Sarcopenia and sarcopenic obesity in Spanish community-dwelling middle-aged and older women: Association with balance confidence, fear of falling and fall risk

Individual and interaction effects of monounsaturated fatty acids on their associations with hypertension in Chinese residents

Currently, associations between dietary intakes of individual monounsaturated fatty acids (MUFAs) and hypertension were not well disclosed, and the interaction effects of MUFAs on their associations with hypertension were unknown. Obesity was correlated with both MUFAs and hypertension, while if anthropometric obesity indices performed mediating roles in associations between MUFAs and hypertension remained underdetermined. In our study, 8509 Chinese adults investigated from 2004 to 2011 were included. Dietary information collection and physical examinations were performed at baseline and each timepoint of follow-up. As we found, inverse associations of MUFA17, MUFA18 and MUFA20 with hypertension were statistically significant after adjustments, hazard ratios (HRs) were 0.87, 0.90 and 0.91, respectively. MUFA15 was positively associated with hypertension, with an HR of 1.07 (95% confidence interval: 1.01, 1.12). By performing principal component analysis (PCA) to estimate the joint effects of MUFAs on hypertension, the PCA score of MUFAs was only inversely associated with blood pressure. No joint effect was observed in g-computation analyses. Both linear and nonlinear interactions of MUFAs on their associations with hypertension were estimated using restricted cubic spline analysis. The association between MUFA15 and hypertension was interacted by MUFA17, and the association between MUFA20 and hypertension was interacted by MUFA18. The mediation effects of body mass index and waist circumference were found on associations of hypertension with MUFA15, MUFA17 and MUFA20. Our findings suggested that associations with hypertension were different among individual MUFAs, and mutual interactions existed, implying that the utility of individual MUFAs might be recommended for estimating relationships between MUFAs and diseases. Moreover, fat accumulation might potentially underlie associations between MUFAs and hypertension.

Sarcopenia in older adults is associated with static postural control, fear of falling and fall risk: A study of Romberg test

BACKGROUND

As a geriatric syndrome, sarcopenia may exacerbate static postural control and increase fall risk among older adults. The Romberg test, a simple method to assess static postural control, has the potential to predict fall, but has rarely been used to assess static postural control and fall risk in sarcopenic older adults.

RESEARCH QUESTION

How does sarcopenia increase fall risk by affecting static postural control?

METHODS

Forty-four older adults performed the Romberg test and were included for analyses. Romberg parameters, including Center of Pressure (CoP), Center of Mass (CoM) and Displacement Angle (DA), were collected under eyes-open/eyes-closed conditions. Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2019 criteria. Fall risk was assessed using the Morse Elderly Fall Risk Assessment Scale (MFS), and fear of falling was evaluated using the Falls Efficacy Scale-International (FES-I). Multivariate linear regression models were conducted to examine the associations of sarcopenia with Romberg test parameters, fear of falling, and fall risk.

RESULTS

Sarcopenic older adults had higher scores of both fear of falling and fall risk (P<0.001 and =0.006, respectively), and worse static postural control parameters (P values ranging from <0.001-0.043) than healthy controls, demonstrated by the multivariate linear regression models. Most of the Romberg test parameters were significantly associated with fear of falling score, especially under eyes-closed condition, and fear of falling was further associated with higher fall risk score (β=0.90, P=0.001). Meanwhile, the presence of sarcopenia also significantly increased fall risk score (β=10.0, P<0.001).

SIGNIFICANCE

Sarcopenia may increase fall risk in older adults via worsen static postural control ability and increase fear of falling. Paying attention and making efforts to prevent sarcopenia may help to alleviate postural control dysfunction, decrease fear of falling, so as to reduce fall risk and prevent severe injuries caused by fall accidents.

Sarcopenia and sarcopenic obesity among older adults in the nordic countries: a scoping review

BACKGROUND

Sarcopenia and sarcopenic obesity (SO) are age-related syndromes that may compromise physical and mental health among older adults. The Nordic countries differ from other regions on prevalence of disease, life-style behavior, and life expectancy, which may impact prevalence of sarcopenia and SO. Therefore, the aim of this study is to review the available evidence and gaps within this field in the Nordic countries.

METHODS

PubMed, Embase, and Web of science (WOS) were searched up to February 2023. In addition, grey literature and reference lists of included studies were searched. Two independent researcher assessed papers and extracted data.

RESULTS

Thirty-three studies out of 6,363 searched studies were included in this scoping review. Overall prevalence of sarcopenia varied from 0.9 to 58.5%. A wide prevalence range was still present for community-dwelling older adults when definition criteria and setting were considered. The prevalence of SO ranged from 4 to 11%, according to the only study on this field. Based on the included studies, potential risk factors for sarcopenia include malnutrition, low physical activity, specific diseases (e.g., diabetes), inflammation, polypharmacy, and aging, whereas increased levels of physical activity and improved dietary intake may reduce the risk of sarcopenia. The few available interventions for sarcopenia were mainly focused on resistance training with/without nutritional supplements (e.g., protein, vitamin D).

CONCLUSION

The findings of our study revealed inadequate research on SO but an increasing trend in the number of studies on sarcopenia. However, most of the included studies had descriptive cross-sectional design, small sample size, and applied different diagnostic criteria. Therefore, larger well-designed cohort studies that adhere to uniform recent guidelines are required to capture a full picture of these two age-related medical conditions in Nordic countries, and plan for prevention/treatment accordingly.

Prevalence of sarcopenic obesity in the older non-hospitalized population: a systematic review and meta-analysis

BACKGROUND

Sarcopenic obesity emerges as a risk factor for adverse clinical outcomes in non-hospitalized older adults, including physical disabilities, metabolic diseases, and even mortality. In this systematic review and meta-analysis, we investigated the overall SO prevalence in non-hospitalized adults aged ≥ 65 years and assessed the sociodemographic, clinicobiological, and lifestyle factors related to SO.

METHODS

We searched the PubMed, Embase, Cochrane Library, and Web of Science databases for studies reporting the prevalence of SO from database inception to October 2023. Two researchers independently screened the literature, evaluated the study quality, and extracted the data. Both fixed- and random-effects models were used in the meta-analysis to estimate the pooled SO prevalence and perform subgroup analyses. Publication and sensitivity bias analyses were performed to test the robustness of the associations.

RESULTS

Among 46 studies eligible for review and a total of 71,757 non-hospitalized older adults, the combined prevalence of SO was 14% (95% CI:11-17%, I2 = 99.5%, P < 0.01). Subgroup analysis according to lifestyle factors demonstrated that the SO prevalence was 17% (95% CI: 8-29%, I2 = 99.5%, P < 0.01) in older adults without exercise habits. Regarding clinicobiological factors, older adults with a history of falls (15% [95% CI: 10-22%, I2 = 82%, P < 0.01]), two or more chronic diseases (19% [95% CI: 10-29%, I2 = 97%, P < 0.01]), functional impairment (33% [95% CI: 29-37%, I2 = 0%, P = 0.95]), cognitive impairment (35% [95% CI: 9-65%, I2 = 83%, P = 0.02]), osteoporosis (20% [95% CI: 8-35%, I2 = 96%, P < 0.01]), high fasting glucose level (17% [95% CI: 1-49%, I2 = 98%, P < 0.01]), or the use of antipsychotics (13% [95% CI: 2-28%, I2 = 0%, P = 0.32]) exhibited a higher SO prevalence.

CONCLUSION

SO prevalence is high among non-hospitalized older adults, especially those with functional and cognitive impairments. Thus, SO is a potential problem for the aging population; implementation of planned interventions in the community is needed to reduce the prevalence and adverse outcomes of SO.

