Geriatric syndromes in an urban elderly population in Cameroon: a focus on disability, sarcopenia and cognitive impairment

Measuring the effects of nurse-led frailty intervention on community-dwelling older people in Ethiopia: a quasi-experimental study

BACKGROUND

Despite the critical need, interventions aimed at frailty in sub-Saharan Africa are scarce, attributed to factors such as insufficient healthcare infrastructure, the pressing need to address infectious diseases, maternal and child health issues, and a general lack of awareness. Hence, the aim of this research was to develop, implement, and evaluate the effect of a nurse-led program on frailty and associated health outcomes in community-dwelling older individuals in Ethiopia.

METHODS

This study utilised a pre-test, post-test, and follow-up single-group quasi-experimental design. The main outcome measure was to determine changes in the frailty levels of older individuals living in communities at three different intervals: initially (T0), immediately after the intervention (T1), and 12 weeks following the intervention (T2). Secondary outcomes were the observed changes in daily living activities, nutritional status, depression levels, and quality of life (QOL), evaluated at each of these data collection points. To analyse changes in frailty and response variables over these periods, Friedman's ANOVA and Cochran's Q test were employed, setting the threshold for statistical significance at P < 0.05.

RESULTS

Sixty-six older people with a high adherence rate of 97% completed the intervention and the follow-up measurements. Participants had an average age of 66.7 ± 7.9 years, with females comprising 79.4% of the group. Notably, 12 weeks post-intervention, there was a marked decrease in frailty (χ2(2) = 101.05, p < 0.001) and depression scores (χ2(2) = 9.55, p = 0.008) compared to the baseline. However, the changes in depression, physical, mental, and environmental domains of QOL were not sustained for 12 weeks post-intervention. Study participants showed an improvement in nutritional status (χ2(2) = 25.68, p < 0.001), activity of daily living (χ2(2) = 6.00, p = 0.05), and global quality of life (χ2(2) = 20.64, p < 0.001).

CONCLUSIONS

The nurse-led intervention notably, 12 weeks post-intervention reduced frailty and depression. The intervention improved the nutritional status and some components of the quality of life of the participants. There is a need for further studies, especially with larger participant groups and stronger research designs such as randomized controlled trials (RCTs).

TRIAL REGISTRATION

ClinicalTrials.gov: NCT05754398 (03/03/2023).

Possible sarcopenia and risk of chronic kidney disease: a four-year follow-up study and Mendelian randomization analysis

INTRODUCTION

Chronic kidney disease (CKD) is a common risk factor for sarcopenia. However, whether sarcopenia increases the risk of CKD remains unclear. To investigate the longitudinal and causal associations between possible sarcopenia and CKD, this study was performed.

METHODS

Possible sarcopenia was defined according to the Asian Working Group for Sarcopenia in 2019. Participants aged ≥ 40 years were recruited from the baseline survey of the China Health and Retirement Longitudinal Study and followed up for four years. Binary logistic regression was used to evaluate the cross-sectional and longitudinal associations between possible sarcopenia, low muscle strength, low physical performance and CKD. Propensity score matching was used to balance the intergroup differences. Subgroup and interactive analyses were adopted to identify potential interactive effects. Mendelian Randomization analysis was used to assess the causal association between appendicular lean mass (ALM) and CKD.

RESULTS

After data cleansing, a total of 7296 participants were included in the baseline survey. In the cross-sectional analyses, the odds ratios (ORs) of prevalent CKD were 1.50 (95% CI = 1.23-1.84, p < 0.001) for possible sarcopenia, 1.37 (95% CI = 1.10-1.70, p < 0.01) for low muscle strength and 1.42 (95% CI = 1.16-1.74, p < 0.001) for low physical performance in the full models. No significant interaction effects of covariates were detected (all P for interaction > 0.05). After four years of follow-up, an increased risk of incident CKD was also observed in participants with possible sarcopenia (OR = 1.66, 95% CI = 1.13-2.44, p = 0.010) and low physical performance (OR = 1.69, 95% CI = 1.16-2.45, p = 0.006), but not in participants with low muscle strength (OR = 1.19, 95% CI = 0.75-1.88, p = 0.469). In the Mendelian Randomization analysis, the inverse variance weighted estimator showed that a 1-standard deviation increase of genetically predicted ALM was associated with a lower risk of CKD (OR = 0.92, 95% CI = 0.85-0.99, p = 0.035). All the sensitivity analyses supported the main findings.

