived fatigue, muscle endurance, and circulating markers of inflammation in participants of the Copenhagen aging and Midlife Biobank (CAMB)

BACKGROUND

Fatigue, low muscle endurance, muscle weakness and low-grade inflammation are strongly related to frailty at higher age. When signs of self-perceived fatigue and low muscle endurance are interrelated with low-grade inflammation at midlife, they might be used as early markers for frailty. This study investigated whether the interrelationships among self-perceived fatigue, muscle endurance and inflammation can be observed at midlife.

METHODS

A total of 965 participants of the Copenhagen Aging and Midlife Biobank (aged 52 ± 4 years, 536 males, 426 females) were assessed for self-perceived fatigue (20-item multidimensional fatigue inventory), muscle endurance (grip work), circulating markers of inflammation (hsCRP, IL-6, IL-10, TNF-alpha and IFN-γ), daily physical activity (PAS-2), body composition (%body fat assessed by bio-impedance) and self-reported health status. Participants were categorised (correcting for age and gender) according to high fatigue and/or low muscle endurance, differences in inflammatory profile between fatigue categories were assessed by ANCOVA (corrected for PAS-2, %body fat and presence of inflammatory conditions).

RESULTS

Overall, muscle endurance, fatigue and inflammatory markers were significantly interrelated. Higher levels of hsCRP (p < 0.001), IL-6 (p < 0.001), IL-10 (p = 0.035) and TNF-alpha (p = 0.028) were observed in participants presenting both low muscle endurance and high fatigue. IFN-γ was highest in those with high fatigue but normal muscle endurance (p = 0.015).

CONCLUSIONS

Middle-aged participants with higher fatigue in combination with low muscle endurance show higher levels of inflammation, independently from physical activity, body fat and inflammatory pathology. The underlying mechanisms should be identified and future studies should also investigate whether these individuals show early signs of reduced physiological reserve capacity, which in later life come to full expression by means of frailty.

Frailty and sarcopenia: A bibliometric analysis of their association and potential targets for intervention

Frailty and sarcopenia are age-related diseases, and exhibit a concomitant relationship, as they share many common clinical features and etiological factors. Transitions within frailty status would be influenced by the presence of sarcopenia. Investigating their association to devise efficacious intervention and management strategies for geriatric patients is imperative, given their potentially unfavorable outcomes. In this study, the literature on sarcopenia and frailty was screened in the Web of Science core collection database over the past 30 years to ascertain the link between them through bibliometric analysis and the exploration of disease-related molecular pathways within the GeneCards and OMIM databases was conducted. Per inclusion and exclusion criteria, 3889 literature sources were selected for subsequent analysis. Keywords, including "cirrhosis" and "postoperative complications," represent the current and potential future research trends and focal points in this field. Moreover, 63 common potential targets between the two diseases were identified. Their pathogenesis involved cellular aging and endocrine metabolism regulation pathways, including AMPK, cell senescence, and the endocrine resistance pathway. This study identified an intimate correlation between frailty and sarcopenia in pathogenesis, prevention, and treatment measures, establishing a foundation for exploring shared prevention and treatment strategies for these two disorders.

What impact does osteoarthritis have on ability to self-care and receipt of care in older adults? Findings from the Hertfordshire Cohort Study

Objectives

Living independently remains the aim of older adults, but musculoskeletal conditions and frailty may hamper this. We examined relationships between osteoarthritis with ability to self-care and access to formal/informal care among community-dwelling older adults, comparing results to relationships between other musculoskeletal conditions of ageing (frailty, sarcopenia, osteoporosis) and these outcomes.

Design

Data from the Hertfordshire Cohort Study were used. Osteoarthritis (hand, hip or knee) was defined by clinical examination. Osteoporosis was assessed using dual-energy X-ray absorptiometry and medication use. Sarcopenia was assessed using EWSGOP2 criteria, frailty using Fried criteria. Ability to self-care and access to formal/informal care were self-reported.

Results

443 men and women aged approximately 75 years participated. Osteoarthritis was reported by 26.8% participants; 11.8% had low grip strength; 21.4% had osteoporosis; 8.6% had sarcopenia; 7.6% were identified as frail. Most participants (90.7%) reported no problems with self-care, but more than one-fifth (21.4%) reported having received formal or informal care at home in the previous year. Odds of reporting difficulties with self-care were significantly greater (p ​< ​0.05) for participants with osteoarthritis and for those with frailty, but not for those with osteoporosis or sarcopenia. Odds of receiving care at home in the past year were significantly greater among participants with osteoarthritis and among those with frailty, but not among those with osteoporosis or sarcopenia.

Conclusions

Frailty and osteoarthritis were associated with both difficulties with self-care and receipt of care; osteoporosis and sarcopenia were not. These results highlight the contribution of clinical osteoarthritis to ability to live independently in later life, and the need to actively manage the condition in older adults.

Association of food insecurity with physical frailty among older adults: study based on LASI, 2017-18

BACKGROUND

Food security can be directly linked to nutritional status and either directly or indirectly, it has an impact on health status and well-being of the population. Physical frailty is one of the most important phenotypes used to understand the vulnerable nature of older adults. This paper examined the association between food security and physical frailty in older adults.

METHODS

We used data from the Longitudinal Ageing Study in India (LASI, 2017-18), wave-1. The sample size was 31,464 older adults aged 60 years and above. Physical frailty was assessed using the modified version of frailty phenotype proposed by Fried and colleagues. Multivariable logistic regression was used to establish the association between food insecurity with physical frailty.

RESULTS

A proportion of 30.65% of older adults were frail in this study. Older adults with food insecurity had higher prevalence of exhaustion (12.1% vs 6.5%), unintentional weight loss (65.5% vs 5.1%), and weak grip strength (8.6% vs 7.9%) in comparison to their food secure counterparts. After adjusting for a large number of confounders, older adults who reported food insecurity had significantly higher odds of being frail [AOR: 2.68; CI: 2.26-3.19] in comparison to older adults with no food insecurity.

CONCLUSION

The study showed that food insecurity is associated with physical frailty among older adults in India. It is suggested that food security programs in the country may be considered as an effective strategy to prevent physical frailty among older adults.

WHO working definition of vitality capacity for healthy longevity monitoring

Intrinsic capacity, a crucial concept in healthy ageing, is defined by WHO as "the composite of all the physical and mental capacities that an individual can draw on at any point in time". Vitality capacity is considered the underlying physiological determinant of intrinsic capacity. To advance the measurement and monitoring of vitality capacity, a working group of WHO staff members and twenty experts representing six WHO regions was convened to discuss and clarify the attributes of vitality capacity and to develop a clear working definition of the concept. Potential biomarkers to measure vitality capacity were identified, and the following consensual working definition was developed: vitality capacity is a physiological state (due to normal or accelerated biological ageing processes) resulting from the interaction between multiple physiological systems, reflected in (the level of) energy and metabolism, neuromuscular function, and immune and stress response functions of the body.

Physical Activity in the Elderly and Frailty Syndrome: A Retrospective Study in Primary Care

Objectives: Physical activity carries numerous therapeutic benefits, and it is more effective when applied before the onset of symptoms. The objective of this study is to compare the correlation of the evaluation of physical activity carried out using the Ricci and Gagnon test and the frailty profile measured by the mSEGA scale in a population of patients consulting in general medicine. Methods: We conducted a retrospective study within a general practitioner clinic in Chaumont and Bologne (Haute-Marne department) during a 3-month period. Patients aged 65 years and up were screened for frailty using the modified SEGA (mSEGA) assessment, and physical activity was measured using the Ricci–Gagnon questionnaire. Results: A total of 44 patients were selected, with a slightly female predominance (59.1%). Of these, 21 patients reported having worked in manual labor. Seven patients were found to be frail using the SEGAm assessment, while 10 (22.73%) patients had an inactive profile according the Ricci–Gagnon score. Malnutrition was detected in six patients (13.64%) using the MNA survey. Frailty as defined by the mSEGA scale had no statistical correlation (p = 0.68) with the Ricci–Gagnon score. A Ricci–Gagnon inactive profile showed statistical correlations with fall indicators (unipedal balance test, p = 0.014) and malnutrition scores using the MNA (p = 0.0057) as well as with the Charlson Comorbidity Index (p = 0.027). Conclusion: A systematic survey of the elderly by a general practitioner implementing a regular and suitable physical activity regimen would allow a better screening of frailty, minimizing its complications.