Poor sleep health predicts the onset of a fear of falling among community-dwelling older adults

INTRODUCTION

A greater fear of falling predicts disability, falls, and mortality among older adults. Although poor sleep has been identified as a relevant risk factor for fear of falling among older adults, evidence is primarily shown in cross-sectional studies using isolated sleep characteristics. Less is known about whether prior fall experiences change the sleep health-fear of falling link among older adults. We investigated the longitudinal relationship between sleep health and the incidence of fear of falling among community-dwelling older adults and how the association differed between those with or without prior fall experiences.

METHODS

Data were from individuals who completed the sleep module in the National Health and Aging Trends Study (2013-2014; n = 686). Fear of falling was assessed with a single item. Multidimensional sleep health was measured with self-reported sleep items based on the SATED model (ie, sleep satisfaction, daytime alertness, timing, efficiency, and duration). Covariates included sociodemographics, assistive device usage, health, risky behavior, and sleep medications. Multiple logistic regression was used to analyze the data.

RESULTS

Poor sleep health was associated with the onset of fear of falling at 1-year follow-up (odds ratios=1.20, 95% confidence interval=1.02-1.41). Moreover, poor sleep health increased the odds of having fear of falling among individuals without prior falls experiences and elevated the already heightened risks of developing fear of falling among those who fell at baseline.

CONCLUSIONS

Given that fear of falling and experiencing a fall each increase the risk of the other occurring in the future, improving sleep health may prevent older adults from stepping into the vicious cycle of fear of falling and falls.

Influence of Concurrent Exercise Training on Ankle Muscle Activation during Static and Proactive Postural Control on Older Adults with Sarcopenic Obesity: A Multicenter, Randomized, and Controlled Trial

Sarcopenic obesity (SO), characterized by age-related muscle loss and excess body fat, significantly impairs postural control. However, limited research has explored the effects of concurrent exercise training on neuromuscular strategies during postural control in older adults with SO. The study enrolled 50 older adults with SO, split into an intervention group (IG, n = 25, mean age = 76.1 ± 3.5 years; mean BMI = 34.4 ± 4.0 kg/m2) and a control group (CG, n = 25, mean age = 75.9 ± 5.4 years; mean BMI = 32.9 ± 2.3 kg/m2). Participants in the IG were engaged in 60-min Total Mobility Plus Program (TMP) sessions three times a week for four months, while the CG maintained their typical daily activities. Standardized evaluations were conducted both before and after the intervention. These assessments included the Romberg and Timed Up and Go (TUG) tests, as well as the measurement of Center of Pressure (CoP) displacements parameters under various conditions. Additionally, ankle muscle activities were quantified during postural control evaluations and maximal voluntary contractions of plantar and dorsal flexors. Post-intervention results revealed a significant reduction of the standing time measured in the Romberg (-15.6%, p < 0.005) and TUG (-34.6%, p < 0.05) tests. Additionally, CoP area and velocity were notably reduced in various conditions (p < 0.05). Postural control improvements were associated with an increase of strength (p < 0.05) and decrease of ankle muscle activation (p < 0.05). These findings highlight the reversibility of neuromuscular system alterations associated with the synergistic effects of sarcopenia and obesity, emphasizing the trainability of postural control regulation within this population. By incorporating these insights into clinical practice and public health strategies, it seems possible to optimize the health and well-being of older adults with SO.

Fear of falling: Scoping review and topic analysis using natural language processing

Fear of falling (FoF) is a major concern among older adults and is associated with negative outcomes, such as decreased quality of life and increased risk of falls. Despite several systematic reviews conducted on various specific domains of FoF and its related interventions, the research area has only been minimally covered by scoping reviews, and a comprehensive scoping review mapping the range and scope of the research area is still lacking. This review aims to provide such a comprehensive investigation of the existing literature and identify main topics, gaps in the literature, and potential opportunities for bridging different strains of research. Using the PRISMA-ScR guidelines, we searched the Cochrane Database of Systematic Reviews, CINAHL, Embase, MEDLINE, PsycInfo, Scopus, and Web of Science databases. Following the screening process, 969 titles and abstracts were chosen for the review. Pre-processing steps included stop word removal, stemming, and term frequency-inverse document frequency vectorization. Using the Non-negative Matrix Factorization algorithm, we identified seven main topics and created a conceptual mapping of FoF research. The analysis also revealed that most studies focused on physical health-related factors, particularly balance and gait, with less attention paid to cognitive, psychological, social, and environmental factors. Moreover, more research could be done on demographic factors beyond gender and age with an interdisciplinary collaboration with social sciences. The review highlights the need for more nuanced and comprehensive understanding of FoF and calls for more research on less studied areas.

Assessing quality of life with SarQol is useful in screening for sarcopenia and sarcopenic obesity in older women

BACKGROUND

Health-related quality of life (HRQoL) may be impaired in the presence of sarcopenia. Since a specific quality of life questionnaire became available for sarcopenia (SarQol), cutoffs to screen for this condition have been proposed, prompting the need to assess them in different populations. Due to the lack of consensus on diagnostic criteria, the tool has not yet been analyzed in screening for sarcopenic obesity.

AIM

Our aim is to measure the SarQoL's metric properties and establish a cutoff in QoL assessments that could be used along the diagnostic pathway for sarcopenia and sarcopenic obesity in community-dwelling older women.

METHODS

This cross-sectional study assessed women aged ≥ 70 years using the SarQol, sarcopenia criteria (EWGSOP2) and sarcopenic obesity criteria (ESPEN/EASO). Cutoffs for the SarQol were defined with a receiver-operating characteristics (ROC) curve, and sensitivity and specificity were analyzed.

RESULTS

Of the 95 included women (mean age 76.0 years, standard deviation [SD] 5.7), 7.3% (n = 7) were classified as having sarcopenic obesity, 22.1% (n = 21) as having sarcopenia, and 70.5% (n = 67) as not having sarcopenia. The total SarQol score was higher in women without sarcopenia (66.5 SD 16.2) versus those with sarcopenia (56.6 SD 15.6) and sarcopenic obesity (45.1 SD 7.9). A cutoff of ≤ 60 points is proposed for sarcopenia screening (area under the ROC curve [AUC] 0.67; 95% confidence interval [CI] 0.53-0.80; sensitivity 61.9%; specificity 62%), and ≤ 50 points for sarcopenic obesity (AUC 0.85; 95% CI 0.74-0.95; sensitivity 71.4%; specificity 76.9%).

CONCLUSIONS

Quality of life is compromised in women with sarcopenia and especially in those with sarcopenic obesity. The SarQol could be useful in screening for these conditions, providing insight into health-related quality of life in older people with sarcopenia.

Dietary intakes of methionine, threonine, lysine, arginine and histidine increased risk of type 2 diabetes in Chinese population: does the mediation effect of obesity exist?

BACKGROUND

Published studies have shown positive associations of branched chain and aromatic amino acids with type 2 diabetes mellitus (T2DM), and the findings remain consistent. However, the associations of other essential and semi-essential amino acids, i.e., methionine (Met), threonine (Thr), lysine (Lys), arginine (Arg) and histidine (His), with T2DM remain unknown. Obesity is an important independent risk factor for T2DM, and excessive amino acids can convert into glucose and lipids, which might underlie the associations of amino acids with obesity. Therefore, we aimed to estimate the associations between dietary intakes of these 5 amino acids and T2DM risk, as well as the mediation effects of obesity on these associations, in a Chinese population.

METHODS

A total of 10,920 participants (57,293 person-years) were included, and dietary intakes of 5 amino acids were investigated using 24-h dietary recalls. Anthropometric obesity indices were measured at both baseline and the follow-up endpoints. Associations of amino acids with T2DM were estimated using COX regression models, hazard ratios (HRs) and 95% confidence intervals (95% CIs) were shown. The mediation effects of obesity indices were analyzed, and the proportion of the mediation effect was estimated.

