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Pinel A, Guillet C, Capel F, Pouget M, De Antonio M, Pereira B, Topinkova E, Eglseer D, Barazzoni R, Cruz-Jentoft AJ, Schoufour JD, Weijs PJM, Boirie Y. Identification of factors associated with sarcopenic obesity development: Literature review and expert panel voting. Clin Nutr 2024; 43:1414-1424. [PMID: 38701709 DOI: 10.1016/j.clnu.2024.04.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 04/09/2024] [Accepted: 04/20/2024] [Indexed: 05/05/2024]
Abstract
Sarcopenic obesity (SO) is defined as the combination of excess fat mass (obesity) and low skeletal muscle mass and function (sarcopenia). The identification and classification of factors related to SO would favor better prevention and diagnosis. The present article aimed to (i) define a list of factors related with SO based on literature analysis, (ii) identify clinical conditions linked with SO development from literature search and (iii) evaluate their relevance and the potential research gaps by consulting an expert panel. From 4746 articles screened, 240 articles were selected for extraction of the factors associated with SO. Factors were classified according to their frequency in the literature. Clinical conditions were also recorded. Then, they were evaluated by a panel of expert for evaluation of their relevance in SO development. Experts also suggested additional factors. Thirty-nine unique factors were extracted from the papers and additional eleven factors suggested by a panel of experts in the SO field. The frequency in the literature showed insulin resistance, dyslipidemia, lack of exercise training, inflammation and hypertension as the most frequent factors associated with SO whereas experts ranked low spontaneous physical activity, protein and energy intakes, low exercise training and aging as the most important. Although literature and expert panel presented some differences, this first list of associated factors could help to identify patients at risk of SO. Further work is needed to confirm the contribution of factors associated with SO among the population overtime or in randomized controlled trials to demonstrate causality.
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Affiliation(s)
- A Pinel
- University of Clermont Auvergne, Human Nutrition Unit, INRAe, CRNH Auvergne, Clermont-Ferrand, France.
| | - C Guillet
- University of Clermont Auvergne, Human Nutrition Unit, INRAe, CRNH Auvergne, Clermont-Ferrand, France.
| | - F Capel
- University of Clermont Auvergne, Human Nutrition Unit, INRAe, CRNH Auvergne, Clermont-Ferrand, France
| | - M Pouget
- CHU Clermont-Ferrand, Clinical Nutrition Department, Clermont-Ferrand, France.
| | - M De Antonio
- CHU Clermont-Ferrand, Biostatistics Unit, Clermont-Ferrand, France.
| | - B Pereira
- CHU Clermont-Ferrand, Biostatistics Unit, Clermont-Ferrand, France.
| | - E Topinkova
- Department of Geriatrics, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.
| | - D Eglseer
- Institute of Nursing Science, Medical University of Graz, Graz, Austria.
| | - R Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Italy.
| | | | - J D Schoufour
- Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands.
| | - P J M Weijs
- Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands; Amsterdam University Medical Centers, Amsterdam Public Health Institute, VU University, Department of Nutrition and Dietetics, Amsterdam, the Netherlands.
| | - Y Boirie
- University of Clermont Auvergne, Human Nutrition Unit, INRAe, CRNH Auvergne, Clermont-Ferrand, France; CHU Clermont-Ferrand, Clinical Nutrition Department, Clermont-Ferrand, France.
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2
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Corral-Tuesta C, Rodríguez Díaz-Pavón A, Montero-Errasquín B, Álvarez-Pinheiro CG, Lavilla-Gracia V, Cruz-Jentoft AJ. Chronic benzodiazepine usage among older people: prevalence, indications, and treatment modifications in patients admitted to an acute geriatric unit. Eur Geriatr Med 2024; 15:539-543. [PMID: 38214865 DOI: 10.1007/s41999-023-00918-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/09/2023] [Indexed: 01/13/2024]
Abstract
AIM To investigate the prevalence and indications of benzodiazepines (BZD) usage among patients admitted to an acute geriatric unit and assess changes in prescriptions. METHODS BZD indications were documented reviewing clinical records, with appropriateness assessed based on the STOPP-START criteria. Changes in BZD prescriptions were recorded at discharge and 3 months later. RESULTS Among the 366 patients included (mean age: 92.8 years, 68% females), 91 (24.9%) were on BZD upon admission, being inappropriate in 93.4%. At discharge, BZD discontinuation was observed in 40.7% and dose reduction initiated in 57.4%. Among patients discharged without prescriptions, 10.8% resumed their use at 3 months. Of those discharged with BZD tapering, 74.1% were still on them 3 months later. CONCLUSIONS The majority of patients employing BZD lacked a medical indication. Admission to a geriatric ward resulted in successful discontinuation or dose reduction for most patients but was not maintained in the outpatient setting.
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Affiliation(s)
- C Corral-Tuesta
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain.
| | | | - B Montero-Errasquín
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - C G Álvarez-Pinheiro
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - V Lavilla-Gracia
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - A J Cruz-Jentoft
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
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3
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Vélez-Díaz-Pallarés M, Delgado-Silveira E, Fernández-Fradejas J, Montero-Llorente B, Palomar-Fernández C, Montero-Errasquín B, Cruz-Jentoft AJ, Álvarez-Díaz A. Potentially Inappropriate Prescribing in Older People Living With HIV: A Scoping Review. J Acquir Immune Defic Syndr 2023; 94:445-460. [PMID: 37851956 DOI: 10.1097/qai.0000000000003298] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/21/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Antiretroviral therapy has transformed HIV from a progressive and often fatal infection to a chronic disease. Currently, people living with HIV (PLHIV) have near-normal life expectancy; however, they face accelerated ageing and a rise in non-AIDS-defining HIV-associated conditions. Comorbidities increase the number of prescribed drugs and, therefore, the risk of polypharmacy and prescribing potentially inappropriate medications (PIMs). Still, there are no specific tools to identify PIMs in older PLHIV, which opens a pathway to investigate the particularities in the prescription of medication in this population. METHODS We conducted a scoping review in 5 electronic databases for studies reporting the use of tools to identify PIMs in older PLHIV. No language or date restrictions were applied. To complete the search, abstracts published in the most relevant HIV Conferences and Events in their editions from 2010 to 2022 were screened. RESULTS Of 50,193 records returned (13,701 of the databases and 36,492 of the Congresses), 39 studies met the inclusion criteria. Most studies were single-centre and conducted in Europe. Twenty-eight studies were cross-sectional, and most researchers used explicit criteria, mainly Beers and STOPP-START criteria, to identify PIMs. CONCLUSIONS Potentially inappropriate prescribing is frequent among older PLHIV. Explicit conventional tools to identify PIMs in older populations may need to be adapted to tackle the needs of PLHIV. Implicit tools may be more valid, although their use is more time-consuming, and standardization is complex.
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Affiliation(s)
| | - Eva Delgado-Silveira
- Servicio de Farmacia, Hospital Universitario Ramón y Cajal, IRYCIS. Madrid, Spain; and
| | | | | | | | | | | | - Ana Álvarez-Díaz
- Servicio de Farmacia, Hospital Universitario Ramón y Cajal, IRYCIS. Madrid, Spain; and
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4
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Delgado-Silveira E, Molina Mendoza MD, Montero-Errasquín B, Muñoz García M, Rodríguez Espeso EA, Vélez-Díaz-Pallarés M, Cruz-Jentoft AJ. [Spanish version of the STOPP/START 3 criteria: Advances in the detection of inappropriate prescribing medication in the older people]. Rev Esp Geriatr Gerontol 2023; 58:101407. [PMID: 37738843 DOI: 10.1016/j.regg.2023.101407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 09/24/2023]
Abstract
The STOPP/START criteria are explicit physiologic systems-based criteria that summarize evidence on clinically relevant prescribing problems related to the use of potentially inappropriate medications (STOPP criteria) and potential prescribing omissions (START criteria). The two previous versions of the STOPP/START criteria were published in 2008 and 2015, and their Spanish versions in 2009 and 2015. Version3 of these criteria has just been published in 2023. The aim of this article is to present the Spanish translated version, and to review the use and impact that version2 of 2015 has had in our language. A translation from English to Spanish was performed by expert professionals with a high level of English of version3 of the STOPP/START criteria, which incorporates the evidence published from April 2014 to March 2022. In addition, a systematic review of publications that have used the Spanish translation of the previous version (version2 of 2015) of the STOPP/START criteria was performed. The new version, presented in this article, has 190 STOPP/START criteria (133 STOPP criteria and 57 START criteria), which is a 40% increase in the number of criteria compared to the previous version. The review found 37 studies (21 observational, 11 interventional and 5 other) that used the Spanish version instead of the international version. The Spanish version 3 of the STOPP/START criteria is an updated explicit list of potentially inappropriate medications and possible omissions in prescribing that aims to optimize medication and minimize adverse drug reactions during medication review in the elderly, particularly those with multimorbidity and polypharmacy. With this new version, the original criteria are intended to be more widely disseminated within the Spanish-speaking healthcare community. The Spanish version2 of the STOPP/START has been widely used, so we consider that the translation into Spanish has helped to improve pharmacotherapy in older patients with polypharmacy and multimorbidity in our linguistic environment.