Analysis of the Effects of Ninjin’yoeito on Physical Frailty in Mice

Physical frailty is an aging-related clinical syndrome involving decreases in body weight, mobility, activity, and walking speed that occurs in individuals with sarcopenia and is accelerated by increased oxidative stress. Ninjin’yoeito, a traditional Japanese Kampo medicine, is used for treating conditions, including anemia and physical weakness. Here, we investigated whether ninjin’yoeito could improve physical frailty by controlling oxidative stress in the senescence-accelerated mouse prone 8 (SAMP8) model. First, SAMP8 mice were divided into two groups, ninjin’yoeito treated and untreated, with the former consuming a diet containing 3% ninjin’yoeito from 3 months of age. At 7 months of age, body weight, motor function, locomotor activity, and mean walking speed were measured. Subsequently, mice were euthanized and measured for muscle weight, 8-hydroxy-2′-deoxyguanosine levels in muscle and brain, and cleaved caspase-3 expression in brain. The results showed reductions in weight, locomotor function, locomotion, and average walking speed in the untreated group, which were significantly improved by ninjin’yoeito. Furthermore, 8-hydroxy-2′-deoxyguanosine levels were reduced in muscle and brain from ninjin’yoeito-treated mice, compared with the levels in untreated mice; cleaved caspase-3 expression was similarly reduced in brain from the treated mice, indicating reduced apoptosis. Our findings suggest that ninjin’yoeito inhibits sarcopenia-based physical frailty through its antioxidant effects.

Are self-management abilities beneficial for frail older people's cognitive functioning?

Background

Self-management abilities seem to be important for the cognitive functioning of older people, especially those who are frail. We investigated relationships between broad self-management abilities (initiative taking, investment behavior, resource variety, resource multifunctionality, self-efficacy, and positive frame of mind) and cognitive functioning among frail older people while controlling for background characteristics (sex, age, marital status, and educational level).

Method

Survey data were collected from mid-2014 to mid-2015 from community-dwelling frail older people residing in North Brabant, the Netherlands. We measured cognitive functioning with the 12-item Mini-Mental State Examination (MMSE-12) and self-management abilities with the short version of the Self-Management Ability Scale (SMAS-S).

Results

In total, 588 of 834 potential participants were willing to participate (70.5% response rate). The mean age was 82.33 ± 5.19 and the majority (68.5%) of respondents were female. About one-third (38.4%) of respondents had low educational levels and 61.7% lived alone. Mean MMSE-12 and SMAS-S scores were 9.68 ± 2.10 and 3.70 ± 0.88, respectively. Bivariate analyses showed that all six self-management abilities were related positively to cognitive functioning. Multivariate analyses with adjustment for background characteristics (sex, age, marital status, and educational level) showed that cognitive functioning was associated positively with initiative taking (β = 0.23, p = 0.030) and investment behavior (β = 0.24, p = 0.030) among community-dwelling frail older people.

Conclusions

This study clearly showed that a repertoire of broad self-management abilities is related to cognitive functioning among community-dwelling frail older people. Initiative taking and investment behavior seem to be especially important. These findings are of interest in a time of populational aging and an increasing number of older people dealing with cognitive problems. Preventive investments in (older) people’s self-management abilities are expected to be beneficial for their cognitive functioning in the long term.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03353-4.

Sarc-frailty: towards an integrated view of ageing

OBJECTIVES

Sarcopenia and frailty have both been related to adverse events in ageing, but have long been studied in parallel. The purpose of this study was to provide a better depiction of ageing by taking the advantages of both entities.

STUDY DESIGN

2532 participants were enrolled from the National Health and Nutrition Examination Survey 1999-2002. A new diagnostic entity, sarc-frailty, was established by merging the diagnostic elements of both sarcopenia and frailty.

MAIN OUTCOME MEASURES

Cox proportional hazard models, Kaplan-Meier curve, and receiver operating characteristic (ROC) curve analysis were utilized to compare the hazard ratios and predictive power in relation to mortality of sarcopenia, frailty, and sarc-frailty. Two different classification strategies, categorical and scoring, were used as alternative assessment methods.

RESULTS

The median follow-up duration was 67.49 months, and no participants were lost to follow-up. ROC analysis revealed the highest area under curves (AUC) in sarc-frailty by both categorical and scoring classification (AUC = 0.660, p value <0.001 and AUC = 0.697, p value <0.001, respectively), indicating the best predictive ability in relation to mortality. Kaplan-Meier analysis also demonstrated the shortest overall survival for sarc-frailty with both classifications (p value both <0.001). In addition, hazard ratios (HRs) of sarc-frailty with both classifications were higher than their counterparts for sarcopenia and frailty (HR = 12.599, 95 % CI = 7.780 to 20.403, p < 0.001 by categorical method, and HR = 20.121, 95 % CI = 8.101 to 49.973, p < 0.001 by scoring classification). Moreover, the scoring classification revealed a more delicate hierarchical structure of mortality levels than the categorical classification.

CONCLUSIONS

Sarc-frailty had a better predictive ability in relation to mortality. Considering that ageing well is a holistic health-care issue, our new entity, along with the scoring method, provides clinicians with more effective tools in geriatric assessment.

Development of a system to analyze oral frailty associated with Alzheimer's disease using a mouse model

The rapid aging of the population makes the detection and prevention of frailty increasingly important. Oral frailty has been proposed as a novel frailty phenotype and is defined as a decrease in oral function coexisting with a decline in cognitive and physical functions. Oral frailty has received particular attention in relation to Alzheimer's disease (AD). However, the pathomechanisms of oral frailty related to AD remain unknown. It is assumed that the mesencephalic trigeminal nucleus (Vmes), which controls mastication, is affected by AD pathology, and as a result, masticatory function may be impaired. To investigate this possibility, we included male 3 × Tg-AD mice and their non-transgenic counterpart (NonTg) of 3-4 months of age in the present study. Immunohistochemistry revealed amyloid-β deposition and excessive tau phosphorylation in the Vmes of 3 × Tg-AD mice. Furthermore, vesicular glutamate transporter 1-immunopositive axon varicosities, which are derived from Vmes neurons, were significantly reduced in the trigeminal motor nucleus of 3 × Tg-AD mice. To investigate whether the AD pathology observed in the Vmes affects masticatory function, we analyzed electromyography of the masseter muscle during feeding. The 3 × Tg-AD mice showed a significant delay in masticatory rhythm compared to NonTg mice. Furthermore, we developed a system to simultaneously record bite force and electromyography of masseter, and devised a new method to estimate bite force during food chewing in mice. Since the muscle activity of the masseter showed a high correlation with bite force, it could be accurately estimated from the muscle activity. The estimated bite force of 3 × Tg-AD mice eating sunflower seeds was predominantly smaller than that of NonTg mice. However, there was no difference in masseter weight or muscle fiber cross-sectional area between the two groups, suggesting that the decreased bite force and delayed mastication rhythm observed in 3 × Tg-AD mice were not due to abnormality of the masseter. In conclusion, the decreased masticatory function observed in 3 × Tg-AD mice was most likely caused by AD pathology in the Vmes. Thus, novel quantitative analyses of masticatory function using the mouse model of AD enabled a comprehensive understanding of oral frailty pathogenesis.

Prevalence and associated factors of possible sarcopenia and sarcopenia: findings from a Chinese community-dwelling old adults cross-sectional study

Purpose

To describe the prevalence and analyse the associated factors of possible sarcopenia and sarcopenia among community-dwelling old adults in China, in order to provide effective strategies for early prevention and treatment of sarcopenia.

Methods

This cross-sectional study evaluated community-dwelling old adults aged over 60 years. The basic information, morphological indices, body composition, physical activities were collected and assessed. Possible sarcopenia and sarcopenia were diagnosed by the criteria of Asian Working Group for Sarcopenia (AWGS) in 2019. A multivariate logistic regression model with stepwise method was employed to identify factors associated with possible sarcopenia and sarcopenia.