CONCLUSIONS

Possible sarcopenia is an independent risk factor for CKD and may serve as a predictor of CKD for early identification and intervention.

Prevalence of sarcopenia in Africa: a systematic review and meta-analysis of observational studies

BACKGROUND

Existing literature suggests that sarcopenia is a highly prevalent condition in older people. However, most studies to date reporting data on its prevalence have been mainly carried out in Western countries, while data on sarcopenia in Africa is scarce. With this systematic review and meta-analysis, we aimed to determine the prevalence of sarcopenia in African countries and to explore potential factors that could explain higher or lower prevalence of this condition in Africa.

METHODS

Major databases for studies reporting data on sarcopenia in African countries were searched from inception to June 2023. We conducted a meta-analysis of the prevalence [and 95% confidence intervals (95% CIs)] of sarcopenia in Africa, applying a random effect model. Several sensitivity and meta-regression analyses were run.

RESULTS

Among 147 articles initially screened, six articles (with seven cohorts) including a total of 10,656 participants were included. Mean age of participants was 66.9 years, and the majority were female (58.1%). The weighted prevalence of sarcopenia in the selected countries of Africa was 25.72% (95%CI: 18.90-32.55). This outcome was characterized by a high heterogeneity (I2 = 99%) and by publication bias. Among the factors investigated, sarcopenia was lower when assessed using only one anthropometric measure, or in South Africa.

CONCLUSION

Sarcopenia is a prevalent condition in Africa and thus research regarding this topic is a public health priority. Future studies that cover African countries for which data are not available and using standardized criteria are needed.

Prevalence of Sarcopenia in Africa: A Systematic Review

Objective

The world population gradually getting older, age-related sarcopenia is becoming more frequent. Known to be highly prevalent in high income countries, relative data in Africa are still scarce. This review aims to estimate the prevalence of sarcopenia in Africa and its characteristics.

Study Design and Setting

A literature search in PubMed, Web of Science, Google Scholar, and Scopus was conducted in October 2022. All studies reporting the prevalence of sarcopenia in Africa within 15 years were included, and we did an assessment of bias with Hoy et al's risk bias assessment tool. The estimated prevalence of sarcopenia was the outcome and we performed secondary analyses by age, gender, and diagnostic criteria. The random effect model was used for the prevalence estimation. The prevalence of sarcopenia and 95% confidence interval (95% CI) were calculated using the inverse-variance method.

Results

A total of 17 studies met our eligibility criteria, for a study population of 12,690 participants with 44.3% males and 55.7% females. The overall prevalence of sarcopenia was 25% (95% CI: 19-30%). The prevalence of sarcopenia among 50 years old and older was 23% (95% CI: 17-29%). We had a higher prevalence of sarcopenia among males (30%, %95 IC: 20-39%) than females (29%, %95 IC: 21-36%). The prevalence of sarcopenia was different depending on the diagnosis criteria used.

Conclusion

The prevalence of sarcopenia in Africa was relatively high. However, the fact that the majority of included studies were hospital-based studies shows the necessity of further community-based studies in order to have a more accurate representation of the situation in the general population.

Relationship between food insecurity and geriatric syndromes in older adults: A multicenter study in Turkey

AIMS

In this study, the aim was to determine the prevalence of geriatric syndromes such as frailty, sarcopenia risk and malnutrition in older adults and to investigate the relationship between food insecurity, and frailty, risk of sarcopenia and malnutrition.

METHODS

The study was cross-sectional. It was conducted between February 2022 and June 2022 with 707 older adults. The data were collected through the face-to-face interview method with a questionnaire including the Descriptive Information Form, Household Food Insecurity Access Scale (HFIAS), Frail Scale, Sarcopenia Risk Screening Scale (SARC-F) and Mini Nutritional Assessment-Short Form (MNA-SF). Numbers, percentages, mean, standard deviation, Pearson chi-square test and binary logistic regression analysis were used in data analysis.