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Affiliation(s)
- Eva Delgado-Silveira
- Servicio de Farmacia, Hospital Universitario Ramón y Cajal. IRYCIS, Madrid, España.
| | | | | | - María Muñoz García
- Servicio de Farmacia, Hospital Universitario Ramón y Cajal. IRYCIS, Madrid, España
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5
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Avgerinou C, Mendonça N, Cavdar S, Cederholm T, Cruz-Jentoft AJ, Kiesswetter E, Siebentritt HM, Sieber C, Torbahn G, Volkert D, Visser M. 1322 DEVELOPMENT OF A CORE OUTCOME SET FOR NUTRITIONAL INTERVENTION STUDIES IN OLDER ADULTS WITH MALNUTRITION AND THOSE AT RISK. Age Ageing 2023. [DOI: 10.1093/ageing/afac322.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Abstract
Background
Malnutrition (i.e., protein-energy malnutrition) in older adults is associated with significant complications and increased mortality, highlighting the need for effective treatments. Many randomised controlled trials (RCTs) testing the effectiveness of nutritional interventions for the treatment of malnutrition showed mixed results and there is a need for meta-analyses. However, evidence synthesis is hampered by the wide variety of outcomes and assessment methods in RCTs. This project, led by EuGMS Special Interest Group Nutrition, aims to develop a Core Outcome Set (COS) for nutritional intervention studies in older adults with malnutrition and those at risk.
Methods
The project consists of five phases: 1) a scoping review (completed) to identify frequently used outcomes in published RCTs and select additional patient-reported outcome measures (PROMs). Patient and Public Involvement (PPI) representatives have been involved to provide feedback on the proposed list of outcomes resulting from the review and PROMs; 2) a modified Delphi Survey whereby experienced researchers and health care professionals working in the field of malnutrition in older adults will be invited to rate the importance of the proposed outcomes; 3) a consensus meeting to discuss and agree what critical outcomes need to be included in the COS; 4) a systematic review to determine how each COS outcome should be measured and a second consensus meeting; 5) a dissemination and implementation phase.
Conclusions
The result of this project will be a COS that should be included in any RCT testing the effectiveness of interventions to tackle malnutrition in older people as a minimum. This COS will facilitate comparison of RCT results, will promote efficient use of research resources and might reduce bias in measurement of the outcome and publication bias. Ultimately, the COS will support clinical decision making by identifying the most effective approaches for treating and preventing malnutrition in older adults.
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Affiliation(s)
| | | | - S Cavdar
- Ege University Hospital , Izmir, Turkey
| | | | | | - E Kiesswetter
- University of Freiburg , Germany
- Institute for Biomedicine of Aging , Nuremberg, German
| | | | - C Sieber
- Institute for Biomedicine of Aging , Nuremberg, German
- Kantonsspital Winterthur , Zurich, Switzerland
| | - G Torbahn
- Institute for Biomedicine of Aging , Nuremberg, German
- Paracelsus Medical University , Nuremberg, Germany
| | - D Volkert
- Paracelsus Medical University , Nuremberg, Germany
| | - M Visser
- Vrije Universiteit Amsterdam , Netherlands
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6
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Rolland Y, Cruz-Jentoft AJ. Editorial: Sarcopenia: Keeping on Search for the Best Operational Definition. J Nutr Health Aging 2023; 27:202-204. [PMID: 36973928 DOI: 10.1007/s12603-023-1099-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Affiliation(s)
- Y Rolland
- Professor Yves Rolland, MD, PhD, Gérontopôle de Toulouse, Institut du Vieillissement, 37 allées Jules Guesdes, 31000 Toulouse, France, + 33 5 61 70 77 21, E-mail:
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Mateos-Nozal J, Pérez-Panizo N, Zárate-Sáez CM, Vaquero-Pinto MN, Roldán-Plaza C, Mejía Ramírez-Arellano MV, Sánchez García E, Garza-Martínez AJ, Cruz-Jentoft AJ. Proactive Geriatric Comanagement of Nursing Home Patients by a New Hospital-Based Liaison Geriatric Unit: A New Model for the Future. J Am Med Dir Assoc 2021; 23:308-310. [PMID: 34958745 PMCID: PMC8709437 DOI: 10.1016/j.jamda.2021.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/30/2021] [Accepted: 12/03/2021] [Indexed: 11/29/2022]
Abstract
During the SARS-CoV-2 pandemic, hospital-based liaison geriatric units (LGUs) were created in Spanish hospitals with the aim to improve health care coordination between nursing homes (NHs) and hospitals. Our university hospital created a comprehensive, proactive LGU serving 31 public and private NHs of different sizes and characteristics to offer support to more than 2500 residents. In the first 3 months of 2021, this LGU performed 1252 assessments (81% as outpatients, 12% at the emergency department, and 7% during hospitalization), avoiding an estimated 49 hospital transfers and 29 hospitalizations. Other activities included giving NHs support and advice during COVID-19 outbreaks, comanagement of selected residents with other hospital-based specialists (implementing telemedicine), and implementation of a protocol that allowed using drugs only approved for hospital use in selected NHs. This model of LGU has been shown to be feasible, to improve residents' health care, and avoid hospital referrals. Long-term care needs to be re-imagined, and hospital geriatric departments need to prove that they are able to offer expertise to support NH health care professionals.
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Affiliation(s)
- Jesús Mateos-Nozal
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain.
| | - Nuria Pérez-Panizo
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
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8
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Mateos-Nozal J, Galán Montemayor JC, Lores Torres S, Barreiro P, Paños Zamora A, Martín Martínez F, García Castelo D, Grandez Torres S, Rodríguez-Domínguez M, Martínez Peromingo FJ, Cruz-Jentoft AJ. SARS-CoV-2 B 1.1.7 Variant Outbreak in a Fully Vaccinated Nursing Home-Madrid, June 2021. J Am Med Dir Assoc 2021; 22:2266-2268. [PMID: 34555339 PMCID: PMC8416647 DOI: 10.1016/j.jamda.2021.08.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 08/27/2021] [Accepted: 08/27/2021] [Indexed: 11/20/2022]
Affiliation(s)
- Jesús Mateos-Nozal
- Servicio de Geriatría. Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
| | - Juan Carlos Galán Montemayor
- Servicio de Microbiología. Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain; Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - Pablo Barreiro
- Laboratorio de Salud Pública. Hospital Isabel Zendal, Madrid, Spain
| | | | | | | | | | - Mario Rodríguez-Domínguez
- Servicio de Microbiología. Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain; Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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9
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Delgado-Silveira E, Vélez-Díaz-Pallarés M, Muñoz-García M, Correa-Pérez A, Álvarez-Díaz AM, Cruz-Jentoft AJ. Effects of hospital pharmacist interventions on health outcomes in older polymedicated inpatients: a scoping review. Eur Geriatr Med 2021; 12:509-544. [PMID: 33959912 DOI: 10.1007/s41999-021-00487-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 03/16/2021] [Indexed: 01/28/2023]
Abstract
PURPOSE To identify the evidence that supports the effect of interventions made by hospital pharmacists, individually or in collaboration with a multidisciplinary team, in terms of healthcare outcomes, a more effective utilization of resources and lower costs in older polymedicated inpatients. METHODS We searched the following databases: MEDLINE, EMBASE and the Cochrane Library. We also conducted a hand search by checking the references cited in the primary studies and studies included in reviews identified during the process of research. Four review authors working by pairs searched for studies, extracted data, and drew up the results tables. RESULTS Twenty-six studies were included in the review. In 13 of them pharmacists carried out their intervention exclusively while the patients were in hospital, whereas in 13 interventions were delivered during admission and after hospital discharge. Outcomes identified were mortality, length of stay, visits to the emergency department, readmissions and reported quality of life, among others. Pharmacist interventions were found to be beneficial in fifteen studies, specifically on hospital readmissions, visits to the emergency department and healthcare costs. CONCLUSION There is no hard evidence demonstrating the effectiveness of hospital pharmacist interventions in older polymedicated patients. Mortality does not show as a relevant outcome. Other health care outcomes, such as hospital readmissions, visits to the emergency department and healthcare costs, seem to be more relevant and amenable to change. Interventions that include pharmacists in multidisciplinary geriatric teams seem to be more promising that isolated pharmacist interventions. Interventions prolonged after hospital discharge seem to be more appropriate that interventions delivered only during hospital admission. Better-designed studies should be conducted in the future to provide further insight into the effect of hospital pharmacist interventions.