Results

In total 729 old adults from Tianjin were included in this study. Eighty-one participants were diagnosed with possible sarcopenia (prevalence of 11.11%). Seventy-five participants were diagnosed with sarcopenia (prevalence of 10.29%). Age (odds ratio (OR):1.047, 95% confidence interval (CI): 1.055–1.090) and lower physical activities (low level OR:4.171, 95% CI:1.790–9.720; medium level OR:2.634, 95% CI:1.352–5.132) were significantly associated with possible sarcopenia. Age (OR:1.187, 95% CI:1.124–1.253), higher body fat percentage (OR:1.225, 95% CI:1.140–1.317), lower BMI (OR:0.424, 95% CI:0.346–0.519), lower mini-mental state examination (MMSE) scores (OR:0.865,95% CI:0.781–0.958) and low physical activities (OR:4.638, 95% CI:1.683–12.782) were significantly associated with sarcopenia.

Conclusion

Possible sarcopenia and sarcopenia are prevalent among community-dwelling old adults in China. Ageing and lower physical activities were both associated with possible sarcopenia and sarcopenia. Old adults with sarcopenia more likely have higher body fat percentage, lower BMI and lower cognitive function compared with those without this condition.

The prevalence and prognostic value of frailty screening measures in patients undergoing surgery for colorectal cancer: observations from a systematic review

Introduction

Frailty is a complex multifactorial syndrome characterised by a significant increase in vulnerability and worsened health outcomes. Despite a range of proposed frailty screening measures, the prevalence and prognostic value of frailty in patients undergoing surgery for colorectal cancer is not clear.

Aim

The aim of this present review was to examine the use of commonly employed frailty screening measures in patients undergoing surgery for colorectal cancer.

Methods

A systematic search of PubMed and Medline was carried out to identify studies reporting the use of frailty screening tools or measures in patients undergoing surgery for colorectal cancer. The screening measure used and prevalence of frailty within the population were recorded. Outcomes of interest were the incidence of post-operative complications, 30-day mortality and overall survival.

Results

Of the 15 studies included (n = 97, 898 patients), 9 studies were retrospective and included patients aged 70 years or older (n = 96, 120 patients). 5 of 12 studies reported that frailty was independently associated with the incidence of post-operative complications. There was also evidence that frailty was independently associated with 30-day mortality (1 of 4 studies, n = 9, 252 patients) and long-term survival (2 of 3 studies, n = 1, 420 patients).

Conclusions

Frailty was common in patients with colorectal cancer and the assessment of frailty may have prognostic value in patients undergoing surgery. However, the basis of the relationship between frailty and post-operative outcomes is not clear and merits further study.

Calf circumference refines sarcopenia in correlating with mortality risk

BACKGROUND

Recommendations in current guidelines on the use of calf circumference (CC) as a diagnostic measure in sarcopenia is conflicting. In this study, we incorporated CC into conventional models of sarcopenia and compared their predictive scores on mortality.

OBJECTIVE

To clarify the predictive capacity of CC-added models of sarcopenia on and establish the correlation of CC with mortality risk.

DESIGN, SETTING AND SUBJECTS

From the National Health and Nutrition Examination Survey 1999-2002, 2,532 participants aged 50-85 and comprising 51.7% male were included.

METHODS

Our definitions contained four sarcopenic components, low CC (C), low muscle strength (S), low muscle mass (M) and low gait speed (G). Cox proportional hazard models and the receiver-operator characteristic curves for all-cause, cardiovascular (CV) and cancer mortality were conducted to compare the different sarcopenia definitions.

RESULTS

For all-cause mortality, the hazard ratio (HR) of C + S + M + G was 15.062, which was substantially higher than the conventional definition S + M + G (HR = 6.433). Other CC-added definitions such as C + M (HR = 2.260), C + G (HR = 4.978), C + S + M (HR = 5.761) also revealed higher HR than their without-CC counterparts. Similar patterns were observed in CV mortality, for instance, HR of C + S + M + G was 31.812 comparing to the conventional definition S + M + G (HR = 18.434). Concerning accuracy in predicting mortality, the area under the curve (AUC) of CC + S + G + M (AUC = 0.702) and C + S + G (AUC = 0.708) were higher than the conventional definition S + G + M (AUC = 0.697). A significant correlation was found between CC and each of the three conventional components of sarcopenia.

CONCLUSIONS

CC-added definitions of sarcopenia correlated with higher all-cause and CV mortality risks. CC is potentially a simple but valuable screening tool for sarcopenia that could improve diagnostic accuracy when used with other parameters.

Relationships between non-communicable disease, social isolation and frailty in community dwelling adults in later life: findings from the Hertfordshire Cohort Study

BACKGROUND

Social relationships play a fundamental role in individuals' lives and health, and social isolation is prevalent among older people. Chronic non-communicable diseases (NCDs) and frailty are also common in older adults.

AIMS

To examine the association between number of NCDs and social isolation in a cohort of community-dwelling older adults in the UK, and to consider whether any potential association is mediated by frailty.

METHODS

NCDs were self-reported by 176 older community-dwelling UK adults via questionnaire. Social isolation was assessed using the six-item Lubben Social Network Scale. Frailty was assessed by the Fried phenotype of physical frailty.

RESULTS

The median (IQR) age of participants in this study was 83.1 (81.5-85.5) years for men and 83.8 (81.5-85.9) years for women. The proportion of socially isolated individuals was 19% in men and 20% in women. More women (18%) than men (13%) were identified as frail. The number of NCDs was associated with higher odds of being isolated in women (unadjusted odds ratio per additional NCD: 1.65, 95% CI 1.08, 2.52, p = 0.021), but not in men, and the association remained robust to adjustment, even when accounting for frailty (OR 1.85, 95% CI 1.06, 3.22, p = 0.031).

DISCUSSION

Number of self-reported NCDs was associated with higher odds of social isolation in women but not in men, and the association remained after considering frailty status.

CONCLUSIONS

Our observations may be considered by healthcare professionals caring for community-dwelling older adults with multiple NCDs, where enquiring about social isolation as part of a comprehensive assessment may be important.

Association of frailty with regional sagittal spinal alignment in the elderly

The degenerative changes in the spine of the frail elderly gradually exacerbate the alignment of the spine as the degeneration progresses. This study was conducted to assess the relationship between frailty and spine sagittal alignment measured in terms of global, cervical, thoracic, and lumbo-pelvic parameters. In total, 101 patients aged 75 years and older hospitalized for spine surgery were prospectively enrolled. We evaluated spinal sagittal parameters by dividing them into global (C7 sagittal vertical axis [SVA] and T1 pelvic angle [T1PA]), cervical (the C2-7 Cobb angle, Jackson line, and C2-7 plumb line), thoracic (thoracic kyphosis [TK]), and lumbo-pelvic (pelvic tilt [PT] and pelvic incidence minus lumbar lordosis value [PI-LL]). Patient characteristics; the Fatigue, Resistance, Ambulation, Illness, Loss of Weight (FRAIL) scale; and sagittal spinal parameters were included in the analysis. Multiple regression analysis was performed to identify associations between the FRAIL scale and sagittal spinal parameters. The FRAIL scale showed correlations with global sagittal parameters (C7 SVA [β = 0.225, p = 0.029] and T1PA [β = 0.273, p = 0.008]) and lumbo-pelvic parameters (PT [β = 0.294, p = 0.004] and PI-LL [β = 0.323, p = 0.001). Cervical and thoracic parameters were not directly associated with the FRAIL scale. LL and PI-LL were associated with TK, and TK was associated with cervical parameters (the C2-7 Cobb angle, Jackson line and C2-7 plumb line). In conclusion, frailty status could be an important factor that influences sagittal spinal alignment in the elderly. In this study, it was found that frailty mainly affected the balance of lumbo-pelvic alignment, and consequently affected the balance of the whole spine.

The role of muscle depletion and visceral adiposity in HCC patients aged 65 and over undergoing TACE

Background

The incidence of hepatocellular carcinoma (HCC) has been increasing among the elderly populations. Trans-arterial chemoembolization (TACE), a widely used first-line non-curative therapy for HCCs is an issue in geriatrics. We investigated the prognosis of elderly HCC patients treated with TACE and determined the factors that affect the overall survival.

Methods

We included 266 patients who were older than 65 years and had received TACE as initial treatment for HCC. We analyzed the skeletal muscle index (SMI) and visceral-to-subcutaneous fat ratio (VSR) around the third lumbar vertebrae using computed tomography scans. Muscle depletion with visceral adiposity (MDVA) was defined by falling below the median SMI and above the median VSR value sex-specifically. We evaluated the overall survival in association with MDVA and other clinical factors.