RESULTS

Higher intakes of the 5 amino acids were associated with increasing T2DM risk, while significant HRs were only shown in men after adjustments. No interaction by gender was found. Regression analyses using quintiles of amino acids intakes showed that T2DM risk was positively associated with amino acids intakes only when comparing participants with the highest intake levels of amino acids to those with the lowest intake levels. Adjusted correlation coefficients between amino acid intakes and obesity indices measured at follow-up endpoints were significantly positive. Mediation analyses showed that mediation effects of obesity indices existed on associations between amino acids intakes and T2DM risk, and the mediation effect of waist circumference remained strongest for each amino acid.

CONCLUSIONS

We found positive associations of dietary intakes of Met, Thr, Lys, Arg and His with increasing T2DM risk in general Chinese residents, on which the mediation effect of obesity existed. These findings could be helpful for developing more constructive guidance in the primary prevention of T2DM based on dietary interventions.

Correlation analysis between body composition, serological indices and the risk of falls, and the receiver operating characteristic curve of different indexes for the risk of falls in older individuals

Objective

This study assessed the risk factors for falls and evaluated the correlation between body composition, serological indices, and the risk of falls in older individuals.

Method

This cross-sectional study included 387 individuals ≥60 years of age in the cadre ward of the First Hospital of Jilin University. The information used in this study was obtained from the comprehensive geriatric assessment database of the cadre ward. The body composition of the individuals was measured by bioelectrical impedance analysis using an InBody S10 device. We assessed fall risk using the fall risk assessment tool. Individuals with ≤2 points were placed in the low-risk group, those with 3-9 points were placed in the medium-risk group, and those with ≥10 points were placed in the high-risk group.

Results

Differences in age, educational background, height, cognitive impairment, malnutrition, ability of daily living, depression, diastolic blood pressure, heart rate, intracellular water, total body moisture, water ratio, limb moisture (right and left, upper and lower), trunk moisture, fat-free weight, arm girth, body cell mass, skeletal muscle mass, limb muscle (right and left, upper and lower), appendicular skeletal muscle mass index (ASMI), sarcopenia, hemoglobin level, hematocrit level, aspartate aminotransferase level, albumin level, anemia, and hypoproteinemia were observed among the three groups (p < 0.001, p = 0.002, p = 0.006, p < 0.001, p < 0.001, p < 0.001, p < 0.001, p < 0.001, p = 0.008, p = 0.010). Ordinal logistic regression analysis showed that the probability of the fall risk increasing by one level was 1.902 times higher for each unit of decrease in educational background, respectively. In addition, the probability of the fall risk increasing by one level was 2.971, 3.732, 3.804, 1.690 and 2.155 times higher for each additional unit of age, cognitive impairment, lower limb edema, decreased skeletal muscle mass, and sarcopenia, respectively.

Conclusion

Our findings suggest that educational background, age, cognitive impairment, lower limb edema, decreased skeletal muscle mass, and sarcopenia were associated with falls in older individuals. Body composition and serological indices can assist in the early identification of falls in the older people.

Rehabilitation after Hip Fracture Surgery Improves Physical and Cognitive Function in Patients with or Without Sarcopenia

Introduction

Sarcopenia is a prevalent risk factor for falls and fractures, and it affects the physical function and mortality of older people. The present study was performed to assess the prevalence of sarcopenia in patients who underwent rehabilitation after hip fracture surgery and to examine the association of sarcopenia with physical and cognitive function outcomes.

Methods

This case-control study involved 132 patients who were admitted to a convalescent rehabilitation ward at a single hospital after surgical treatment of hip fractures from April 2018 to March 2020. The skeletal muscle mass index was examined using whole-body dual-energy X-ray absorptiometry. The Asian Working Group for Sarcopenia 2019 diagnostic criteria were applied on admission. We compared the walking speed, Mini-Mental State Examination (MMSE) score, and Functional Independence Measure (FIM) score between the sarcopenia group and non-sarcopenia group on admission and on discharge.

Results

The prevalence of sarcopenia was 59.8%. In the non-sarcopenia group, the walking speed, MMSE score, FIM total score, FIM motor score, and FIM cognitive score were significantly lower on admission than those on discharge (P < .05). In the sarcopenia group, the walking speed, MMSE score, FIM total score, and FIM motor score were significantly lower on admission than those on discharge (P < .05); there was no significant difference in the FIM cognitive score between admission and discharge. On both admission and discharge, the MMSE score, FIM total score, FIM motor score, and FIM cognitive score were significantly better in the non-sarcopenia group than those in the sarcopenia group.

Conclusions

After postoperative rehabilitation of hip fractures in patients with and without sarcopenia, physical and cognitive function outcomes on discharge were significantly better than those on admission. Patients with sarcopenia had significantly worse physical and cognitive function outcomes than patients without sarcopenia both on admission and on discharge.

Evaluation of functional parameters of the foot and ankle in elderly with sarcopenia

OBJECTIVE

With population aging, the prevalence of sarcopenia has increased. It is a pathology often neglected, with the potential to cause great damage if not diagnosed and treated. The objective of this study was to identify sarcopenic elderly people through the SARC-F score and palm grip test and to evaluate foot and ankle functionality parameters: gait speed, plantar sensitivity, and baropodometry.

METHODS

This is a descriptive and cross-sectional study. The sample consisted of 20 sarcopenic elderly diagnosed through the SARC-F score and the handgrip strength test, from which demographic data were obtained, and the three functional tests related to the foot and ankle were performed.

RESULTS

No individual was aware of the term sarcopenia. Regarding gait speed, 20 (100%) presented values compatible with sarcopenia (average of 0.52 m/s). Regarding plantar sensitivity, five (25%) of the patients showed changes in the exam with the detection of insensitivity. Regarding baropodometry, higher pressure values were observed in the right foot (average of 52.9±7.01%) compared to the left (average of 47.10±7.01%) and in the hindfoot (average of 55.85±16.21%) compared to the forefoot (mean 44.15±15.35%). When correlating the analyzed variables with the SARC-F scores, the only association that showed statistical significance (p<0.05) was the dynamometry on the right.

CONCLUSION

The SARC-F score and the handgrip strength test are easy to apply in the screening of sarcopenia, and the functional parameters of the foot and ankle were shown to be altered in the studied group.

Handgrip strength is correlated with activities of daily living, balance, and body composition in patients with thoracolumbar compression fracture

This study assessed the relationship between handgrip strength (HGS) and activities of daily living, balance, walking speed, calf circumference, body muscle, and body composition in elderly patients with thoracolumbar vertebral compression fracture (VCF). A cross-sectional study in a single hospital was performed with elderly patients diagnosed with VCF. After admission, we evaluated HGS, 10-meter walk test (speed), Barthel Index, Berg Balance Scale (BBS), numerical rating scale of body pain, and calf circumference. We examined skeletal muscle mass, skeletal muscle mass index, total body water (TBW), intracellular water, extracellular water (ECW), and phase angle (PhA) in patients with VCF using multi-frequency direct segmental bioelectrical impedance analysis after admission. A total of 112 patients admitted for VCF were enrolled (26 males, 86 females; mean age 83.3 years). The prevalence of sarcopenia according to the 2019 Asian Working Group for Sarcopenia guideline was 61.6%. HGS was significantly correlated with walking speed (P < .001, R = 0.485), Barthel Index (P < .001, R = 0.430), BBS (P < .001, R = 0.511), calf circumference (P < .001, R = 0.491), skeletal muscle mass index (P < .001, R = 0.629), ECW/TBW (P < .001, r = -0.498), and PhA (P < .001, R = 0.550). HGS was more strongly correlated with walking speed, Barthel Index, BBS, ECW/TBW ratio, and PhA in men than women. In patients with thoracolumbar VCF, HGS is associated with walking speed, muscle mass, activities of daily living measured using the Barthel Index, and balance measured using BBS. The findings suggest that HGS is an important indicator of activities of daily living, balance, and whole-body muscle strength. Furthermore, HGS is related to PhA and ECW/TBW.