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Affiliation(s)
- E Delgado-Silveira
- Pharmacy Department, Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain.
| | | | - M Muñoz-García
- Pharmacy Department, Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain
| | - A Correa-Pérez
- Clinical Biostatistics Unit, Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain.,Faculty of Medicine, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - A M Álvarez-Díaz
- Pharmacy Department, Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain
| | - A J Cruz-Jentoft
- Geriatric Department, Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain
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10
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Bermejo-Bescós P, Martín-Aragón S, Cruz-Jentoft AJ, Merello de Miguel A, Vaquero-Pinto MN, Sánchez-Castellano C. Peripheral IL-6 Levels but not Sarcopenia Are Predictive of 1-Year Mortality After Hip Fracture in Older Patients. J Gerontol A Biol Sci Med Sci 2021; 75:e130-e137. [PMID: 32585691 DOI: 10.1093/gerona/glaa154] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Sarcopenic patients may have an increased risk of poor outcomes after a hip fracture. The objective of this study was to determine whether sarcopenia and a set of biomarkers were potential predictors of 1-year-mortality in older patients after a hip fracture. METHODS About 150 patients at least 80 years old were hospitalized for the surgical treatment of a hip fracture. The primary outcome measure was the death in the first year after the hip fracture. Sarcopenia was defined at baseline by having both low muscle mass (bioimpedance analysis) and handgrip and using the updated European Working Group on Sarcopenia in Older People (EWGSOP2) definition of probable sarcopenia. Janssen's (J) and Masanés (M) cutoff points were used to define low muscle mass. RESULTS Mortality 1 year after the hip fracture was 11.5%. In univariate analyses, baseline sarcopenia was not associated with mortality, using neither of the muscle mass cutoff points: 5.9% in sarcopenic (J) versus 12.4% in non-sarcopenic participants (p = .694) and 16% in sarcopenic (M) versus 9.6% in non-sarcopenic participants (p = .285). Probable sarcopenia (EWGSOP2) was not associated with mortality. Peripheral levels of IL-6 at baseline were significantly higher in the group of participants who died in the year after the hip fracture (17.14 ± 16.74 vs 11.42 ± 7.99 pg/mL, p = .026). TNF-α peripheral levels had a nonsignificant trend to be higher in participants who died. No other biomarker was associated with mortality. CONCLUSIONS Sarcopenia at baseline was not a predictor of 1-year mortality in older patients after a hip fracture. IL-6 was associated with a higher risk of mortality in these patients, regardless of sarcopenia status.
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Affiliation(s)
- Paloma Bermejo-Bescós
- Departamento de Farmacología, Farmacognosia y Botánica, Facultad de Farmacia, Universidad Complutense de Madrid (UCM), Spain
| | - Sagrario Martín-Aragón
- Departamento de Farmacología, Farmacognosia y Botánica, Facultad de Farmacia, Universidad Complutense de Madrid (UCM), Spain
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11
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Rolland Y, Cesari M, Fielding RA, Reginster JY, Vellas B, Cruz-Jentoft AJ. Osteoporosis in Frail Older Adults: Recommendations for Research from the ICFSR Task Force 2020. J Frailty Aging 2021; 10:168-175. [PMID: 33575707 DOI: 10.14283/jfa.2021.4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Interactions among physiological pathways associated with osteoporosis and sarcopenia are thought to contribute to the onset of frailty. The International Conference on Frailty and Sarcopenia Research Task Force thus met in March 2020 to explore how emerging interventions to manage fracture and osteoporosis in older adults may reduce frailty, disability, morbidity, and mortality in the older population. Both pharmacological and non-pharmacological interventions (including nutritional intervention, exercise, and other lifestyle changes) were discussed, including nutritional intervention, exercise, and other lifestyle changes. Pharmacological treatments for osteoporosis include bone-forming and antiresorptive agents, which may optimally be used in sequential or combination regimens. Since similar mechanisms related to resorption underlie physiological changes in muscle and bone, these interventions may provide benefits beyond treating osteoporosis. Clinical trials to test these interventions, however, often exclude frail older persons because of comorbidities (such as mobility disability and cognitive impairment) or polypharmacy. The Task Force recommended that future clinical trials use harmonized protocols, including harmonized inclusion criteria and similar outcome measures; and that they test a range of multidomain therapies. They further advocated more high-quality research to develop interventions specifically for people who are frail and old. The ICOPE program recommended by WHO appears to be highly recommended to frail older adults with osteoporosis.
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Affiliation(s)
- Y Rolland
- Yves Rolland, Service de Médecine Interne et Gérontologie Clinique, Gérontopôle, CHU Toulouse, INSERM 1027, France,
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Ruiz JG, Dent E, Morley JE, Merchant RA, Beilby J, Beard J, Tripathy C, Sorin M, Andrieu S, Aprahamian I, Arai H, Aubertin-Leheudre M, Bauer JM, Cesari M, Chen LK, Cruz-Jentoft AJ, De Souto Barreto P, Dong B, Ferrucci L, Fielding R, Flicker L, Lundy J, Reginster JY, Rodriguez-Mañas L, Rolland Y, Sanford AM, Sinclair AJ, Viña J, Waters DL, Won Won C, Woo J, Vellas B. Screening for and Managing the Person with Frailty in Primary Care: ICFSR Consensus Guidelines. J Nutr Health Aging 2021; 24:920-927. [PMID: 33155616 PMCID: PMC7568453 DOI: 10.1007/s12603-020-1492-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- J G Ruiz
- John E. Morley, MB, BCh, Division of Geriatric Medicine, Saint Louis University, SLUCare Academic Pavilion, Section 2500 1008 S. Spring Ave., 2nd Floor, St. Louis, MO 63110, USA, , Twitter: @drjohnmorley
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13
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Marco E, Sánchez-Rodríguez D, Meza D, Cruz-Jentoft AJ. [Evolution of the concept of sarcopenia. Rehabilitation perspectives]. Rehabilitacion (Madr) 2020; 54:75-78. [PMID: 32370831 DOI: 10.1016/j.rh.2020.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 01/09/2020] [Indexed: 11/18/2022]
Affiliation(s)
- E Marco
- Servei de Medicina Física i Rehabilitació, Parc de Salut Mar, Barcelona, España; Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, España; Grupo de Investigación en Rehabilitación, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, España.
| | - D Sánchez-Rodríguez
- Grupo de Investigación en Rehabilitación, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, España; WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Bélgica; Servei de Geriatria, Parc de Salut Mar, Barcelona, España; Departament de Ciències de la Salut, Universitat Pompeu Fabra, Barcelona, España
| | - D Meza
- Grupo de Investigación en Rehabilitación, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, España
| | - A J Cruz-Jentoft
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, España
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14
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Sánchez-Castellano C, Martín-Aragón S, Bermejo-Bescós P, Vaquero-Pinto N, Miret-Corchado C, Merello de Miguel A, Cruz-Jentoft AJ. Biomarkers of sarcopenia in very old patients with hip fracture. J Cachexia Sarcopenia Muscle 2020; 11:478-486. [PMID: 31912666 PMCID: PMC7113494 DOI: 10.1002/jcsm.12508] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 09/14/2019] [Accepted: 09/25/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Hip fracture is both a cause and a consequence of sarcopenia. Older persons with sarcopenia have an increased risk of falling, and the prevalence of sarcopenia may be increased in those who suffer a hip fracture. The aim of this study was to explore potential biomarkers (neuromuscular and peripheral pro-inflammatory and oxidative stress markers) that may be associated with sarcopenia in very old persons with hip fracture. METHODS We recruited 150 consecutive patients ≥80 years old admitted to an orthogeriatric unit for an osteoporotic hip fracture. Muscle mass was assessed pre-operatively using bioelectrical impedance analysis; Janssen's (J) and Masanés' (M) reference cut-off points were used to define low muscle mass. Muscle strength was assessed with handgrip strength (Jamar's dynamometer). Sarcopenia was defined by having both low muscle mass and strength and using the European Working Group on Sarcopenia in Older People 2 definition of probable sarcopenia (low grip strength). Peripheral markers-pro-inflammatory and oxidative stress parameters-were determined either in the plasma or in the erythrocyte fraction obtained from peripheral whole blood of every patient pre-operatively. RESULTS Mean age was 87.6 ± 4.9 years, and 78.7% were women. The prevalence of sarcopenia was 11.5% with Janssen's, 34.9% with Masanés' cut-offs, and 93.3% with the European Working Group on Sarcopenia in Older People 2 definition of probable sarcopenia. Among the four pro-inflammatory cytokines tested in plasma, only tumour necrosis factor-α was different (lower) in sarcopenic than in non-sarcopenic participants using both muscle mass cut-offs (J 7.9 ± 6.2 vs. 8.3 ± 5.8, M 6.8 ± 4.7 vs. 9.1 ± 6.2). Erythrocyte glutathione system showed a non-significant tendency to lower glutathione levels and glutathione/oxidized glutathione ratios in sarcopenic participants compared with non-sarcopenic subjects. Catalase activity was also lower in sarcopenic participants (J 2904 ± 1429 vs. 3329 ± 1483, M 3037 ± 1430 vs. 3431 ± 1498). No significant differences were found between groups in chymotrypsin-like activity of the 20S proteasome, superoxide dismutase, glutathione peroxidase and butyrylcholinesterase activity, C-terminal agrin fragment, interferon-γ, or interleukin-1β. CONCLUSIONS The prevalence of sarcopenia in patients with hip fracture varies according to the definition and the muscle mass reference cut-off points used. We did not find differences in most neuromuscular, pro-inflammatory, or oxidative stress markers, except for lower peripheral tumour necrosis factor-α levels and catalase activity in sarcopenic participants, which may be markers of an early inflammatory reaction that is hampered in sarcopenic patients.