Results

The mean age was 69.9 ± 4.5 years, and 70.3% of the patients were men. According to the Barcelona Clinic Liver Cancer (BCLC) staging system, 29, 136, and 101 patients were classified as BCLC 0, A, and B stages, respectively, and 79 (29.7%) had MDVA. During the median follow-up of 4.1 years, patients with MDVA had a shorter life expectancy than those without MDVA (P = 0.007) even though MDVA group had a higher objective response rate after the first TACE (82.3% vs. 75.9%, P = 0.035). Multivariate analysis revealed that MDVA (Hazard ratio [HR] 1.515) age (HR 1.057), liver function (HR 1.078), tumor size (HR 1.083), serum albumin level (HR 0.523), platelet count (HR 0.996), tumor stage (stage A, HR 1.711; stage B, HR 2.003), and treatment response after the first TACE treatment (HR 0.680) were associated with overall survival.

Conclusions

MDVA is a critical prognostic factor for predicting survival in the elderly patients with HCC who have undergone TACE.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12885-021-08905-2.

Association Between Sarcopenia and Survival of Patients with Organ-Confined Renal Cell Carcinoma after Radical Nephrectomy

BACKGROUND

We aimed to describe the effect of preoperative sarcopenia on oncologic outcomes of organ-confined renal cell carcinoma (RCC) after radical nephrectomy.

PATIENTS AND METHODS

A total of 632 patients with pT1-2 RCC who underwent radical nephrectomy between 2004 and 2014 were retrospectively analyzed. From preoperative computerized tomography (CT) scans, skeletal muscle index (SMI) was measured and gender-specific cutoff values at third lumbar vertebra of 52.4 cm²/m² for men and 38.5 cm²/m² for women were used to define sarcopenia. Survivals were compared and associations with sarcopenia were analyzed using Kaplan-Meier log rank tests and Cox proportional hazard regression models. Median follow-up was 83 months.

RESULTS

Of 632 patients, 268 (42.4%) were classified as sarcopenic. The sarcopenic group was more advanced in age (57 versus 53 years) and more predominantly male (71.3% versus 59.9%). Sarcopenic patients had lower body mass index (BMI, 23.0 versus 25.9 kg/m²), but there was no difference in tumor size, stage, or nuclear grade. Sarcopenia was associated with poorer overall survival (OS) and cancer-specific survival (CSS; OS 94.0% versus 82.1%; p < 0.001 and CSS 97.5% versus 91.8%; p < 0.001). On multivariate analysis, sarcopenia was an independent risk factor for all-cause mortality [hazard ratio (HR) 2.58; 95% CI 1.02-6.54] and cancer-specific mortality (HR 3.07; 95% CI 1.38-6.83).

CONCLUSIONS

Sarcopenia at diagnosis was an independent risk factor for all-cause and cancer-specific mortality after radical nephrectomy for pT1-2 RCC. These findings underscore the importance of assessing presence of sarcopenia for risk stratification even among surgical candidates.

Combined Impact of Positive Screen for Sarcopenia and Frailty on Physical Function, Cognition and Nutrition in the Community Dwelling Older Adult

Background

While sarcopenia and frailty independently contribute to functional impairment and disability, the combined impact resulting from their interplay is unclear. We investigated if functional, physical, cognitive, and nutritional measures were more adversely affected in community-dwelling older adults who were screened positive for both frailty and sarcopenia.

Methods

Using the FRAIL (≥1) and SARC-F (Strength, Assistance with walking, Rising from a chair, Climbing stairs, and Falls) (≥1) scales for screening, we categorized 200 participants (age, 67.9±7.9 years) as combined (both positive, 12.5%), intermediate (either positive, 25.5%), or robust (both negative, 62%).

Results

Comparisons of the three groups showed that the combined group had significantly worse functional ability (Frenchay Activities Index and Modified Barthel Index), physical performance (knee extension, gait speed, and Short Physical Performance Battery score), cognition/mood (Chinese Mini-Mental State Examination [CMMSE] score and Geriatric Depression Scale), and nutrition (Mini Nutritional Assessment [MNA] score) (p<0.05, one-way analysis of variance). Post-hoc comparisons revealed similar findings between the combined and robust groups, except for knee extension and CMMSE scores. Only MNA scores were significantly lower between the intermediate and robust groups.

Conclusion

Functional ability, physical performance, and nutrition were more adversely affected in our study population of community-dwelling older adults who screened positive for both frailty and sarcopenia than in those who screened positive for either or neither, supporting the use of community screening for early detection and intervention for both frailty and sarcopenia as opposed to either alone.

Abdominal obesity, body mass index and the risk of frailty in community-dwelling older adults: a systematic review and meta-analysis

Obese older people are more likely to be frail than those with a normal body mass index (BMI), but the results of individual studies have been inconsistent. We conducted a systematic review and meta-analysis to clarify the association between obesity and the risk of frailty, and whether there was a relationship between BMI and frailty, in community-dwelling older adults aged ≥60 years. Eight databases (PubMed/MEDLINE, EMBASE, EBSCO, CINAHL, Scopus, Cochrane Library and Web of Science) were systematically searched from inception to August 2020. Relative risks for incident frailty were pooled using a random-effects model. We found a positive association between abdominal obesity and frailty [relative risk (RR) = 1.57, 95% confidence interval (CI) 1.29-1.91, I2 = 48.1%, P = 0.086, six observational studies, 18,764 subjects]. People in the higher category of waist circumference had a pooled 57% higher risk of frailty than those with a normal waist circumference. In addition, a total of 12 observational studies comprising 37,985 older people were included in the meta-analysis on the relationship between BMI and the risk for frailty. Taking the normal BMI as the reference group, the pooled RR of frailty risk ranged from 1.45 (95% CI 1.10-1.90, I2 = 83.3%; P < 0.01) for the underweight group, to 0.93 (95% CI 0.85-1.02, I2 = 34.6%; P = 0.114) for the overweight group and to 1.40 (95% CI 1.17-1.67, I2 = 86.1%; P < 0.01) for the obese group. We have shown that obesity or underweight is associated with an increased risk of frailty in community-dwelling older adults.

The interrelationship between grip work, self-perceived fatigue and pre-frailty in community-dwelling octogenarians

INTRODUCTION

Low grip work and high feelings of self-perceived fatigue could be an early characteristic of decline in reserve capacity, which comes to full expression as physical frailty in a later stage. When grip work and self-perceived fatigue can be identified as characteristics differentiating between robustness and pre-frailty it might allow to identify pre-frailty earlier. Therefore, this study aimed to investigate whether the combination of grip work and self-perceived fatigue is related to pre-frailty in well-functioning older adults aged 80 and over.

METHODS

Four-hundred and five community-dwelling older adults aged 80 and over (214 robust and 191 pre-frail) were assessed for muscle endurance (grip Work corrected for body weight (GW_bw)), self-perceived fatigue (MFI-20) and frailty state (Fried Frailty Index, FFI). A Capacity to Perceived Vitality ratio (CPV) was calculated by dividing GW_bw by the MFI-20 scores. ANCOVA analysis (corrected for age and gender) was used to compare robust and pre-frail older adults, and binary logistic regressions were applied to analyze the relationship between CPV and pre-frailty status.

RESULTS

Pre-frail older adults who scored negative on the exhaustion item of the FFI still showed significantly lower GW (p < 0.001), CPV ratios (p < 0.001) and higher self-perceived fatigue (p < 0.05) compared to the robust ones. The likelihood for pre-frailty related significantly to higher age, being men and lower CPV ratios. In women, every unit increase in CPV ratio decreased the likelihood for pre-frailty by 78% (OR 0.22; 95% CI: 0.11-0.44), for men this effect was less strong (34%, OR 0.66; 95% CI: 0.47-0.93).

CONCLUSIONS

Pre-frail community-dwelling persons aged 80 years and over without clinical signs of exhaustion on the FFI still experience significantly higher fatigue levels (lower Grip Work, higher self-perceived fatigue and lower CPV levels) compared to robust ones. CPV ratio could therefore be a good tool to identify subclinical fatigue in the context of physical (pre-)frailty.