Sarcopenia Definition Outcome Consortium - defined Weakness and Risk of Falls: The National Health and Aging Trends Survey

AIM

The prevalence of obesity continues to rise, as does that of weakness. However, it is unclear how this impacts the risk of falling. We aimed to ascertain the risk of falls using new definitions of clinically defined weakness.

METHODS

We applied clinically defined weakness definitions to the National Health and Aging Trends Survey using the Sarcopenia Definitions Outcomes Consortium cutpoints. Three exposure variables were created: grip-strength-defined weakness and body mass index [GS/BMI]-defined obesity; weakness and obesity, weakness and waist circumference-derived obesity (GS/WC); and weakness defined by a ratio of GS÷BMI. Proportional hazards modeled incident falls as a function of weakness with/without obesity (hazard ratio [HR] [95% confidence intervals]).

RESULTS

Of 4906 respondents aged ≥ 65 years (54.5% female), the mean ± SD grip strength, BMI, and WC were 26.7 ± 10.6 kg, 27.4 ± 5.4 kg/m2 , and 99.5 ± 16.3 cm, respectively. Using the neither weakness/obesity as the referent, weakness was associated with incident falls across all definitions (GS/BMI: HR 1.19 [1.07, 1.33]; GS/WC: HR 1.39 [1.19, 1.62]; GS ÷ BMI: HR 1.16 [1.05, 1.28]). Weakness with obesity was associated with falls using GS/WC (HR 1.28 [1.11, 1.48]). Obesity status was associated with falls in both the BMI and the WC definition (1.17 [1.02-1.35], 1.16 [1.05-1.28]).

CONCLUSION

Our findings further evaluate the definitions of clinically defined weakness with and without obesity in older adults. As falls are an important patient outcome, establishing this relationship is critical for both clinicians and researchers. Future study should identify high-risk individuals in order to direct specific interventions to them. Geriatr Gerontol Int 2023; 23: 213-220.

Is waist circumference associated with fear of falling in community-dwelling older adults? A cross-sectional study

INTRODUCTION

Fear of falling (FOF) is a prevalent condition among older adults and several variables have been pointed out as risk factors.

OBJECTIVES

To identify the cut-off point on waist circumference (WC), capable of discriminating between older adults with and without FOF, and to test the association between WC and FOF.

METHODS

A cross-sectional observational study was carried out with older adults of both sexes from Balneário Arroio do Silva, Brazil. We used Receiver Operating Characteristic (ROC) curves to determine the cut-off point on WC and logistic regression adjusted for potential confounding variables to test the association.

RESULTS

Older women with WC >93.5 cm [area under the curve: 0.61 (95%CI 0.53; 0.68)] had 3.30 (95%CI 1.53; 7.14) greater chances of having FOF compared with older women with WC ≤93.5 cm. WC was not able to discriminate FOF in older men.

CONCLUSION

WC values >93.5 cm are associated with higher chances of FOF in older women.

Prediction model of all-cause death based on balance ability among middle-aged and older Chinese adults of overweight and obesity

Background

Advances in studies using body indicators to predict death risk. Estimating the balance ability of death risk in middle-aged and older Chinese adults with overweight and obesity is still challenging.

Methods

A retrospective analysis of the data from the China Health and Retirement Study from January 2011 to December 2018. A total of 8,632 participants were randomly divided into 7:3 a training group and a verification group, respectively. Univariable Cox analysis was used to prescreen 17 potential predictors for incorporation in the subsequent multivariable Cox analysis. Nine variables were included in the nomogram finally and validated with concordance index (C-index), calibration plots, Hosmer-Lemeshow test, and internal validation population.

Results

287 participants were death in the training group. One hundred and thirteen participants were death in the verification group. A total of nine indicators were included in the modeling group, including gender, age, marriage, hypertension, diabetes, stroke, ADL, IADL, and balance ability to establish a prediction model. The nomogram predicted death with a validated concordance index of (C-index = 0.77, 95% CI: 0.74-0.80). The inclusion of balance ability variables in the nomogram maintained predictive accuracy (C-index = 0.77, 95% CI: 0.73-0.82). The calibration curve graph and Hosmer-Lemeshow test (P > 0.05 for both the modeling group and the verification group) showed the model has a good model consistency.

Conclusion

In the present study, we provide a basis for developing a prediction model for middle-aged and older people with overweight and obesity. In most cases, balance ability is more reversible than other predictors.

Enhanced Risk of Osteoporotic Fracture in Patients with Sarcopenia: A National Population-Based Study in Taiwan

Sarcopenia is a progressive and generalized skeletal muscle disorder associated with poor health outcomes in older adults. However, its association with the risk of fracture risk is yet to be clarified. Therefore, this study aimed to assess the incidence and consequence of osteoporosis-related fractures among patients with sarcopenia in Taiwan. A retrospective, population-based study on 616 patients with sarcopenia, aged >40 years, and 1232 individuals without sarcopenia was conducted to evaluate claims data from Taiwan’s National Health Insurance Research Database collected in the period January 2000−December 2013. The incidence rate of osteoporosis-related fracture was 18.13 and 14.61 per 1000 person years in the patients with sarcopenia and comparison cohort, respectively. Patients with sarcopenia had a greater osteoporotic fracture risk (adjusted hazard ratio [HR] 2.11; 95% confidence interval [CI] 1.47−3.04) after correcting for possible confounding. Additionally, females showed statistically significant correlations of sarcopenia with osteoporosis-related fracture risk (HR 1.53; CI 0.83−2.8 for males and HR 2.40, CI 1.51−3.81 for females). During this retrospective study on the fracture risk in Taiwan, an adverse impact of sarcopenia was observed, which substantiates the need to work toward sarcopenia prevention and interventions to reverse fracture susceptibility in patients with sarcopenia.

Fear of Falling in Older Adults: A Scoping Review of Recent Literature

Background

Fear of falling (FOF) is prevalent among older adults and associated with adverse health outcomes. Over recent years a substantial body of research has emerged on its epidemiology, associated factors, and consequences. This scoping review summarizes the FOF literature published between April 2015 and March 2020 in order to inform current practice and identify gaps in the literature.

Methods

A total of 439 articles related to FOF in older adults were identified, 56 selected for full-text review, and 46 retained for data extraction and synthesis.

Results

The majority of included studies were cross-sectional. Older age, female sex, previous falls, worse physical performance, and depressive symptoms were the factors most consistently associated with FOF. Studies that measured FOF with a single question reported a significantly lower prevalence of FOF than those using the Falls Efficacy Scale, a continuous measure. FOF was associated with higher likelihoods of future falls, short-term mortality, and functional decline.

Conclusions

Comparisons between studies were limited by inconsistent definition and measurement of FOF, falls, and other characteristics. Consensus on how to measure FOF and which participant characteristics to evaluate would address this issue. Gaps in the literature include clarifying the relationships between FOF and cognitive, psychological, social, and environmental factors.