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Affiliation(s)
| | - Sagrario Martín-Aragón
- Departamento de Farmacología. Facultad de Farmacia. Universidad Complutense de Madrid.Departamento de Farmacología Universidad Complutense de Madrid, Spain
| | - Paloma Bermejo-Bescós
- Departamento de Farmacología. Facultad de Farmacia. Universidad Complutense de Madrid.Departamento de Farmacología Universidad Complutense de Madrid, Spain
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15
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Volkert D, Visser M, Corish CA, Geisler C, de Groot L, Cruz-Jentoft AJ, Lohrmann C, O'Connor EM, Schindler K, de van der Schueren MAE. Joint action malnutrition in the elderly (MaNuEL) knowledge hub: summary of project findings. Eur Geriatr Med 2019; 11:169-177. [PMID: 32297234 DOI: 10.1007/s41999-019-00264-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 11/08/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE The Joint Action Malnutrition in the Elderly (MaNuEL) Knowledge Hub was established to extend scientific knowledge, strengthen evidence-based practice, build a sustainable, transnational network of experts and harmonize research and clinical practice in the field of protein-energy malnutrition in older persons. This paper aims to summarize the main scientific results achieved during the 2-year project and to outline the recommendations derived. METHODS 22 research groups from seven countries (Austria, France, Germany, Ireland, Spain, The Netherlands and New Zealand) worked together on 6 relevant domains of malnutrition-i.e. prevalence, screening, determinants, treatment, policy measures and education for health care professionals-making use of existing datasets, evidence and expert knowledge. RESULTS Four systematic reviews, six secondary data analyses of existing cohort and intervention studies, two web-based surveys and one Delphi study were performed. In addition, a scoring system to rate malnutrition screening tools and a theoretical framework on the aetiology of malnutrition in older persons were developed. Based on these activities and taking existing evidence into consideration, 13 clinical practice, 9 research and 4 policy recommendations were developed. The MaNuEL Toolbox was created and made available to effectively distribute and disseminate the MaNuEL results and recommendations. CONCLUSIONS The MaNuEL Knowledge Hub successfully achieved its aims. Results and recommendations will support researchers, healthcare professionals, policy-makers as well as educational institutes to advance their efforts in tackling the increasing problem of protein-energy malnutrition in the older population.
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Affiliation(s)
- D Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstraße 60, 90408, Nuremberg, Germany.
| | - M Visser
- Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - C A Corish
- University College Dublin, Dublin, Ireland
| | - C Geisler
- Christian-Albrechts-Universitat, Kiel, Germany
| | - L de Groot
- Wageningen University, Wageningen, The Netherlands
| | | | - C Lohrmann
- Medical University of Graz, Graz, Austria
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16
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Delgado-Silveira E, Mateos-Nozal J, Muñoz García M, Rexach Cano L, Vélez-Díaz-Pallarés M, Albeniz López J, Cruz-Jentoft AJ. [Inappropriate drug use in palliative care: SPANISH version of the STOPP-Frail criteria (STOPP-Pal)]. Rev Esp Geriatr Gerontol 2019; 54:151-155. [PMID: 30606497 DOI: 10.1016/j.regg.2018.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 11/28/2018] [Accepted: 11/30/2018] [Indexed: 06/09/2023]
Abstract
Multiple medication and inappropriate drug prescription are prevalent and challenging problems in older patients in end-of-life situations, and increases both preventable adverse events and health care costs. Recent literature recommends de-prescribing some drugs in patients with short life expectancy, when the aim of drug treatments is not prevention or cure, but symptom control. Recently, a list of explicit criteria (STOPP-Frail) intended to guide prescribing physicians in decision making on the use of drugs in older patients with terminal conditions. This article presents a Spanish version of such criteria, which have been named STOPP-Pal to avoid confusion with the current concept of frailty.
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Affiliation(s)
| | - Jesús Mateos-Nozal
- Servicio de Geriatría (IRYCIS), Hospital Universitario Ramón y Cajal, Madrid, España
| | - Maria Muñoz García
- Servicio de Farmacia, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Lourdes Rexach Cano
- Unidad de Cuidados Paliativos, Hospital Universitario Ramón y Cajal, Madrid, España
| | | | - Jana Albeniz López
- Servicio de Geriatría (IRYCIS), Hospital Universitario Ramón y Cajal, Madrid, España
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17
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Mateos-Nozal J, Farré-Mercadé MV, Cruz-Jentoft AJ, Ribera Casado JM. [Ten recommendations to improve undergraduate training in Geriatric Medicine]. Rev Esp Geriatr Gerontol 2019; 54:203-206. [PMID: 30777383 DOI: 10.1016/j.regg.2018.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 12/03/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Population ageing and scientific progress have made specific training in Geriatrics essential for any medical students. There are different international recommendations on the teaching of Geriatric Medicine at undergraduate level, but they are still far from being offered systematically. The aim of this work was to develop a National list of recommendations in order to improve training in Geriatric Medicine at the undergraduate level. MATERIAL AND METHODS A list of 10 recommendations was produced by reflecting on the Geriatric training situation in Spain in 2016/2017 and international recommendations. Consensus was reached among the members of the Spanish Society of Geriatrics and Gerontology (SEGG) working group on «Geriatric training at undergraduate level» through 2meetings and online discussions. RESULTS A list of 10 of recommendations on Geriatric training in Spanish Medical Schools is proposed, including areas such as, the status of the discipline in the curriculum, length, contents, practical training, lecturers, teaching methods, and innovation. CONCLUSIONS These recommendations are intended to improve Geriatrics training. They can be used by different Medical Schools either to adapt their programs or to start training in Geriatric Medicine.
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Affiliation(s)
- Jesus Mateos-Nozal
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal, Madrid, España.