Nutritional Concerns for Cancer, Cachexia, Frailty, and Sarcopenia in Canine and Feline Pets

Cachexia and frailty can be described as independent entities yet are interrelated as constituents of malnutrition and the aging process. The unifying aspect is lean muscle loss, ultimately driven by inflammation and the adverse ramifications to pets with chronic, debilitating, or terminal disease states, including cancer. Modification to intake of dietary protein, fat, omega-3 fatty acids, and selected vitamins has shown benefit in management protocols as preventative and palliative care, but further investigation is imperative.

ESPEN guideline on clinical nutrition in hospitalized patients with acute or chronic kidney disease

Acute kidney disease (AKD) - which includes acute kidney injury (AKI) - and chronic kidney disease (CKD) are highly prevalent among hospitalized patients, including those in nephrology and medicine wards, surgical wards, and intensive care units (ICU), and they have important metabolic and nutritional consequences. Moreover, in case kidney replacement therapy (KRT) is started, whatever is the modality used, the possible impact on nutritional profiles, substrate balance, and nutritional treatment processes cannot be neglected. The present guideline is aimed at providing evidence-based recommendations for clinical nutrition in hospitalized patients with AKD and CKD. Due to the significant heterogeneity of this patient population as well as the paucity of high-quality evidence data, the present guideline is to be intended as a basic framework of both evidence and - in most cases - expert opinions, aggregated in a structured consensus process, in order to update the two previous ESPEN Guidelines on Enteral (2006) and Parenteral (2009) Nutrition in Adult Renal Failure. Nutritional care for patients with stable CKD (i.e., controlled protein content diets/low protein diets with or without amino acid/ketoanalogue integration in outpatients up to CKD stages four and five), nutrition in kidney transplantation, and pediatric kidney disease will not be addressed in the present guideline.

Influence of sarcopenia focused on critically ill patients

A systemic review was performed to evaluate the epidemiological, pathophysiological, and clinical features of sarcopenia, the relationship of sarcopenia with critical illness and its impact on mortality, and diagnostic methods and treatment modalities. Generally, in the presence of critical illness, sarcopenia is not included in the treatment approach strategies. An intensivist should be aware that sarcopenia may be present in critically ill patients. Although the main modalities against sarcopenia are early mobilization and nutritional support, they can only prevent its development and may have positive effects on prognosis rather than treating the existing sarcopenia.

Liver steatosis and nonalcoholic fatty liver disease with fibrosis are predictors of frailty in people living with HIV

OBJECTIVE

The aim was to investigate the contribution of liver steatosis and significant fibrosis alone and in association [nonalcoholic fatty liver disease (NAFLD) with fibrosis] to frailty as a measure of biological age in people living with HIV (PLWH).

DESIGN

This was a cross-sectional study of consecutive patients attending Modena HIV Metabolic Clinic in 2018-2019.

METHODS

Patients with hazardous alcohol intake and viral hepatitis coinfection were excluded. Liver steatosis was diagnosed by controlled attenuation parameter (CAP), while liver fibrosis was diagnosed by liver stiffness measurement (LSM). NAFLD was defined as presence of liver steatosis (CAP ≥248 dB/m), while significant liver fibrosis or cirrhosis (stage ≥F2) as LSM at least 7.1 kPa. Frailty was assessed using a 36-Item frailty index. Logistic regression was used to explore predictors of frailty using steatosis and fibrosis as covariates.

RESULTS

We analysed 707 PLWH (mean age 53.5 years, 76.2% men, median CD4 cell count 700 cells/μl, 98.7% with undetectable HIV RNA). NAFLD with fibrosis was present in 10.2%; 18.9 and 3.9% of patients were classified as frail and most-frail, respectively. Univariate analysis demonstrated that neurocognitive impairment [odds ratio (OR) = 5.1, 1.6-15], vitamin D insufficiency (OR = 1.94, 1.2-3.2), obesity (OR = 8.1, 4.4-14.6), diabetes (OR = 3.2, 1.9-5.6), metabolic syndrome (OR = 2.41, 1.47-3.95) and osteoporosis (OR = 0.37, 0.16-0.76) were significantly associated with NAFLD with fibrosis. Predictors of frailty index included steatosis (OR = 2.1, 1.3-3.5), fibrosis (OR = 2, 1-3.7), NAFLD with fibrosis (OR = 9.2, 5.2-16.8), diabetes (OR = 1.7, 1-2.7) and multimorbidity (OR = 2.5, 1.5-4).

CONCLUSION

Liver steatosis and NAFLD with fibrosis were associated with frailty. NAFLD with fibrosis exceeded multimorbidity in the prediction of frailty, suggesting the former as an indicator of metabolic age in PLWH.

Longitudinal partially ordered data analysis for preclinical sarcopenia

Sarcopenia is a geriatric syndrome characterized by significant loss of muscle mass. Based on a commonly used definition of the condition that involves three measurements, different subclinical and clinical states of sarcopenia are formed. These states constitute a partially ordered set (poset). This article focuses on the analysis of longitudinal poset in the context of sarcopenia. We propose an extension of the generalized linear mixed model and a recoding scheme for poset analysis such that two submodels-one for ordered categories and one for nominal categories-that include common random effects can be jointly estimated. The new poset model postulates random effects conceptualized as latent variables that represent an underlying construct of interest, that is, susceptibility to sarcopenia over time. We demonstrate how information can be gleaned from nominal sarcopenic states for strengthening statistical inference on a person's susceptibility to sarcopenia.

Association between frailty and vitamin B12 in the older Korean population

Frailty is a common geriatric condition due to aging and defined as a decline in strength and a decrease in the physiologic ability to maintain the homeostasis. Vitamin B12 (B12), water-soluble vitamins, are a cofactor in DNA synthesis and involved in the metabolism of every cell in the human body, including the central nervous system. Demyelination neuromuscular symptoms observed in the peripheral nervous system, along with signs of significant damage to nerve fibers, often cause weakness, numbness in distal limbs, impaired balance, gait ataxia, and even physical frailty. In this cross-sectional study, we aimed to investigate the relationship between frailty and B12 level in community-dwelling Korean older adults.Using the data from the Korean Frailty and Aging Cohort Study, 2938 participants (1400 men and 1538 women) were recruited in this study. To evaluate frailty, we compared the frail group and not-frail group based on the modified Korean version of the cardiovascular health study frailty index developed by Fried. SARC-F is used to screen for sarcopenia. The short physical performance battery (SPPB) timed up and go (TUG) test and activities-specific balance confidence scale used to evaluate the physical function and fall risk of participants. B12 concentrations were classified into clinically relevant categories: insufficient (<350 pg/mL) and sufficient (≥350 pg/mL). Linear and logistic regression analyses were used to evaluate the relationship between frailty and B12 levels.The mean age of the frail group was 77.8 (standard deviation = 3.7) years, while that of the not-frail group was 76.7 (SD = 4.0); of which the frail group's mean age was significantly high. In the unadjusted model, frailty was highly prevalent in the B12 insufficient group (odds ratio = 1.298). In the model fully adjusted for demographic data and comorbidities, these associations were attenuated. The B12 sufficiency group showed better total SPPB and TUG test scores. However, they were not statistically significant in the fully adjusted model.In this cross-sectional study, low B12 increased the incidence of frailty and affected physical performance, but it does not increase the incidence of frailty when considering the confounding factors. Frailty is caused by several factors rather than 1 factor, and B12 is one of these factors.

Prospective evaluation and comparison of the predictive ability of different frailty scores to predict outcomes in geriatric trauma patients

BACKGROUND

Different frailty scores have been proposed to measure frailty. No study has compared their predictive ability to predict outcomes in trauma patients. The aim of our study was to compare the predictive ability of different frailty scores to predict complications, mortality, discharge disposition, and 30-day readmission in trauma patients.

METHODS

We performed a 2-year (2016-2017) prospective cohort analysis of all geriatric (age, >65 years) trauma patients. We calculated the following frailty scores on each patient; the Trauma-Specific Frailty Index (TSFI), the Modified Frailty Index (mFI) derived from the Canada Study of Health and Aging, the Rockwood Frailty Score (RFS), and the International Association of Nutrition and Aging 5-item a frailty scale (FS). Predictive models, using both unadjusted and adjusted logistic regressions, were created for each outcome. The unadjusted c-statistic was used to compare the predictive ability of each model.