Qigong for Muscle Strength and Static Postural Control in Middle-Aged and Older Postmenopausal Women: A Randomized Controlled Trial

In the present study, we aimed to determine the effects of a Qigong exercise program on the muscle strength and postural control in middle-aged and older postmenopausal women. This is a randomized clinical trial (https://clinicaltrials.gov/ct2/show/NCT03989453) conducted on 125 women who were initially assigned to either an experimental group (n = 63) that performed a Qigong exercise program for 12 weeks or to a control group (n = 62) that did not receive any intervention. Muscle strength (dynamometer) and postural control (stabilometric platform) were evaluated before and immediately after an intervention period. The main findings of this study suggest that the women in the experimental group had improvements in muscle strength, mean velocity of the displacement of the center of pressure (CoP) with both eyes open and closed, and the surface sway area covered by the CoP, as well as the mediolateral and anteroposterior oscillations of the CoP, only with eyes open. The results of the present study determined that a 12 week Qigong exercise program has beneficial effects on muscle strength and postural control of middle-aged and older postmenopausal Spanish women.

SARC-F and the Risk of Falling in Middle-Aged and Older Community-Dwelling Postmenopausal Women

(1) Background: The objective of the present study was to determine the ability of the SARC-F questionnaire to identify individuals at risk of falling among middle-aged and older community-dwelling postmenopausal women. (2) Methods: An analytical cross-sectional study was conducted on 157 women (70.80 ± 8.37 years). The SARC-F questionnaire was used to screen for risk of sarcopenia. Fear of falling and balance confidence, as measured by the Falls Efficacy Scale-International (FES-I) and the Activities-Specific balance Scale-16 items (ABC-16) respectively, were used to assess risk of falling. Anxiety and depression (Hospital Anxiety and Depression Scale), fatigue (Fatigue Severity Scale), body mass index, waist-to-hip ratio, and sleep duration were also determined. (3) Results: Logistic regression showed that higher risk of falling as assessed by FES-I was associated with higher SARC-F scores (OR = 1.656), anxiety levels (OR = 1.147), and age (OR = 1.060), while increased SARC-F scores (OR = 1.612), fatigue (OR = 1.044), and shorter sleep duration (OR = 0.75) were related to ABC-16 scores. In addition, a SARC-F cutoff of 1.50 (83.33% sensitivity and 59.13% specificity) and 3.50 (44.44% sensitivity and 89.26% specificity) were shown to be able to discriminate participants at risk of falling according to the FES-I and the ABC-16, respectively. (4) Conclusions: our results show that SARC-F is an independent predictor of the risk of falling among middle-aged and older community-dwelling postmenopausal women.

Mental and Physical Self-Awareness of Alzheimer Patients: Decreased Awareness of Amnesia and Increased Fear of Falling Compared to Views of Families: The Tajiri and Wakuya Projects

INTRODUCTION

The purpose of this study is to examine self-awareness of patients with Alzheimer disease (AD) regarding forgetfulness and physical status, with the goal of further psychological understanding of these patients.

METHODS

The 255 subjects included 33 healthy volunteers and 48 patients with mild cognitive impairment who were elderly community residents selected from the 2017 Wakuya Project and 174 consecutive outpatients with AD at the Tajiri Clinic. Test data were selected from a pooled database. Results from the Mini-Mental State Examination, Clinical Dementia Rating (CDR), Short Falls Efficacy Scale International (FES), and Everyday Memory Checklist (EMC) were used in the study. FES and EMC data were also obtained from family members for comparison.

RESULTS

EMC scores in the AD groups (mild to moderate and moderate to severe) were significantly higher (more complaining memory impairment) than those in the CDR 0 (healthy) group and significantly lower (less self-awareness for memory impairment) than the corresponding EMC scores of families of the subjects. In contrast, FES scores of the AD groups did not differ significantly from those of the CDR 0 group, and these scores were higher (more fear of falling) than those of family members. Additionally, family-FES scores of the AD groups were higher than those of the CDR 0 and 0.5 groups.

CONCLUSION

The results showed an evidence of the heterogeneity of awareness, an emotional response (concern or fear, FES), and a cognitive appraisal of function (EMC). These may be explained whereby awareness of/fear of falling increases with AD due to a preserved emotional awareness, whereas awareness of cognitive impairment is impaired due to memory deficits.

Loss of skeletal muscle mass can be predicted by sarcopenia and reflects poor functional recovery at one year after surgery for geriatric hip fractures

INTRODUCTION

Hip fractures in the elderly impact negatively on functional dependence, and carry great social costs and morbidity. We assessed the decline in muscle mass and functional outcomes following hip fracture surgery .

MATERIAL AND METHODS

Thirty patients with a hip fracture (mean age: 80.8 years) were assessed using dual-energy X-ray absorptiometry and reassessed for changes in body composition 1 year after hip surgery. Baseline demographic data, sarcopenia, and bone mineral density were recorded. Body mass index (BMI), handgrip strength, appendicular skeletal muscle mass (ASM), total body fat percentage, and responses to questionnaires measuring quality of life and activities of daily living (ADL) before injury and 1 year after hip surgery were analyzed to identify changes. Associations with changes in ADL or quality of life were analyzed with time-variant independent variables.

RESULTS

Significant losses in ADL were identified at the 1-year follow-up, at which time only 43% of patients had regained their preinjury ADL status. Additionally, the participants had lost an average of 4.63% of ASM. ASM loss was significantly higher in patients with baseline sarcopenia than in those without (mean loss: 9.18% and 1.15%, respectively). When confounders were controlled for, a greater loss of ASM and handgrip strength and larger increase in BMI were associated with greater decrease in ADL 1 year after hip surgery.

CONCLUSION

Geriatric hip fracture patients may experience a significant loss of muscle mass, associated with impaired functional recovery 1 year after hip surgery, highlighting a potential treatment target of maintaining muscle mass to improve prognosis in these patients.

Fear-related barriers to physical activity among adults with overweight and obesity: A narrative synthesis scoping review

Physical activity is a health behavior contributing to successful weight management. Adults with overweight and obesity find it challenging to meet recommended activity guidelines because of a range of barriers, some of which are not yet fully understood. A barrier receiving limited consideration, compared with other literature within this field, is that of fear. The purpose of this scoping review was to establish the extent of literature on fear-related barriers to physical activity in adults with overweight or obesity and to identify gaps in this literature. The review followed the scoping review framework outlined by Arksey and O'Malley and adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. The findings of the identified papers were charted thematically using a framework of fears and age group. In total, 34 studies were included that identified nine different fears related to barriers to activity in this population. However, only a small number of studies (n = 5) had explicitly intended to explore fear-related barriers. There were notable knowledge gaps including activity-related fear of pain and movement in adults under 45 years of age. There is a strong rationale to further explore these fears because they may restrict health promoting behavior.

Sarcopenia, Obesity, and Sarcopenic Obesity: Relationship with Skeletal Muscle Phenotypes and Single Nucleotide Polymorphisms