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18
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Dent E, Morley JE, Cruz-Jentoft AJ, Woodhouse L, Rodríguez-Mañas L, Fried LP, Woo J, Aprahamian I, Sanford A, Lundy J, Landi F, Beilby J, Martin FC, Bauer JM, Ferrucci L, Merchant RA, Dong B, Arai H, Hoogendijk EO, Won CW, Abbatecola A, Cederholm T, Strandberg T, Gutiérrez Robledo LM, Flicker L, Bhasin S, Aubertin-Leheudre M, Bischoff-Ferrari HA, Guralnik JM, Muscedere J, Pahor M, Ruiz J, Negm AM, Reginster JY, Waters DL, Vellas B. Physical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management. J Nutr Health Aging 2019; 23:771-787. [PMID: 31641726 PMCID: PMC6800406 DOI: 10.1007/s12603-019-1273-z] [Citation(s) in RCA: 401] [Impact Index Per Article: 80.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 08/02/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The task force of the International Conference of Frailty and Sarcopenia Research (ICFSR) developed these clinical practice guidelines to overview the current evidence-base and to provide recommendations for the identification and management of frailty in older adults. METHODS These recommendations were formed using the GRADE approach, which ranked the strength and certainty (quality) of the supporting evidence behind each recommendation. Where the evidence-base was limited or of low quality, Consensus Based Recommendations (CBRs) were formulated. The recommendations focus on the clinical and practical aspects of care for older people with frailty, and promote person-centred care. Recommendations for Screening and Assessment: The task force recommends that health practitioners case identify/screen all older adults for frailty using a validated instrument suitable for the specific setting or context (strong recommendation). Ideally, the screening instrument should exclude disability as part of the screening process. For individuals screened as positive for frailty, a more comprehensive clinical assessment should be performed to identify signs and underlying mechanisms of frailty (strong recommendation). Recommendations for Management: A comprehensive care plan for frailty should address polypharmacy (whether rational or nonrational), the management of sarcopenia, the treatable causes of weight loss, and the causes of exhaustion (depression, anaemia, hypotension, hypothyroidism, and B12 deficiency) (strong recommendation). All persons with frailty should receive social support as needed to address unmet needs and encourage adherence to a comprehensive care plan (strong recommendation). First-line therapy for the management of frailty should include a multi-component physical activity programme with a resistance-based training component (strong recommendation). Protein/caloric supplementation is recommended when weight loss or undernutrition are present (conditional recommendation). No recommendation was given for systematic additional therapies such as cognitive therapy, problem-solving therapy, vitamin D supplementation, and hormone-based treatment. Pharmacological treatment as presently available is not recommended therapy for the treatment of frailty.
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Affiliation(s)
- E Dent
- E. Dent, Torrens University Australia, Adelaide, Australia,
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19
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Vellas B, Fielding RA, Bens C, Bernabei R, Cawthon PM, Cederholm T, Cruz-Jentoft AJ, Del Signore S, Donahue S, Morley J, Pahor M, Reginster JY, Rodriguez Mañas L, Rolland Y, Roubenoff R, Sinclair A, Cesari M. Implications of ICD-10 for Sarcopenia Clinical Practice and Clinical Trials: Report by the International Conference on Frailty and Sarcopenia Research Task Force. J Frailty Aging 2018; 7:2-9. [PMID: 29412436 DOI: 10.14283/jfa.2017.30] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Establishment of an ICD-10-CM code for sarcopenia in 2016 was an important step towards reaching international consensus on the need for a nosological framework of age-related skeletal muscle decline. The International Conference on Frailty and Sarcopenia Research Task Force met in April 2017 to discuss the meaning, significance, and barriers to the implementation of the new code as well as strategies to accelerate development of new therapies. Analyses by the Sarcopenia Definitions and Outcomes Consortium are underway to develop quantitative definitions of sarcopenia. A consensus conference is planned to evaluate this analysis. The Task Force also discussed lessons learned from sarcopenia trials that could be applied to future trials, as well as lessons from the osteoporosis field, a clinical condition with many constructs similar to sarcopenia and for which ad hoc treatments have been developed and approved by regulatory agencies.
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Affiliation(s)
- B Vellas
- Bruno Vellas, MD. Gérontopôle, CHU Toulouse, Service de Médecine Interne et Gérontologie, Clinique, 170 Avenue de Casselardit, 31059 Toulouse, France. Phone: +33 (0) 5 6177-6425; Fax: +33 (0) 6177-6475.
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20
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Vellas B, Fielding RA, Bens C, Bernabei R, Cawthon PM, Cederholm T, Cruz-Jentoft AJ, Del Signore S, Donahue S, Morley J, Pahor M, Reginster JY, Rodriguez Mañas L, Rolland Y, Roubenoff R, Sinclair A, Cesari M. Implications of ICD-10 for Sarcopenia Clinical Practice and Clinical Trials: Report by the International Conference on Frailty and Sarcopenia Research Task Force. J Frailty Aging 2018. [PMID: 29412436 DOI: 10.14283/jfa.2017.30.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Establishment of an ICD-10-CM code for sarcopenia in 2016 was an important step towards reaching international consensus on the need for a nosological framework of age-related skeletal muscle decline. The International Conference on Frailty and Sarcopenia Research Task Force met in April 2017 to discuss the meaning, significance, and barriers to the implementation of the new code as well as strategies to accelerate development of new therapies. Analyses by the Sarcopenia Definitions and Outcomes Consortium are underway to develop quantitative definitions of sarcopenia. A consensus conference is planned to evaluate this analysis. The Task Force also discussed lessons learned from sarcopenia trials that could be applied to future trials, as well as lessons from the osteoporosis field, a clinical condition with many constructs similar to sarcopenia and for which ad hoc treatments have been developed and approved by regulatory agencies.
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Affiliation(s)
- B Vellas
- Bruno Vellas, MD. Gérontopôle, CHU Toulouse, Service de Médecine Interne et Gérontologie, Clinique, 170 Avenue de Casselardit, 31059 Toulouse, France. Phone: +33 (0) 5 6177-6425; Fax: +33 (0) 6177-6475.
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21
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Dent E, Morley JE, Cruz-Jentoft AJ, Arai H, Kritchevsky SB, Guralnik J, Bauer JM, Pahor M, Clark BC, Cesari M, Ruiz J, Sieber CC, Aubertin-Leheudre M, Waters DL, Visvanathan R, Landi F, Villareal DT, Fielding R, Won CW, Theou O, Martin FC, Dong B, Woo J, Flicker L, Ferrucci L, Merchant RA, Cao L, Cederholm T, Ribeiro SML, Rodríguez-Mañas L, Anker SD, Lundy J, Gutiérrez Robledo LM, Bautmans I, Aprahamian I, Schols JMGA, Izquierdo M, Vellas B. International Clinical Practice Guidelines for Sarcopenia (ICFSR): Screening, Diagnosis and Management. J Nutr Health Aging 2018; 22:1148-1161. [PMID: 30498820 DOI: 10.1007/s12603-018-1139-9] [Citation(s) in RCA: 447] [Impact Index Per Article: 74.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Sarcopenia, defined as an age-associated loss of skeletal muscle function and muscle mass, occurs in approximately 6 - 22 % of older adults. This paper presents evidence-based clinical practice guidelines for screening, diagnosis and management of sarcopenia from the task force of the International Conference on Sarcopenia and Frailty Research (ICSFR). METHODS To develop the guidelines, we drew upon the best available evidence from two systematic reviews paired with consensus statements by international working groups on sarcopenia. Eight topics were selected for the recommendations: (i) defining sarcopenia; (ii) screening and diagnosis; (iii) physical activity prescription; (iv) protein supplementation; (v) vitamin D supplementation; (vi) anabolic hormone prescription; (vii) medications under development; and (viii) research. The ICSFR task force evaluated the evidence behind each topic including the quality of evidence, the benefit-harm balance of treatment, patient preferences/values, and cost-effectiveness. Recommendations were graded as either strong or conditional (weak) as per the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Consensus was achieved via one face-to-face workshop and a modified Delphi process. RECOMMENDATIONS We make a conditional recommendation for the use of an internationally accepted measurement tool for the diagnosis of sarcopenia including the EWGSOP and FNIH definitions, and advocate for rapid screening using gait speed or the SARC-F. To treat sarcopenia, we strongly recommend the prescription of resistance-based physical activity, and conditionally recommend protein supplementation/a protein-rich diet. No recommendation is given for Vitamin D supplementation or for anabolic hormone prescription. There is a lack of robust evidence to assess the strength of other treatment options.
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Affiliation(s)
- E Dent
- Dr. Elsa Dent, , Torrens University Australia, Wakefield Street, Adelaide, SA, Australia
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22
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Sanz-Paris A, Camprubi-Robles M, Lopez-Pedrosa JM, Pereira SL, Rueda R, Ballesteros-Pomar MD, Garcia Almeida JM, Cruz-Jentoft AJ. Role of Oral Nutritional Supplements Enriched with β-Hydroxy-β-Methylbutyrate in Maintaining Muscle Function and Improving Clinical Outcomes in Various Clinical Settings. J Nutr Health Aging 2018; 22:664-675. [PMID: 29806855 PMCID: PMC5984960 DOI: 10.1007/s12603-018-0995-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 08/09/2017] [Indexed: 02/07/2023]
Abstract
Aging and disease-related malnutrition are well associated with loss of muscle mass and function. Muscle mass loss may lead to increased health complications and associated increase in health care costs, especially in hospitalized individuals. High protein oral nutritional supplements enriched with β-hydroxy-β-methylbutyrate (HP-ONS+HMB) have been suggested to provide benefits such as improving body composition, maintaining muscle mass and function and even decreasing mortality rates. The present review aimed to examine current evidence on the effect of HP-ONS+HMB on muscle-related clinical outcomes both in community and peri-hospitalization patients. Overall, current evidence suggests that therapeutic nutrition such as HP-ONS+HMB seems to be a promising tool to mitigate the decline in muscle mass and preserve muscle function, especially during hospital rehabilitation and recovery.