RESULTS

A total of 341 patients were enrolled. Mean age was 76 ± 9 years, median Injury Severity Score was 13 [9-18], and median Glasgow Coma Scale score was 15 [12-15]. The unadjusted models indicated that both the TSFI and the RFS had comparable predictive value, as indicated by their unadjusted c-statistics, for mortality, in-hospital complications, skilled nursing facility disposition and 30-day readmission. Both TSFI and RFS models had unadjusted c-statistics indicating a relatively strong predictive ability for all outcomes. The unadjusted mFI and FS models did not have a strong predictive ability for predicting mortality and in-hospital complications. They also had a lower predictive ability for skilled nursing facility disposition and 30-day readmissions.

CONCLUSION

There are significant differences in the predictive ability of the four commonly used frailty scores. The TSFI and the RFS are better predictors of outcomes compared with the mFI and the FS. The TSFI is easy to calculate and might be used as a universal frailty score in geriatric trauma patients.

LEVEL OF EVIDENCE

Prognostic, level III.

Is There Enough Evidence for Osteosarcopenic Obesity as a Distinct Entity? A Critical Literature Review

The co-existence of impaired bone health (osteopenia/osteoporosis), reduced muscle mass and strength (sarcopenia), and increased adiposity (obesity) in middle-aged and older people has been identified in recent studies, leading to a proposal for the existence of "osteosarcopenic obesity" as a distinct entity. Evidence for the pathophysiological overlap of these conditions is mounting, although a causal relationship is yet to be established. Each component condition occurs frequently with increasing age, and with shared risk factors in many instances, thus, an overlap of these three conditions is not surprising. However, whether the concurrent existence of sarcopenia, osteoporosis and obesity leads to an increased risk of adverse musculoskeletal outcomes and mortality above and beyond the risks associated with the sum of the component parts remains to be proven and is a question of research interest. In this article, we review evidence for the existence of osteosarcopenic obesity including the current operational definition of osteosarcopenic obesity, prevalence, pathophysiology, outcomes and exploratory approaches to the management of components. We conclude that, there is insufficient evidence to support a discrete clinical entity of osteosarcopenic obesity at this time. To expand knowledge and understanding in this area, there is a need for consensus on a definition of osteosarcopenic obesity which will allow for identification, further epidemiological studies and comparisons between studies. Additionally, studies should assess whether the clinical outcomes associated with osteosarcopenic obesity are worse than the mere addition of those linked with its components. This will help to determine whether defining a person as having this triad will eventually result in a more effective treatment than addressing each of the three conditions separately.

Frailty assessment: from clinical to radiological tools

Frailty is a syndrome of cumulative decline across multiple physiological systems, which predisposes vulnerable adults to adverse events. Assessing vulnerable patients can potentially lead to interventions that improve surgical outcomes. Anaesthesiologists who care for older patients can identify frailty to improve preoperative risk stratification and subsequent perioperative planning. Numerous clinical tools to diagnose frailty exist, but none has emerged as the standard tool to be used in clinical practice. Radiological modalities, such as computed tomography and ultrasonography, are widely performed before surgery, and are therefore available to be used opportunistically to objectively evaluate surrogate markers of frailty. This review presents the importance of frailty assessment by anaesthesiologists; lists common clinical tools that have been applied; and proposes that utilising radiological imaging as an objective surrogate measure of frailty is a novel, expanding approach for which anaesthesiologists can significantly contribute to broad implementation.

Ultrasound measurement of rectus femoris muscle thickness as a quick screening test for sarcopenia assessment

INTRODUCTION

Sarcopenia is a geriatric syndrome related to loss of muscle mass and function, leading to disability, frailty and higher mortality. According to European Working Group on Sarcopenia in Older People (EWGSOP) the diagnosis of sarcopenia requires the assessment of muscle mass, muscle force and function, that is time-consuming and not easily at hand in everyday clinical practice. We propose the B-mode ultrasound measurement of muscle thickness as a quick screening test to assess the presence of sarcopenia.

METHODS

A cross-sectional study was realized, 119 patients (average age 82 years, 50.4% females) from the Department of Internal Medicine of the University Hospital of Siena (Italy) were enrolled. The diagnosis of sarcopenia was assessed according to EWGSOP criteria. Rectus femoris muscle (RFM) thickness (in cm) was measured by ultrasound B-mode scanning. Sensibility and specificity of the test was evaluated and Receiver Operating Analysis (ROC) was performed to assess the accuracy of the test.

RESULTS

Average RFM thickness was 0.78 ± 0.26, significantly lower in sarcopenic patients (0.55 ± 0.2 vs. 0.9 ± 0.3; Mann-Whitney; p < 0.001) and females (0.7 ± 0.3 vs 0.86 ± 0.3; Mann-Whitney; p < 0.001). The cut-off point of 0.7 cm for females and 0.9 cm for males was established as a threshold to assess the presence of sarcopenia by ultrasound. Sensibility of ultrasound measurement of RFM thickness was 100%, specificity 64%, positive predictive value (PPV) 64.3% and negative predictive value (NPV) 100%. ROC analysis was performed in order to quantify how accurately RFM thickness can discriminate between sarcopenia and non-sarcopenia state. AUC for all patients was 0.9 and after a comparative analysis for gender higher values for males (0.94 vs. 0.92) were observed.

CONCLUSION

We suggest a screening test for sarcopenia based on the ultrasound measurement of RFM thickness, as a not invasive and easy to perform method even in elderly patients with functional or cognitive impairment.

Lumbar muscle volume in postmenopausal women with osteoporotic compression fractures: quantitative measurement using MRI

OBJECTIVE

To investigate the relationship between paraspinal and psoas muscle volumes and acute osteoporotic or low-bone-mass compression fractures of the lumbar spine in postmenopausal women.

METHODS

Patient data were retrieved retrospectively for postmenopausal women with L-spine magnetic resonance imaging (MRI) and dual-energy X-ray absorptiometry showing osteoporosis/low bone mass. Group 1 comprised eight women aged 60-80 years with MRI showing a single acute compression fracture. The age-matched group 2a (N = 12) and younger group 2b (N = 12) comprised of women whose MRIs showed no fractures. Cross-sectional MRIs of the paraspinal and psoas muscles and intramuscular fat volume for each muscle group were measured. Operator repeatability and reproducibility were obtained.

RESULTS

Group 1 showed significantly smaller lean muscle volume for all muscle groups at L5/S1. Intramuscular fat volume was also smaller in most muscle groups in group 1, though only reaching statistical significance at variable muscle groups and levels. Measurements show both good intrarater repeatability and interrater reproducibility of lean muscle volume estimations (intraclass correlation coefficient (ICC), 0.999 for rater A and 0.997 for rater B; Cronbach's alpha 0.995) and intramuscular fat volume estimations (ICC, 0.995 for rater A and 0.982 for rater B; Cronbach's alpha was 0.981).

CONCLUSIONS

This study provides the first quantitative evidence that compression fractures in postmenopausal women with underlying osteoporosis/low bone mass are associated with less paraspinal and psoas muscle volumes. Further longitudinal studies with larger cohorts are needed to verify this relationship.

KEY POINTS

• The risk of osteoporotic compression fractures is higher in older women with smaller paraspinal muscle volume. • Older women show smaller paraspinal muscle volume and more intramuscular fat compared to younger controls.

[Self-design and prevention potential for older people in institutional long-term care]

Healthcare in inpatient long-term care facilities (nursing homes) should not be limited to medical curative measures, but should also include strengthening social participation, autonomy, self-responsibility and joint responsibility of the residents. Prevention and rehabilitation should therefore be even more integrated into care concepts.This article first introduces various areas of prevention physical activity, nutrition, cognitive competence, psychosocial health, abuse, and freedom-removing measures and then discusses their evidence. Essential for the implementation and the success of such measures is the ability and willingness of people in need of care to engage actively in these therapies; here, appropriate and motivating information plays an important role.Subsequently, geriatric rehabilitation is referred to. In the 2013-2017 empirical study Organization and Rehabilitation for Residents in the Nursing Home to Improve Independence and Participation (ORBIT), 215 people in need of care participated in three-month therapeutic interventions, which were followed by three-months of rehabilitative care. Improvements in mobility and quality of life (Barthel index, QOL-AD) could be demonstrated compared to a control group (n = 28). The results have to be considered against the background of a worsening health and reduced functional capacities in old age. A stronger integration of prevention and rehabilitation services into long-term institutional care is functional for strengthening participation and independence - an important condition for the residents' certainty that their dignity will be respected, competence and strive for self-responsibility and self-determination.