Obesity may aggravate the effects of sarcopenia on skeletal muscle structure and function in the elderly, but no study has attempted to identify the gene variants associated with sarcopenia in obese women. Therefore, the aims of the present study were to: (1) describe neuromuscular function in sarcopenic and non-sarcopenic women with or without obesity; (2) identify gene variants associated with sarcopenia in older obese women. In 307 Caucasian women (71 ± 6 years, 66.3 ± 11.3 kg), skeletal muscle mass was estimated using bioelectric impedance, and function was tested with a 30 s one-leg standing-balance test. Biceps brachii thickness and vastus lateralis cross-sectional area (VL_ACSA) were measured with B-mode ultrasonography. Handgrip strength, maximum voluntary contraction elbow flexion (MVC_EF), and knee extension torque (MVC_KE) were measured by dynamometry, and MVC_KE/VL_ACSA was calculated. Genotyping was performed for 24 single-nucleotide polymorphisms (SNPs), selected based on their previous associations with muscle-related phenotypes. Based on sarcopenia and obesity thresholds, groups were classified as sarcopenic obese, non-sarcopenic obese, sarcopenic non-obese, or non-sarcopenic non-obese. A two-way analysis of covariance was used to assess the main effects of sarcopenia and obesity on muscle-related phenotypes and binary logistic regression was performed for each SNP to investigate associations with sarcopenia in obesity. There were no significant obesity * sarcopenic status interactions for any of the investigated muscle-related phenotypic parameters. Neither sarcopenia nor obesity had a significant effect on biceps brachii thickness, but sarcopenia was associated with lower VL_ACSA (p = 0.003). Obesity was associated with lower MVC_EF (p = 0.032), MVC_KE (p = 0.047), and MVC_KE/VL_ACSA (p = 0.012) with no significant effect of sarcopenia. Adjusted for age and height, three SNPs (ACTN3 rs1815739, MTHFR rs1801131, and MTHFR rs1537516) were associated with sarcopenia in obese participants. Sarcopenia was associated with a smaller muscle size, while obesity resulted in a lower muscle quality irrespective of sarcopenia. Three gene variants (ACTN3 rs1815739, MTHFR rs1801131, and MTHFR rs1537516) suspected to affect muscle function, homocysteine metabolism, or DNA methylation, respectively, were associated with sarcopenia in obese elderly women. Understanding the skeletal muscle features affected by sarcopenia and obesity, and identification of genes related to sarcopenia in obese women, may facilitate early detection of individuals at particular risk of sarcopenic obesity.

Global prevalence of sarcopenic obesity in older adults: A systematic review and meta-analysis

BACKGROUND & AIMS

Sarcopenic obesity (SO), which refers to the coexistence of sarcopenia and obesity. It can lead to physical disability, morbidity, and even mortality. This systematic review and meta-analysis aimed to estimate the global prevalence of SO in older adults.

METHODS

We searched PubMed, Embase, and Web of Science for studies reporting the prevalence of SO from inception to December 2020. Two researchers independently screened the literature, evaluated study quality, and extracted data. A random-effects model was used to pool the estimates for the prevalence of SO. Subgroup analysis, sensitivity analysis, and meta-regression analysis were conducted. Publication bias was assessed using a funnel plot and the Egger test. All statistical analyses were performed using Stata 15.0 software.

RESULTS

This review included 50 studies, we found that the global prevalence of SO in older adults was 11%. Subgroup analyses showed that the prevalence of SO was higher among studies using diagnostic criteria of muscle mass alone (15%) to diagnose sarcopenia, using dual-energy X-ray absorptiometry (15%) to assess muscle mass, and those focused on age ≥ 75 years old (23%), hospitalized (16%), South Americans (21%) and North Americans (19%). There were no significant differences in the prevalence of SO among studies using body fat percentage (10%), body mass index (13%), waist circumference (16%) to diagnose obesity and in female (14%), male (10%) patients. Sensitivity analysis showed that none of the studies affected the overall pooled results. Meta-regression analysis found that publication year, geographical region, study setting, and the diagnostic criteria of sarcopenia were sources of heterogeneity.

CONCLUSION

This meta-analysis indicated SO affects more than one in ten older adults globally. Therefore, we should attach importance to the screening and early diagnosis of SO in older adults, then selecting appropriate interventions to reduce the occurrence of it and various adverse outcomes in this demographic.

Fatores associados à Sarcopenia em idosos da comunidade

RESUMO O objetivo deste estudo foi identificar os fatores associados à sarcopenia em idosos da comunidade. Tratou-se de um estudo correlacional, de corte transversal e abordagem quantitativa, realizado com 234 idosos da comunidade. Para avaliar a sarcopenia foram utilizados os critérios do European working group on sarcopenia in older people (EWGSOP2) e para coleta de dados foram utilizados: questionário sociodemográfico e de saúde para caracterização dos idosos; escala de depressão geriátrica, Addenbrooke’s cognitive examination-revised, international physical activity questionnaire, versão longa e o medical outcomes study 36-item short-form health survey. Houve predominância de pessoas do sexo feminino (n=151; 68,30%), de cor branca (n=163; 73,80%), com sobrepeso, segundo o Índice de Massa Corporal (IMC) (n=124; 56,10%) e 24,90% (n=55) dos participantes apresentaram sarcopenia, segundo os critérios do consenso europeu. Se associaram à sarcopenia os seguintes fatores: idade (OR=1,06; p=0,010), IMC<22kg/m2(OR=5,82; p=0,003), ser insuficientemente ativo fisicamente (OR=3,29; p=0,002) e presença de quedas (OR=2,20; p=0,033). Os idosos com idade avançada, com baixo peso, insuficientemente ativos fisicamente e que sofreram quedas têm mais chance de apresentar sarcopenia.

Falls, fractures, and areal bone mineral density in older adults with sarcopenic obesity: A systematic review and meta-analysis

Sarcopenia and obesity are common conditions in older adults that may have differing effects on falls and fracture risk. This systematic review and meta-analysis aimed to determine whether older adults with sarcopenic obesity have increased risk of falls and fractures or lower bone mass compared with older adults with sarcopenia, obesity, or neither condition. Twenty-six studies (n = 37,124) were included in the systematic review and 17 (n = 31,540) were included in the meta-analysis. Older adults with sarcopenic obesity had lower femoral neck areal bone mineral density (aBMD) compared with those with obesity alone but had higher femoral neck aBMD compared with counterparts with sarcopenia alone (both P < 0.05). Older adults with sarcopenic obesity had higher nonvertebral fracture rates (incidence rate ratio: 1.88; 95% confidence intervals: 1.09, 3.23; based on two studies), compared with those with sarcopenia alone, and also had higher falls risk compared with controls (risk ratio: 1.30; 95% confidence intervals: 1.10, 1.54) and obesity alone (risk ratio: 1.17; 95% confidence intervals: 1.01, 1.36). In conclusion, this systematic review and meta-analysis has demonstrated that older adults with sarcopenic obesity are at increased risk of adverse musculoskeletal outcomes compared with individuals with obesity, sarcopenia, or neither condition. These data support the need for developing interventions to improve bone health and physical function in this population.

Role of physical therapists and aromatherapy for fall prevention in older people: A narrative review

Falls among older people are usually the result of several causes combined. Identifying all the fall-related factors that apply to a particular individual and providing comprehensive multifactorial intervention is recommended for the prevention of falls among older people. However, the overall net benefit of multifactorial intervention in preventing falls is small, and it does not appear to improve fall-related outcomes, such as the number of fall-related injuries. Therefore, we might require new perspectives to overcome this situation. Here, we raise two novel strategies for fall prevention among older people. One is using physical therapists more actively. The other is using aromatherapy for stabilization of older people. Physical therapists should carry out detailed gait assessment and caregiver education. Aromatherapy is effective in improving balance and mental stability in older people. To overcome refractory geriatric syndrome, there is no choice but to eliminate all preconceived ideas before choosing the best fall prevention strategies. Geriatr Gerontol Int 2021; 21: 445-450.

Can physical activity levels and relationships with energy expenditure change the clinical aspects of sarcopenia and perceptions of falls among elderly women? Observational cross-sectional study

BACKGROUND

Physical activity (PA) is an effective strategy for managing sarcopenia in the elderly, but few studies have addressed PA levels regarding age-related changes.

OBJECTIVE

To ascertain the effects of elderly women's PA levels on sarcopenia, physical performance, handgrip strength and perception of the risk of falling, and their relationship with energy expenditure.

DESIGN AND SETTING

Observational cross-sectional study conducted in the southern region of the city of São Paulo, Brazil.

METHODS

Forty-seven elderly women were evaluated and divided into three groups: low PA (n = 13); moderate PA (n = 16); and high PA (n = 18). Their PA levels were investigated through the International Physical Activity Questionnaire (IPAQ); sarcopenia index, through dual-energy radiological absorptiometry; physical performance through the Timed Up & Go test; handgrip strength, using a digital dynamometer; and perception of the risk of falling, through the Fall Risk Awareness Questionnaire.