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Affiliation(s)
- A Sanz-Paris
- Alejandro Sanz-Paris, Nutrition Unit, Universitary Hospital Miguel Servet, Isabel the Catholic 1-3, Zaragoza 50009, Spain.
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23
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Cruz-Jentoft AJ, González B, de la Rubia J, Hernández Rivas JÁ, Soler JA, Fernández Lago C, Arnao M, Gironella M, Pérez Persona E, Zudaire MT, Olivier C, Altés A, García Guiñón A, Nomdedeu B, Arnan M, Ramírez Payer Á, Sánchez-Godoy P, Pajuelo N, Vilanova D, Monjil DF, Bonanad S. Further psychometric validation of the GAH scale: Responsiveness and effect size. J Geriatr Oncol 2017; 8:211-215. [DOI: 10.1016/j.jgo.2016.12.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 11/03/2016] [Accepted: 12/06/2016] [Indexed: 10/20/2022]
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24
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Masanés F, Rojano I Luque X, Salvà A, Serra-Rexach JA, Artaza I, Formiga F, Cuesta F, López Soto A, Ruiz D, Cruz-Jentoft AJ. Cut-off Points for Muscle Mass - Not Grip Strength or Gait Speed - Determine Variations in Sarcopenia Prevalence. J Nutr Health Aging 2017; 21:825-829. [PMID: 28717813 DOI: 10.1007/s12603-016-0844-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The European Working Group on Sarcopenia in Older People (EWGSOP) has proposed different methods and cut-off points for the three parameters that define sarcopenia: muscle mass, muscle strength and physical performance. Although this facilitates clinical practice, it limits comparability between studies and leads to wide differences in published prevalence rates. The aim of this study was to assess how changes in cut-off points for muscle mass, gait speed and grip strength affected sarcopenia prevalence according to EWGSOP criteria. METHODS Cross-sectional analysis of elderly individuals recruited from outpatient clinics (n=298) and nursing homes (n=276). We measured muscle mass, grip strength and gait speed and assessed how changes in cut-off points changed sarcopenia prevalence in both populations. RESULTS An increase from 5.45 kg/m2 to 6.68 kg/m2 in the muscle mass index for female outpatients and nursing-home residents increased sarcopenia prevalence from 4% to 23% and from 9% to 47%, respectively; for men, for an increase from 7.25 kg/m2 to 8.87 kg/m2, the corresponding increases were from 1% to 22% and from 6% to 41%, respectively. Changes in gait speed and grip strength had a limited impact on sarcopenia prevalence. CONCLUSION The cut-off points used for muscle mass affect the reported prevalence rates for sarcopenia and, in turn, affect comparability between studies. The main factors influencing the magnitude of the change are muscle mass index distribution in the population and the absolute value of the cut-off points: the same difference between two references (e.g., 7.5 kg/m2 to 7.75 kg/m2 or 7.75 kg/m2 to 8 kg/m2) may produce different changes in prevalence. Changes in cut-off points for gait speed and grip strength had a limited impact on sarcopenia prevalence and on study comparability.
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Affiliation(s)
- F Masanés
- Xavier Rojano i Luque, Fundació Salut i Envelliment Universitat Autònoma de Barcelona. Institute for Biomedical Research Sant Pau. Barcelona, Spain,
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25
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Muñoz García M, Delgado Silveira E, Martín-Aragón Álvarez S, Bermejo Vicedo T, Cruz-Jentoft AJ. Agreement between the 2009 STOPP Criteria and the 2003 Beers Criteria at the time of hospital admission. Farm Hosp 2016; 40:504-513. [PMID: 27894225 DOI: 10.7399/fh.2016.40.6.8886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
UNLABELLED Potentially inappropriate prescription in elderly patients can be evaluated by different methods. The STOPP Criteria and Beers Criteria stand out among the explicit criteria most widely used. OBJECTIVE The main objective of this study is to identify the agreement in the detection of potentially inappropriate prescribing between the STOPP criteria and the Beers Criteria, in elderly patients assessed at the time of hospital admission. METHOD An observational retrospective study was designed in order to estimate the prevalence of potentially inappropriate prescription in the habitual treatment before admission, and to compare the agreement in detection capability between the 2003 Beers Criteria and the 2009 STOPP Criteria, in >70-yearold patients with an emergency hospital admission. There was also a specific analysis of the prescription of first-generation antihistamines, tricyclic antidepressants, benzodiazepines, and selective serotonin reuptake inhibitors, which are considered drugs with irregular management and potential toxicity. RESULTS The total prevalence of patients with a potentially inappropriate prescription was 23.8% using the Beers Criteria and 33.3% using the STOPP Criteria. There was a low level of agreement between both questionnaires. First-generation antihistamines (Beers) and pharmacological duplication (STOPP J) were the criteria most frequently found. There were differences in the prevalence of potentially inappropriate prescription in the four pharmacological groups selected; and in all cases, detection by Beers Criteria was superior. CONCLUSION There is no agreement between the STOPP Criteria and the Beers Criteria regarding the detection of patients with potentially inappropriate prescribing at the time of hospital admission.
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Cesari M, Abellan Van Kan G, Ariogul S, Baeyens JP, Bauer J, Cankurtaran M, Cederholm T, Cherubini A, Cruz-Jentoft AJ, Curgunlu A, Landi F, Sayer AA, Strandberg T, Topinkova E, Van Asselt D, Vellas B, Zekry D, Michel JP. The European Union Geriatric Medicine Society (EUGMS) Working Group on «Frailty in Older Persons». J Frailty Aging 2016; 2:118-20. [PMID: 27070810 DOI: 10.14283/jfa.2013.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The concept of frailty was introduced in literature to help atclinically depicting the transition of a robust older individualinto a different clinical phenotype of risk (1-5). Frailty isgenerally described as a multisystemic impairment responsiblefor a state of increased vulnerability to endogenous andexogenous stressors (6, 7). This syndrome may represent thefirst step towards the evident and clinically relevant functionaldisability (a cornerstone outcome for geriatric medicine)8, andhas shown to be predictive of major negative health-relatedevents, including
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Affiliation(s)
- M Cesari
- Matteo Cesari, MD, PhD, Institut du Vieillissement, Gérontopôle, INSERM UMR 1027, Université Toulouse III - Paul Sabatier, 37 Allées Jules Guesde, 31000 Toulouse France, Phone: +33 (0)5 61145628, Fax: +33 (0)5 61145640,
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Bonanad S, De la Rubia J, Gironella M, Pérez Persona E, González B, Fernández Lago C, Arnan M, Zudaire M, Hernández Rivas JA, Soler A, Marrero C, Olivier C, Altés A, Valcárcel D, Hernández MT, Oiartzabal I, Fernández Ordoño R, Arnao M, Esquerra A, Sarrá J, González-Barca E, González J, Calvo X, Nomdedeu M, García Guiñón A, Ramírez Payer A, Casado A, López S, Durán M, Marcos M, Cruz-Jentoft AJ. Development and psychometric validation of a brief comprehensive health status assessment scale in older patients with hematological malignancies: The GAH Scale. J Geriatr Oncol 2015; 6:353-61. [PMID: 26139300 DOI: 10.1016/j.jgo.2015.03.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 03/24/2015] [Accepted: 03/31/2015] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The purpose of this study was to develop a new brief, comprehensive geriatric assessment scale for older patients diagnosed with different hematological malignancies, the Geriatric Assessment in Hematology (GAH scale), and to determine its psychometric properties. MATERIALS AND METHODS The 30-item GAH scale was designed through a multi-step process to cover 8 relevant dimensions. This is an observational study conducted in 363 patients aged≥65years, newly diagnosed with different hematological malignancies (myelodysplasic syndrome/acute myeloblastic leukemia, multiple myeloma, or chronic lymphocytic leukemia), and treatment-naïve. The scale psychometric validation process included the analyses of feasibility, floor and ceiling effect, validity and reliability criteria. RESULTS Mean time taken to complete the GAH scale was 11.9±4.7min that improved through a learning-curve effect. Almost 90% of patients completed all items, and no floor or ceiling effects were identified. Criterion validity was supported by reasonable correlations between the GAH scale dimensions and three contrast variables (global health visual analogue scale, ECOG and Karnofsky), except for comorbidities. Factor analysis (supported by the scree plot) revealed nine factors that explained almost 60% of the total variance. Moderate internal consistency reliability was found (Cronbach's α: 0.610), and test-retest was excellent (ICC coefficients, 0.695-0.928). CONCLUSION Our study suggests that the GAH scale is a valid, internally reliable and a consistent tool to assess health status in older patients with different hematological malignancies. Future large studies should confirm whether the GAH scale may be a tool to improve clinical decision-making in older patients with hematological malignancies.