Rapid Geriatric Assessment, Physical Activity, and Sleep Quality in Adults Aged more than 65 Years: A Preliminary Study

OBJECTIVE

(1) To evaluate geriatric syndromes using the Rapid Geriatric Assessment; (2) To investigate possible association of geriatric syndomes with physical activity and sleep quality in adults aged more than 65 years who applied to outpatients physical medicine and rehabilitation clinic.

DESIGN

A cross-sectional study.

SETTING

Outpatient physical medicine and rehabilitation clinic in Edirne, Turkey.

PARTICIPANTS

A total of 56 adults (mean aged 69.7 ± 4.0 (range, 65-80) years, 33 women).

MEASUREMENTS

The Rapid Geriatric Assessment, which includes the FRAIL Questionnaire Screening Tool for frailty, Simplified Nutritional Assessment Questionnaire (SNAQ), SARC-F Screen for Sarcopenia, and Rapid Cognitive Screen (RCS), was used to assess geriatric syndromes. The International Physical Activity Questionnaire (IPAQ) was used to obtain data regarding health-related physical activity. The Pittsburgh Sleep Quality Index (PSQI) was used to measure sleep quality during the past month.

RESULTS

The mean age of the patients was 69.7 ± 4.0 years. Of the 56 patients, 12.5% were frail, 50.0% were pre-frail, 35.7% had sarcopenia, 44.6% had a risk of weight loss, 33.9% had dementia, 57.1% were physically inactive, and 53.6% had poor sleep quality. The total FRAIL and SARC-F scores were positively correlated with the global PSQI score (correlation coefficient (r) = 0.300, p < 0.05; r = 0,327, p < 0.05, respectively) and negatively correlated with the total RCS score (r= -0,267, p < 0.05; r = -0,314, p < 0.05, respectively)). The total FRAIL score was positively correlated with the SARC-F score (r = 0.695, p < 0.001), and the concurrence of frailty and sarcopenia in the same patients was 10.7%. The global PSQI score was negatively correlated with the SNAQ score (r = -0.273, p < 0.05).

CONCLUSION

Frailty and sarcopenia were positively correlated with poor sleep quality and negatively correlated with cognition and physical activity. In clinical practice, the Rapid Geriatric Assessment and determination of physical activity level could assist in disability prevention.

Upper-extremity function prospectively predicts adverse discharge and all-cause COPD readmissions: a pilot study

Background

Frailty can inform management approaches for individuals with COPD. However, inpatient measures of frailty are seldom employed because they are time-consuming or inapplicable for bed-bound patients. We investigated the feasibility and potential of an innovative sensor-based upper-extremity function (UEF) test for frailty assessment in predicting adverse outcomes.

Methods

Hospitalized patients with COPD-related exacerbations (aged ≥55 years) were recruited and performed the UEF test within 24 hours of admission. UEF parameters were obtained and fed into our previously developed frailty model to calculate frailty status (non-frail, pre-frail, and frail) and frailty score (0: extreme resilience to 1: extreme frailty). In-hospital (length of stay) and post-discharge (discharge disposition, 30-day exacerbation with treatment, and all-cause 30-day readmission) outcomes were collected. Associations between UEF frailty and outcomes were investigated using ANOVA and logistic models adjusted for demographic data.

Results

In total, 42 patients were recruited. All participants were able to perform the UEF test. Based on UEF, participants were stratified into three groups of non-frail (n=6, frailty score =0.18±0.09), pre-frail (n=14, frailty score =0.45±0.09), and frail (n=22, frailty score =0.78±0.11). Both frailty status and frailty score were significantly associated with unfavorable discharge disposition (P<0.005) and all-cause 30-day readmission (P<0.05). On the other hand, UEF frailty measures were associated with neither hospital length of stay (P>0.5) nor 30-day exacerbation with treatment (P>0.70). Age was only significantly associated with unfavorable discharge disposition (P=0.048).

Conclusion

In agreement with previous work, the current findings underline the importance of measuring frailty for risk-stratification of COPD patients. The UEF was feasible and easily performed among all hospitalized COPD patients. In this study, we have shown that, using our quick and objective frailty measures, COPD patients can be prospectively risk-stratified in terms of unfavorable discharge disposition and all-cause 30-day readmissions.

Factors associated with falls in older adults with cataracts

The aim of the present study was to evaluate factors associated with falls in community-dwelling older adults diagnosed with cataracts. An analytical, cross-sectional study was conducted with a sample of community-dwelling older adults residing in the Federal District of Brazil. Interviews and assessment tools were administered, such as the Timed Up and Go test, Short Physical Performance Battery (SPPB), Biodex Balance System, Katz Index, Lawton Scale, Minnesota Leisure Time Physical Activity Questionnaire and Mini Mental State Examination. Statistical analysis involved binary logistic regression. One hundred forty-two older adults (85 with cataracts) participated in the study (mean age: 69.39 ± 5.67 years). Falls were associated with the female sex (OR: 4.45) and sub-maximum score on the SPPB (OR: 3.53) among patients with cataracts, whereas multimorbidity (OR: 5.10) was the risk factor risk for older adults without cataracts. The data suggest different risk factors for falls among older adults diagnosed with cataracts.

Frailty in advanced liver disease

Prognostication of patients with cirrhosis is complex, depending on more than just the severity of liver disease. Scores such as the model for end-stage liver disease (MELD) and Child Pugh can assist with prognostication, yet by focusing on physiological parameters they fail to completely capture the elements contributing to a patient's clinical status. Evidence is increasing to support an important role for physical functioning in patient outcomes. Frailty has been increasingly recognised in medical literature over recent years, including in hepatology where it is identified in nearly half of cirrhosis patients. It is a complex construct consisting of multisystemic physiological decline and increased vulnerability to stressors. Diagnosis is complicated by lack of a consensus definition and measurement tool for frailty in cirrhosis. Frailty heralds a poor prognosis, predicting increased morbidity and mortality both pre- and postliver transplant, independent of MELD score. It is thought to be reversible, with promising data supporting prehabilitation and lifestyle intervention programs. In the future, assessment of patients with cirrhosis is likely to incorporate a measure of frailty, however, further research is required.

The Effect of Fun Physical Activities on Sarcopenia Progression among Elderly Residents in Nursing Homes: a Randomized Controlled Trial

Introduction: Immobilization in the elderly can reduce the size and strength of muscle mass and ultimately lead to sarcopenia, the severity and progression of which can be prevented by exercise. However, due to physical and mental conditions, the elderly may be unable to take full advantage of regular exercise. Therefore, fun exercise through motivation and effective participation of older adults is likely to have positive effects on decreasing the volume and power of muscle mass. The aim of this study was to determine the effect of fun physical activities on the progression of sarcopenia among elderly residents in nursing homes.

Methods: This study was a two-group randomized controlled trial conducted in 2014. Sixty three older adults were recruited by the random sampling. The elderly in the fun physical exercise group did the exercise for 8 weeks, three times a week for 20 minutes at a time, and in the control group, the adults did the routine exercises. The Berg Balance Scale, a dynamometer, and the Six-Minute Walk Test were used to measure sarcopenia criteria (balance, muscle strength, distance traveled).The statistical analysis was done by SPSS version 13.

Results: The results showed that the mean score of the sarcopenia criterion (balance, distance walked, muscles strength) was significantly increased in the fun physical exercise group than in the control group.

Conclusion: The fun physical activity reduces sarcopenia progression through improving balance, increasing distances walked, and strengthening muscles.

Sarcopenia defined by a computed tomography estimate of the psoas muscle area does not predict frailty in geriatric trauma patients

INTRODUCTION

The aim of our study was to assess the correlation between frailty & sarcopenia and impact of each condition on outcomes in geriatric trauma patients.

METHODS

We performed a four-year (2013-2016) secondary analysis of our prospectively maintained frailty database and included all trauma patients age ≥65 y who had CT-abdomen. Trauma-Specific-Frailty-Index (TSFI) was used to calculate frailty. Patients were classified as non-frail or frail. Sarcopenia was defined as the lowest sex-specific-quartile of total-psoas-index (TPI). Outcome measures included in-hospital complications, mortality and adverse disposition.