RESULTS

In the present sample, 30% of the participants experienced some degree of food insecurity. The prevalence of frailty, sarcopenia risk, and malnutrition in the participants was 15.3%, 19.5%, and 1.3%, respectively. We determined that food insecurity was not associated with pre-frailty/frailty and sarcopenia risk. After adjusment for potential counfounders moderate and severe food insecurity was associated with higher odds of malnutrition risk and malnutrition (AOR: 2.06, 95% CI: 1.21-3.51, p:0.007).

CONCLUSION

While food insecurity is not associated with pre-frailty/frailty and sarcopenia risk, moderate and severe food insecurity is a modifiable risk factor for malnutrition risk and malnutrition. Thus, economic and social policies to eliminate food insecurity should be implemented, and efforts to prevent food insecurity should be planned through inter-sectoral cooperation.

Breast cancer in elderly patients: a clinicopathological review of a Nigerian database

Background

Breast cancer in the elderly population has not been evaluated in the Nigerian context. With the rising incidence of breast cancer and the changing demographics, it is likely that an increasing number of elderly patients will be managed in the coming years in Nigeria. This review describes the clinicopathological profile of elderly patients with breast cancer in a Nigerian database.

Method

From a prospective institutional database, elderly patients (65 years and above) managed for breast cancer over a 9-year period were reviewed. Details of their socio-demographic characteristics, patterns of presentation, pathology, treatment and outcome were obtained and analysed.

Results

Of the 607 patients managed during the study period, there were 87 older patients accounting for 14.3% of the total. There was a progressive rise in the number of patients with breast cancer towards the latter part of the study. Expectedly, they were all post-menopausal, with their ages ranging from 65 to 92 years, with a mean of 71 ± 6.58 years. Systemic hypertension was the commonest co-morbidity (29.8%). The mean tumour size at presentation was 10 cm, with the majority presenting with stage 3 disease. Invasive ductal carcinoma was the predominant histological type 83 (95.4%); 44.4% of those who had immunohistochemistry were oestrogen receptor-positive. Approximately half underwent mastectomy (52.8%), 63 (72.4%) had chemotherapy, 8 (44.4%) had hormonal therapy and only 6 (6.9%) had combined multimodal therapy in addition to surgery. Overall 5-year survival was 42.1%.

Conclusion

The pattern of presentation and outcomes of care in this elderly cohort is similar to the general population. Early presentation and use of multimodal treatment is still the mainstay of survival.

A Model for Effective Nonverbal Communication between Nurses and Older Patients: A Grounded Theory Inquiry

Nonverbal communication is an inevitable art to be effectively mastered by nurses. Nurse nonverbal communication has many benefits when it is effective. For instance, nonverbal communication is important to convey affective and emotional information, and demonstrate respect for and build therapeutic relationships with older patients. As the older population is growing fast worldwide, effective nonverbal communication with older patients is an essential skill for nurses and will improve patients' satisfaction and the quality of care. Therefore, this article presents a model to guide effective nonverbal communication between nurses and older patients. A Grounded Theory approach guided the study. Data were collected between July 2018 and January 2020 through overt participant observations and individual interviews. Purposive and theoretical sampling were used to select 13 clinically experienced nurses, 4 nursing students, and 8 older adults. Data analysis encompassed open coding, axial coding, and selective coding. The results showed that effective nonverbal communication emerged as the co-phenomenon hinged within context and/or environment and is influenced by certain factors. This model, which is in support of person-centered communication and care, advocates for effective nonverbal communication between nurses and older patients.

Sarcopenia definition, diagnosis and treatment: consensus is growing

Sarcopenia is a skeletal muscle disorder that commonly occurs with advancing age as well as with a number of long-term conditions. Recognition in clinical practice is relatively recent but important because of the association between sarcopenia and a range of adverse effects on health including impaired mobility, increased morbidity and mortality. Originally characterised as loss of muscle mass, the definition has evolved to focus on loss of skeletal muscle function, particularly strength, through a number of international definitions such as that of the European Working Group on Sarcopenia in Older People most recently revised in 2019. Progress in the decades ahead is likely to be seen with regard to use of routine health data, prescription of resistance exercise, translation of biology and epidemiology into first in man studies for new treatments, and focus on sarcopenia in low and middle-income countries. Immediate next steps include the newly formed Global Leadership Initiative on Sarcopenia to develop international consensus on definition and diagnosis.