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Affiliation(s)
- S Bonanad
- Hematology Department, H. U. La Fe, Av. Fernando Abril Martorell, 106, 46026 Valencia, Spain.
| | - J De la Rubia
- Hematology Department, H. U. La Fe, Av. Fernando Abril Martorell, 106, 46026 Valencia, Spain
| | - M Gironella
- Hematology Department, H. U. Vall d'Hebrón, Passeig de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain
| | - E Pérez Persona
- Hematology Department, H. U. Txagorritxu, c/ Jose Atxotegi, s/n, 01009 Vitoria-Gasteiz, Álava, Spain
| | - B González
- Hematology Department, H. U. de Canarias, Ctra. Ofra, s/n, 38320 San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain
| | - C Fernández Lago
- Hematology Department, C.H.U. A Coruña, As Xubias, 84, 15006, A Coruña, Spain
| | - M Arnan
- Hematology Department, Catalan Institute of Oncology, IDIBELL, Hospital Duran i Reynals, Avinguda Granvia de l'Hospitalet, 199-203 08908 l'Hospitalet de Llobregat, Barcelona, Spain
| | - M Zudaire
- Hematology Department, C.H. de Navarra, Av. Pío XII, 36, 31008 Pamplona, Navarra, Spain
| | - J A Hernández Rivas
- Hematology Department, H.U. Infanta Leonor, Avenida Gran Vía del Este, 80, 28031 Madrid, Spain
| | - A Soler
- Hematology Department, C.S. Parc Taulí, Parc Taulí, 1, 08208 Sabadell, Barcelona, Spain
| | - C Marrero
- Hematology Department, H. Ntra. Sra. de La Candelaria, Carretera del Rosario, 145, 38010 Santa Cruz de Tenerife, Spain
| | - C Olivier
- Hematology Department, C.H. de Segovia, c/ de Miguel Servet, s/n, Segovia, Spain
| | - A Altés
- Hematology Department, H. Sant Joan de Déu, Passeig de Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Barcelona, Spain
| | - D Valcárcel
- Hematology Department, H. U. Vall d'Hebrón, Passeig de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain
| | - M T Hernández
- Hematology Department, H. U. de Canarias, Ctra. Ofra, s/n, 38320 San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain
| | - I Oiartzabal
- Hematology Department, H. U. Txagorritxu, c/ Jose Atxotegi, s/n, 01009 Vitoria-Gasteiz, Álava, Spain
| | - R Fernández Ordoño
- Hematology Department, H.U. Infanta Leonor, Avenida Gran Vía del Este, 80, 28031 Madrid, Spain
| | - M Arnao
- Hematology Department, H.U. de La Ribera, Carretera Corbera, km 1, 46600 Alzira, Valencia, Spain
| | - A Esquerra
- Hematology Department, C.S. Parc Taulí, Parc Taulí, 1, 08208 Sabadell, Barcelona, Spain
| | - J Sarrá
- Hematology Department, Catalan Institute of Oncology, IDIBELL, Hospital Duran i Reynals, Avinguda Granvia de l'Hospitalet, 199-203 08908 l'Hospitalet de Llobregat, Barcelona, Spain
| | - E González-Barca
- Hematology Department, Catalan Institute of Oncology, IDIBELL, Hospital Duran i Reynals, Avinguda Granvia de l'Hospitalet, 199-203 08908 l'Hospitalet de Llobregat, Barcelona, Spain
| | - J González
- Hematology Department, H.U. Virgen del Rocío, Avenida Manuel Siurot, s/n, 41013 Sevilla, Spain
| | - X Calvo
- Hematology Department, Hospital Clínic de Barcelona, Carrer Villarroel, 170, 08036 Barcelona, Spain
| | - M Nomdedeu
- Hematology Department, Hospital Clínic de Barcelona, Carrer Villarroel, 170, 08036 Barcelona, Spain
| | - A García Guiñón
- Hematology Department, H.U. Arnau de Vilanova, Avenida Alcalde Rovira Roure, 80, 25198 Lleida, Spain
| | - A Ramírez Payer
- Hematology Department, H.U. Central de Asturias, Calle Carretera de Rubín, s/n, 33011 Oviedo, Spain
| | - A Casado
- U. Autónoma de Madrid, Dynamic Science S.L., c/Azcona, 31, 28028 Madrid, Spain
| | - S López
- Celgene S.L.U., Paseo de Recoletos, 37, 28004 Madrid, Spain
| | - M Durán
- Celgene S.L.U., Paseo de Recoletos, 37, 28004 Madrid, Spain
| | - M Marcos
- Celgene S.L.U., Paseo de Recoletos, 37, 28004 Madrid, Spain
| | - A J Cruz-Jentoft
- Geriatric Department, H.U. Ramón y Cajal, Ctra. de Colmenar Viejo, km. 9,100, 28034 Madrid, Spain
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Delgado Silveira E, Montero Errasquín B, Muñoz García M, Vélez-Díaz-Pallarés M, Lozano Montoya I, Sánchez-Castellano C, Cruz-Jentoft AJ. [Improving drug prescribing in the elderly: a new edition of STOPP/START criteria]. Rev Esp Geriatr Gerontol 2015; 50:89-96. [PMID: 25466971 DOI: 10.1016/j.regg.2014.10.005] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 10/09/2014] [Indexed: 06/04/2023]
Abstract
Inappropriate use of drugs in older patients may have an adverse impact on several individual health outcomes, such as increasing the prevalence of adverse drug reactions, morbidity and mortality, and geriatric syndromes, as well as on health care systems, such as increased costs and longer hospital stays. Explicit criteria of drug appropriateness are increasingly used to detect and prevent inappropriate use of drugs, either within a comprehensive geriatric assessment or as tool used by different multidisciplinary geriatric teams. STOPP-START criteria, first published in 2008 (in Spanish in 2009), are being adopted as reference criteria throughout Europe. The Spanish version of the new 2014 edition (recently published in English) of the STOPP-START criteria is presented here. A review of all the papers published in Spain using the former version of these criteria is also presented, with the intention of promoting their use and for research in different health care levels.
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Affiliation(s)
- E Delgado Silveira
- Servicio de Farmacia, Hospital Universitario Ramón y Cajal, Madrid, España
| | | | - M Muñoz García
- Servicio de Farmacia, Hospital Universitario Ramón y Cajal, Madrid, España
| | | | - I Lozano Montoya
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal, Madrid, España
| | | | - A J Cruz-Jentoft
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal, Madrid, España.
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Cederholm T, Cruz-Jentoft AJ, Maggi S. Sarcopenia and fragility fractures. Eur J Phys Rehabil Med 2013; 49:111-117. [PMID: 23575205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Sarcopenia, a reduction in muscle mass and muscle function, is considered one of the hallmarks of the aging process. Current views consider sarcopenia as the consequence of multiple medical, behavioural and environmental factors that characterize aged individuals. Likewise bone fragility is known to depend on several pathogenetic mechanisms leading to bone mass loss and reduction of bone strength. Muscle weakness, fear of falls, falls and subsequent fractures are associated to concurrent sarcopenia and osteoporosis and lead to restricted mobility, loss of autonomy and reduced life expectancy. The skeletal and the muscular organ systems are tightly intertwined: the strongest mechanical forces applied to bones are, indeed, those created by muscle contractions that condition bone density, strength, and microarchitecture. Not surprising, therefore, the decrease in muscle strength leads to lower bone strength. The degenerative processes leading to osteoporosis and sarcopenia show many common pathogenic pathways, like the sensitivity to reduced anabolic hormone secretion, increased inflammatory cytokine activity and reduced physical activity. Thus they may also respond to the same kind of treatments. Basic is life-style interventions related to exercise and nutrition. Sufficient vitamin D levels are of importance for both bone and muscle, primarily provided by sun exposure at younger age, and by supplementation at older age. Resistance training several times per week is crucial, and to be effective adequate access to energy and proteins is necessary.
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Affiliation(s)
- T Cederholm
- Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, Sweden.