RESULTS

325 patients were included in the study, 36% (n = 117) were frail and 24.9% (n = 81) had sarcopenia. There was a weak correlation between frailty and sarcopenia (R² = 0.04). The overall rate of complications and mortality was 19.4% and 7.7% respectively. On regression analysis, after controlling for possible confounding variables and frailty status, sarcopenia was associated with adverse disposition (OR:1.41,p = 0.01). However, it was not associated with in-hospital complications (OR:1.21,p = 0.54) or in-hospital mortality (OR:1.12,p = 0.73).

CONCLUSION

Sarcopenia as an individual marker might not be an effective screening tool for risk assessment in geriatric-trauma patients. Frailty assessment should be a part of risk assessment and prognostication.

Different protein and derivatives supplementation strategies combined with resistance training in pre-frail and frail elderly: Rationale and protocol for the "Pro-Elderly" Study

BACKGROUND

Frailty is a multifactorial geriatric syndrome characterized by progressive decline in health and associated with decreased muscle mass, strength, and functional capacity. Resistance training (RT) combined with protein or amino acids supplementation has been shown to be promising for mitigating age-related impairments.

AIM

To investigate the chronic effects of different strategies of protein and derivatives supplementation in association with RT on selected health-related parameters in pre-frail and frail elderly.

METHODS

This is a series of double-blind, randomized, placebo-controlled, parallel-group clinical trials. Volunteers will be divided into nine groups, comprising four different sub-studies evaluating the effects of: isolated leucine supplementation (study 1); protein source (whey vs. soy - study 2); combination of whey protein and creatine (study 3); and sexual dimorphism on the response to protein intake and RT (males vs. females - study 4). Muscle cross-sectional area, fiber cross-sectional area, body composition, lower-limb maximal dynamic and isometric strength, functionality, lipid profile, biochemical parameters, renal function, quality of life, and nutritional status will be assessed before and after a 16-week intervention period. Data will be tested for normality and a mixed-model for repeated measures will be conducted to assess within- and between-group effects of the intervention on the dependent variables. Confidence intervals (95%), effect sizes, and relative changes will also be determined, with significance set at p < 0.05.

Agreement Between Bioelectrical Impedance and Dual-Energy X-Ray Absorptiometry to Track Changes in Fat-Free Mass After Resistance Training in Older Women

Nascimento, MA, Silva, DRP, Ribeiro, AS, Pina, FLC, Gerage, AM, Gobbo, LA, Mayhew, JL, and Cyrino, ES. Agreement between bioelectrical impedance and dual-energy x-ray absorptiometry to track changes in fat-free mass after resistance training in older women. J Strength Cond Res 34(6): 1700-1708, 2020-The aim of our study was to compare the agreement between bioelectrical impedance (BIA) and dual-energy X-ray absorptiometry (DXA) to track changes on fat-free mass (FFM) after a resistance training (RT) program in older women. Forty-three older women (65.2 ± 4.6 years, 59.5 ± 9.2 kg, 156.4 ± 6.0 cm, 24.3 ± 3.3 kg·m) participated in a RT intervention (12 weeks, 8 exercises, 2 sets, 10-15 repetitions, 3 nonconsecutive days per week). Fat-free mass changes were determined by a single-frequency BIA device (EQ1), 6 BIA prediction equations for older women (EQ2, EQ3, EQ4, EQ5, EQ6, and EQ7), and DXA. At pretraining, 3 equations overpredicted, and 3 underpredicted DXA FFM (F = 244.63, p < 0.001), although all equations had high correlations with DXA (r = 0.78-0.83). After training, 4 equations overpredicted and one underpredicted DXA FFM (F = 176.25, p < 0.001). Dual-energy X-ray absorptiometry detected significant gains in FFM (0.65 ± 0.82 kg; p < 0.05), as did EQ3 (0.55 ± 1.69 kg; p < 0.05), and EQ4 (0.61 ± 1.88 kg; p < 0.05), whereas the remaining equations did not indicate significant changes in FFM. Low correlations between FFM and equation change values suggest that single-frequency BIA-derived equations may not provide sufficient accuracy to track changes in FFM after 12 weeks of RT in older women.

Association between the nutritional status and the severity of sarcopenia among community-dwelling elderly Japanese people

AIM

To investigate the association between nutritional evaluation indices (body mass index, albumin, and weight loss) and sarcopenia severity among community-dwelling elderly people in Japan.

METHODS

The subjects consisted of 758 community-dwelling elderly people ≥65 years of age, categorized into two groups by based on Operation of long life medical care system (medical care system for elderly in the latter stage of life), the cut-off value for age used was 75. The outcome measures were basic characteristics, anthropometric measures, physical function, and blood biochemistry (five assessments). The appendicular skeletal muscle mass was calculated via a bioelectrical impedance analysis. The subjects were categorized into three groups by the body mass index (BMI) [BMI 3 group]. The cut-off value for albumin used was 3.8 g/dL [A1b 2 group]. Weight loss was assessed using item 11 on the Kihon check list: "Have you experienced more than 2-3 kg weight loss over the past 6 months? Yes=1, No=0." [weight loss 2 group]. Sarcopenia was defined based on the European Working Group on Sarcopenia in Older People definition, using the Asian Working Group for Sarcopenia cut-off values. All subjects were then categorized into four groups based on their sarcopenia status: non-sarcopenic (non-), pre-sarcopenic (pre-), sarcopenic (sarco-), or severely sarcopenic (severe-) [sarco4 group].

RESULTS

The prevalence of sarcopenia and severe sarcopenia in men was 5.6% (n=18) and 1.2% (n=4), respectively, and in women was 7.8% (n=34) and 1.6% (n=7), respectively. The analysis showed that, among the people (>75 years of age) with normal BMI (18.5-25.0), 10.4%-15.6% were in the Sarco group. Further, among women over 75 years of age with BMI >25.0, 5.7% (n=2) were in the Sarco group. There was a significant association between weight loss and sarcopenia severity in older men. No significant association between albumin levels and sarcopenia severity was observed. 80.0% of weight-loss was presented in above BMI 18.5 kg/m2 and Alb 3.8 g/dL.

CONCLUSION

Sarcopenia and severe sarcopenia were prevalent among those with normal BMI, and particularly among obese women over 75 years of age. Weight-loss was presented in above BMI 18.5 kg/m2 and Alb 3.8 g/dL. Our findings indicate that the nutritional evaluation indices, including BMI, albumin, and weight loss, were insufficient in screening for malnutrition and sarcopenia among the elderly.

Cognitive Dysfunction in Urban-Community Dwelling Prefrail Older Subjects

OBJECTIVES

A number of studies have reported that frailty is cross-sectionally associated with cognitive decline and is also a risk for future cognitive decline or dementia; however, there have been only a few studies that focus on the association between prefrailty and cognitive dysfunction. In the current study, we investigated the association between prefrailty and cognition.

DESIGN

A cross-sectional study of the data obtained at registration in a randomized control trial.

SETTING

Toyota, Japan.

PARTICIPANTS

Community-dwelling older subjects (male 54.6%) who had cognitive complaints.

MEASUREMENTS

A battery of neuropsychological and physical assessments were performed. Prefrailty was defined as exhibiting one or two of the five Fried criteria (weight loss, exhaustion, weakness, slow gait speed and low physical activity). We performed a multiple regression analysis to investigate the associations of cognitive performance with prefrailty, adjusting for the factors that were significantly different between the robust and prefrailty groups. To assess the cognitive attributes that were significantly associated with prefrailty, logistic analysis was performed to see if one specific criterion of the five frailty criteria was associated with cognitive performance.

RESULTS

The study subjects included 183 prefrail and 264 robust individuals. The prefrail subjects with cognitive complaints were older, less educated, more depressive, and more likely to have diabetes mellitus than the robust subjects. The prefrail subjects had lower performance in a wide-range of cognitive domains, and after adjustments for age, education, depressive mood, and diabetes mellitus, prefrailty was associated with a decline in delayed memory and processing speed. Among the components of the Fried criteria, slow gait speed and loss of activity were significantly associated with slow processing speed as assessed by the digit symbol substitution test.

CONCLUSION

The current results demonstrated that prefrailty was associated with worse memory and processing speed performance, but not with other cognitive domains.