RESULTS

High PA level indicated higher skeletal muscle mass index, physical performance and IPAQ score, compared with low and moderate PA levels. Multiple linear regression analysis showed that higher IPAQ energy expenditure at high and moderate PA levels was a good predictor of higher physical performance and increased perception of the risk of falling.

CONCLUSION

Elderly women classified as having high PA level showed improvements in sarcopenia, handgrip strength, physical performance and perception of the risk of falling. The IPAQ energy expenditure of the elderly women with high and moderate PA levels was a good predictor of physical performance and improved perception of the risk of falling.

Validity and reliability testing of the Spanish version of the BESTest and mini-BESTest in healthy community-dwelling elderly

BACKGROUND

The Balance Evaluation Systems Test (BESTest) and its abbreviated version, the Mini-BESTest are clinical examination of balance impairment, but its psychometric properties have not yet been tested in European Spanish. We aimed to assess the psychometric properties of BESTest and Mini-BESTest in Spanish in community-dwelling elderly people.

METHODS

We designed a cross-sectional transcultural adaptation and validation study. Convenience sample of thirty (N-30) adults aged 65 to 89 years old without balance problems were recruited. Two physiotherapists assessed participants at the same time. Internal consistency of Spanish BESTest and Mini-BESTest was carried out by obtaining the Cronbach Alpha. The reproducibility between raters was studied with the Intraclass Correlation Coefficient. The Pearson correlation coefficient was calculated by comparing the relationship between the BESTest, mini-BESTest, Berg Balance Scale (BBS) and Falls Efficacy Scale-International (FES-I).

RESULTS

BESTest and Mini-BESTest showed good internal consistency. BESTest and Mini-BESTest total scores showed an excellent inter-rater agreement. There was a significant correlation between total score of the BESTest and the Mini-BESTest (r = 0.65; p < 0.001). BESTest had a moderate association with BBS and a strong association with FES-I. Mini-BESTest had a fair correlation with BBS and FES-I. Total scores obtained by women at BESTest and at Mini-BESTest were significantly lower than those reached by men. The differences observed in all the test when disaggregating data by sex require further research.

CONCLUSIONS

Spanish versions of BESTest and Mini-BESTest are comprehensible for new raters. They are reliable tools to provide information on which particular balance systems show impairment in community dwelling older adults. Elderly women had a worse quality of balance and a greater perception of their risk of falling.

TRIAL REGISTRATION

This study was registered in ClinicalTrials.gov with NCT03403218 on 2018/01/17.

The high prevalence of sarcopenia and its associated outcomes following hip surgery in Taiwanese geriatric patients with a hip fracture

BACKGROUND

Sarcopenia, which is a common risk factor for falls and fractures, affects the functional outcome and mortality in geriatric populations. However, the prevalence of sarcopenia among geriatric Taiwanese patients with a hip fracture is unknown, nor is the effect of sarcopenia on the outcome of hip surgery.

METHODS

From December 2017 to February 2019, geriatric patients who underwent surgery for a hip fracture were prospectively enrolled. Basic demographic data, responses to questionnaires for dementia screening and quality of life (QoL) and daily living activities (ADL) before the injury were analyzed to identify any association with sarcopenia. The QoL and ADL were monitored at six months after the operation to determine the difference between hip fracture patients with or without sarcopenia.

RESULTS

Of 139 hip fracture patients, 70 (50.36%) were diagnosed with sarcopenia. Accounting for all confounding factors in the multivariate logistic regression, lower body mass index (BMI), male gender and a weaker handgrip are the risk factors that are most strongly associated with a diagnosis of sarcopenia in geriatric patients with a hip fracture. Hip fracture patients with sarcopenia also have poor ADL and a lower QoL than patients without sarcopenia before the injury and six months after the operation.

CONCLUSION

A high prevalence of sarcopenia among geriatric hip fracture patients is associated with a poor mid-term outcome following hip surgery. Clinicians must recognize the risk of sarcopenia, especially for male hip fracture patients with a lower BMI and a weaker handgrip.

Combined Effect of Osteoporosis and Poor Dynamic Balance on the Incidence of Sarcopenia in Elderly Chinese Community Suburban-Dwelling Individuals

OBJECTIVES

Given the increasing prevalence of osteoporosis and the important role dynamic balanced plays in the assessment of muscle function, we aimed to examine the joint and separate effects of osteoporosis and poor dynamic balance on the incidence of sarcopenia in Chinese elderly individuals.

DESIGN

This study was conducted on 658 (44.4% male) Chinese suburban-dwelling participants with a mean age of 68.42 ± 5.43 years who initially had no sarcopenia and were aged ≥60 years. A quantitative ultrasound scan of each participant's calcaneus with a T score less than -2.5 was used to identify the prevalence of osteoporosis. Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia criteria. We assessed dynamic balance using the Timed Up and Go Test (TUGT). Participants who scored in the top 20% on the TUGT were defined as having poor dynamic balance.

RESULTS

After a follow-up of three years, the incidence of sarcopenia in the general population was 8.1% (9.6% in males, 6.8% in females). The incidence of sarcopenia was progressively greater in people suffering from both osteoporosis and poor dynamic balance (OR=2.416, 95%CI=1.124-5.195) compared to those who only had osteoporosis (OR=0.797, 95%CI=0.378-1.682) or poor dynamic balance (OR=1.226, 95%CI=0.447-3.363) in models without adjustments. Even after adjusting for potential confounders, the result still held true (OR=2.431, 95%CI=1.053-5.614).

CONCLUSIONS

In our study, we found individuals who suffered from both osteoporosis and poor dynamic balance simultaneously had a significantly higher incidence of sarcopenia than those who suffered from either one or the other.

Falls in community-dwelling prefrail older adults

Frailty has been established as a risk factor for falls, and prefrailty also seems a risk; however, few studies have focused on the association between falls and each of the five components of frailty proposed by Fried. In the present study, we sought to elucidate the association between prefrailty and falls, and moreover, the association of frailty component with falls. Participants were community-dwelling older people who had cognitive complaints but not dementia (N = 447, male 54.6%). Prefrailty was defined as exhibiting one or two of the five Fried criteria. Frail individuals were excluded. Background characteristics were compared between the prefrail and robust groups, and multiple regression analysis was performed to investigate the associations between fall history within the past year and factors that were significantly different between the groups. We also performed logistic regression analysis with adjustment for age, education and gender to assess associations with frailty components. We found that prefrailty was associated with fall history. Depressed mood was also significantly associated with fall history. Among the five frailty criteria, exhaustion was significantly associated with falls. Prefrailty, especially the criteria of exhaustion, and depressed mood were associated with fall history.

Sarcopenia for predicting falls and hospitalization in community-dwelling older adults: EWGSOP versus EWGSOP2

The European Working Group on Sarcopenia in Older People (EWGSOP) recently published an updated version (EWGSOP2). We aimed to compare the predictive values of EWGSOP-defined and EWGSOP2-defined sarcopenia for the incidence of falls and hospitalization in older adults. We defined sarcopenia according to the EWGSOP and the EWGSOP2. We further modified the cut-off points of the EWGSOP and EWGSOP2 according to the lowest quintile values of the gender-specific distribution of our study population, named "modified EWGSOP" and "modified EWGSOP2", respectively. We included 384 participants. During the follow-up, 98 participants (26.5%) and 51 participants (13.8%) had at least one fall or hospitalization, respectively. EWGSOP2-defined sarcopenia (hazard ratio [HR] 1.86, 95% confidence interval [CI] 1.22-1.84) and modified EWGSOP2-defined sarcopenia (HR 2.09, 95% CI 1.23-3.55) were significantly associated with an increased incidence of falls, respectively. EWGSOP-defined sarcopenia and modified EWGSOP-defined sarcopenia also have a trend to be associated with the incidence of falls, but the results were not statistically significant. Only modified EWGSOP2-defined sarcopenia (HR 2.07, 95% CI 1.01-4.27) was significantly related to an increased incidence of hospitalization. In conclusion, EWGSOP2-defined sarcopenia performed more sensitive than EWGSOP-defined sarcopenia for predicting the incidence of falls or hospitalization, especially when using the modified cutoffs.

Derivation of a clinical prediction rule to determine fall risk in community-dwelling individuals with knee osteoarthritis: a cross-sectional study

We derived a clinical prediction rule (CPR) to determine fall risk. The probability of falls increased, with positive likelihood ratio being 17.8 and post-test probability (positive predictive value) being 88.2%, in cases where the CPR score was 2 points. Our CPR could be a useful screening test to detect fall risk probability.

PURPOSE

We aimed to examine the risk factors for falls in individuals with knee osteoarthritis (OA) and derive a clinical prediction rule (CPR) to determine fall risk.

METHODS

Eighty-one individuals with medial compartment knee OA were included. The outcome was whether the participants had a self-reported fall within the past 1 year of this study being conducted. The collected data included sex, age, body mass index, Kellgren-Lawrence grade, lesion type (bilateral or unilateral knee OA), pain (rated using the visual analog scale), muscle strength test of the quadriceps femoris, one-leg standing test (OLST), five times sit-to-stand test (FTSST), and 5-m walk test, which were used in binomial logistic regression analysis. The outcome measure of the analysis was whether the study participants belonged to a fall or non-fall group. Receiver operating characteristic (ROC) analysis was performed for the outcome measurements, and the factors were selected by binomial logistic regression analysis. Then, a CPR to determine fall risk was extracted, and its diagnostic characteristics were calculated.

RESULTS

Binomial logistic regression analysis showed that the OLST and FTSST were significant. ROC analysis showed that the cut-off values of the OLST and FTSST were 5.3 s and 7.9 s, respectively. The post-test probability (positive predictive value) increased to 88.2% (positive likelihood ratio = 17.8) when the OLST and FTSST were both positive (the CPR score was 2 points).

CONCLUSION

The CPR obtained from this study would be useful as a screening test to detect the fall risk probability in individuals with knee OA.

Falls Experiences and Prevention Preferences of Adults in Mid-life

Falls prevention research and practice has focused primarily on older adults, yet healthy and productive aging does not begin at age 65. To help fill this gap in knowledge, the purpose of this study was to explore the falls experiences and prevention program preferences of adults in mid-life who had experienced falls or near falls. A qualitative study using content analysis was used. Multiple coders were employed to increase the reliability of the findings. Results revealed three major themes with regard to falls experiences including precursors to falls, physical implications, and functional implications. For prevention preferences, themes included a continuum of interest, convenience is key, money matters, people you trust prompt action, and preventing future injury. Study results reveal new insights regarding the falls experiences and prevention preferences of adults in mid-life and can serve as a starting point to inform prevention programs targeting this population.

Lower grip strength and dynamic body balance in women with distal radial fractures

In this case-control study, we concluded that women with distal radial fractures who were surgically treated showed lower grip strength and dynamic body balancing than those of controls. These results suggest that measurements of grip strength and dynamic body balance may be useful screening tools to assess future fracture risk.

INTRODUCTION

Patients with distal radial fractures (DRFs) are at risk of future fragility fractures. However, their physical characteristics and tendencies for falls remain unclear. We aimed to compare the physical characteristics of women with and without distal radial fractures.

METHODS

We included 128 women with a DRF as their first fragility fracture (fracture group) who underwent surgical treatment. Concurrently, 128 age- and sex-matched participants without a history of fragility fractures were selected as controls (control group). The participants underwent assessments of grip strength and the body balancing ability test. Measurements were taken twice in the fracture group, at 2 weeks and 6 months postoperatively, and once in the control group. The body balancing ability test included the Functional Reach Test, Timed Up and Go test (TUG), 2-Step test (2ST), and Timed Uni-pedal Stance test. The participants also completed questionnaires about their health.

RESULTS

There were no significant differences (p > 0.05) in patient characteristics between the groups. The fracture group showed lower grip strength across all age groups. In the DRF group, prolonged TUG time was observed at 2 weeks postoperatively in all age groups and at 6 months in participants aged 55-74 years; the 2ST score was significantly lower in participants aged between 65 and 74 years.

CONCLUSIONS

Women with DRF demonstrated lower grip strength and dynamic body balancing ability. Lower grip strength and dynamic body balancing ability were identified as significant risk factors in women with DRF, suggesting that these may be useful screening tools to assess fracture risk.

Bioelectrical impedance analysis in the assessment of sarcopenia

PURPOSE OF REVIEW

Bioelectrical impedance analysis (BIA) is an accepted technique to estimate low muscle mass for sarcopenia diagnosis. However, muscularity assessment from BIA relies on prediction equations, estimating different compartments according to the calibration method. Low muscle mass can be defined using different approaches.

RECENT FINDINGS

There is a lack of standardization on how low muscularity is defined in the context of sarcopenia. Recent studies have shown discrepant results for the estimation of low muscle mass when different prediction equations are used in the same BIA device. Different sarcopenia prevalence rates are observed if different definitions are used to identify low muscle mass. Most of the studies using BIA for diagnosing sarcopenia use the incorrect combination of specific population cut-off or a different device from the original equation.

SUMMARY

The lack of standardization of BIA use for assessing muscularity results in a wide range of sarcopenia prevalence rates among studies, even when conducted in the same population. As BIA equations and cut-off values are population and device-specific, results should be interpreted with caution when data from different devices are applied in equations or using cut-off values from a different population.

Effect of exercise alone or combined with dietary supplements on anthropometric and physical performance measures in community-dwelling elderly people with sarcopenic obesity: A meta-analysis of randomized controlled trials

OBJECTIVE

To evaluate the effect of exercise (EXE) alone or exercise combined with dietary supplements (EXE-SUPPL) on body composition and physical performance in subjects 60 years and older with sarcopenic obesity.

METHODS

A systematic review was carried out of studies identified through five search engines up to April 15, 2018. We searched for randomized controlled trials (RCTs) evaluating EXE or EXE-SUPPL in elderly individuals with sarcopenic obesity for at least six weeks. Primary outcomes were percentage of body fat mass, appendicular skeletal muscle mass, and hand grip strength. Random effects meta-analyses with the inverse variance method were used to evaluate the effects of interventions on outcomes. Effects were expressed as mean differences (MD) and their 95% confidence intervals (CI). Risk of bias was assessed with the Cochrane tool.

RESULTS

Nine papers reporting seven RCTs (with a total of 558 participants) were included in the review. EXE alone and EXE-SUPPL increased grip strength (MD 1.30 kg; 95% CI 0.58-2.01), gait speed (MD 0.05 m/s; 95% CI 0.03-0.07) and appendicular skeletal muscle mass (MD 0.40 kg; 95% CI 0.18-0.63). EXE alone and EXE-SUPPL reduced waist circumference (MD -1,40 cm; 95% CI -1.99 to -0.81), total fat mass (MD -1,77 kg; 95% CI -2.49 to -1.04), and trunk fat mass (MD -0.82 kg; 95% CI -1.22 to -0.42).

CONCLUSION

EXE alone and EXE-SUPPL improved muscle-related outcomes and reduced fat-related outcomes in subjects with sarcopenic obesity. There is a need for better-designed RCTs with systematic assessment of both different exercise regimes and dietary supplements in sarcopenic obese subjects.