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Berrut G, Andrieu S, Araujo de Carvalho I, Baeyens JP, Bergman H, Cassim B, Cerreta F, Cesari M, Cha HB, Chen LK, Cherubini A, Chou MY, Cruz-Jentoft AJ, De Decker L, Du P, Forette B, Forette F, Franco A, Guimaraes R, Guttierrez-Robledo LM, Jauregui J, Khavinson V, Lee WJ, Peng LN, Perret-Guillaume C, Petrovic M, Retornaz F, Rockwood K, Rodriguez-Manas L, Sieber C, Spatharakis G, Theou O, Topinkova E, Vellas B, Benetos A. Promoting access to innovation for frail old persons. IAGG (International Association of Gerontology and Geriatrics), WHO (World Health Organization) and SFGG (Société Française de Gériatrie et de Gérontologie) Workshop--Athens January 20-21, 2012. J Nutr Health Aging 2013; 17:688-93. [PMID: 24097023 DOI: 10.1007/s12603-013-0039-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
UNLABELLED Frailty tends to be considered as a major risk for adverse outcomes in older persons, but some important aspects remain matter of debate. OBJECTIVES The purpose of this paper is to present expert's positions on the main aspects of the frailty syndrome in the older persons. PARTICIPANTS Workshop organized by International Association of Gerontology and Geriatrics (IAGG), World Health Organization (WHO) and Société Française de Gériatrie et de Gérontologie (SFGG). RESULTS Frailty is widely recognized as an important risk factor for adverse health outcomes in older persons. This can be of particular value in evaluating non-disabled older persons with chronic diseases but today no operational definition has been established. Nutritional status, mobility, activity, strength, endurance, cognition, and mood have been proposed as markers of frailty. Another approach calculates a multidimensional score ranging from "very fit" to "severely frail", but it is difficult to apply into the medical practice. Frailty appears to be secondary to multiple conditions using multiple pathways leading to a vulnerability to a stressor. Biological (inflammation, loss of hormones), clinical (sarcopenia, osteoporosis etc.), as well as social factors (isolation, financial situation) are involved in the vulnerability process. In clinical practice, detection of frailty is of major interest in oncology because of the high prevalence of cancer in older persons and the bad tolerance of the drug therapies. Presence of frailty should also be taken into account in the definition of the cardiovascular risks in the older population. The experts of the workshop have listed the points reached an agreement and those must to be a priority for improving understanding and use of frailty syndrome in practice. CONCLUSION Frailty in older adults is a syndrome corresponding to a vulnerability to a stressor. Diagnostic tools have been developed but none can integrate at the same time the large spectrum of factors and the simplicity asked by the clinical practice. An agreement with an international common definition is necessary to develop screening and to reduce the morbidity in older persons.
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Affiliation(s)
- G Berrut
- Pr Athanase Benetos, MD, PhD, Département de Médecine Gériatrique, CHU de Nancy, Avenue de Bourgogne, BP 217, 54511 Vandoeuvre-les-Nancy, France,
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Sánchez García E, Montero Errasquín B, Sánchez Castellano C, Cruz-Jentoft AJ. Importance of nutritional support in older people. Nestle Nutr Inst Workshop Ser 2012; 72:101-8. [PMID: 23052005 DOI: 10.1159/000339998] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
Proper nutrition is an essential part of successful aging and may delay the onset of diseases. Nutrition-related problems in older subjects have been long-time ignored; good nutritional status is an essential component of health and a relevant part of therapeutic plans of most chronic diseases. Moreover, food and nutrition are a relevant aspect of most cultures and are strongly linked with individual lifestyles. Research has proved that nutritional intervention can improve outcomes in many clinical scenarios. This is especially true for older individuals with different acute and chronic conditions and diseases, or with malnutrition. Nutritional intervention can provide sufficient energy, protein and micronutrients, maintain or improve nutritional status, reduce morbidity and increase survival. Evidence is still lacking on the impact of nutritional intervention on physical and mental function, and on quality of life, very relevant outcomes for older individuals. Nutritional screening and assessment should become part of health care of both healthy and sick older people. Nutritional counseling and intervention should be embedded in a general care plan that takes into account all aspects of an aging person. Nutritional programs that aim for high compliance should be individualized, and would have to consider every aspect of old age: beliefs, attitudes, preferences, expectations, and aspirations.
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Affiliation(s)
- E Sánchez García
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Michel JP, Lang PO, Cruz-Jentoft AJ. [Sarcopenia: a new geriatric hot topic]. Rev Med Suisse 2009; 5:2200-2204. [PMID: 19994668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Highly prevalent in the population older than 65 years, and leading to poor outcomes (functional decline and its related consequences), sarcopenia does not benefit yet either of a clear understanding of its patho-physiology. Its origin, its risk factors, its clinical presentation will be detailed. The diagnosis of sarcopenia imposes a clear identification of the risk factors, a specific muscular assessment, a pragmatic clinical approach. The treatment is based on nutritional supplements and/or drugs which to be active need to be associated to physical exercises of moderate intensity. Geriatricians are expecting new therapy to delay the consequences of sarcopenia, e.g. frailty and inability in daily living.
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Affiliation(s)
- J-P Michel
- Département de réhabilitation et gériatrie, Faculté de médecine et HUG, 1211 Genève 14
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Cruz-Jentoft AJ, Calvo JJ, Durán JC, Ordóñez J, De Castellar R. Compliance with an oral hyperproteic supplement with fibre in nursing home residents. J Nutr Health Aging 2008; 12:669-73. [PMID: 18953467 DOI: 10.1007/bf03008280] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Undernutrition is a common problem in older individuals that may be related to a low protein dietary intake. Oral supplements may improve the health status in this population, but their use may be limited by compliance and side effects. OBJECTIVES To evaluate effects of an oral supplement of protein and fibre on compliance, on nutritional status, and on intestinal habits in nursing home residents. METHOD A prospective observational study was carried out in 66 Spanish nursing homes. 358 subjects undernourished or at risk of undernutrition requiring nutritional supplements. After informed consent was given, subjects received 2 daily cartons (400 ml) of a liquid oral supplement rich in protein and fibre along 3 months. Supplement intake compliance was measured at baseline and after 6 and 12 weeks. Nutritional status was assessed using the Mini- Nutritional Assessment (MNA), weight, and Body Mass Index (BMI). Changes in intestinal habits and digestive symptoms were also recorded, as well as subject's supplement acceptance. RESULTS Compliance with the supplement intake was 97.46% at 6 weeks and 96% at 12 weeks of follow-up. Significant changes (p<0.0001) were found in nutritional status: mean value of MNA improved from baseline (MNA=14.0+/-3.9) after 12 weeks (MNA=17.0+/-4.0), as well as weight (+2.1 kg, a 4.1% increase). The BMI did not change significantly (BMI=21.43 at baseline; BMI=21.78 at 12 weeks). Undernutrition prevalence (MNA<17) decreased from 76.4 to 46.6% (p<0.0001). Intestinal habits showed a significant improvement in defecation frequency (from 4.7 to 6.1 stools per week, p<0.0001) and faeces consistency (from 53.2% to 74.5% reporting formed soft stools, p<0.0001). 48.9% of the subjects considered to have better intestinal habits after 6 weeks and 50.5% after 3 months of supplementary food intake, the rest reporting no change. Vomits and flatulence were also significantly reduced (p<0.0001). CONCLUSION The administration of an oral hyperproteic supplement with fibre in aged subjects who are undernourished or at risk of malnutrition can be done in nursing homes with a high level of compliance. Supplements improve their nutritional status and their intestinal habits.
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Affiliation(s)
- A J Cruz-Jentoft
- Servicio de Geriatria, Hospital Universitario Ramon y Cajal, Madrid, Spain
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Olazarán J, Muñiz R, Reisberg B, Peña-Casanova J, del Ser T, Cruz-Jentoft AJ, Serrano P, Navarro E, García de la Rocha ML, Frank A, Galiano M, Fernández-Bullido Y, Serra JA, González-Salvador MT, Sevilla C. Benefits of cognitive-motor intervention in MCI and mild to moderate Alzheimer disease. Neurology 2004; 63:2348-53. [PMID: 15623698 DOI: 10.1212/01.wnl.0000147478.03911.28] [Citation(s) in RCA: 209] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy of a cognitive-motor program in patients with early Alzheimer disease (AD) who are treated with a cholinesterase inhibitor (ChEI). METHODS Patients with mild cognitive impairment (MCI) (12), mild AD (48), and moderate AD (24) (Global Deterioration Scale stages 3, 4, and 5) were randomized to receive psychosocial support plus cognitive-motor intervention (experimental group) or psychosocial support alone (control group). Cognitive-motor intervention (CMI) consisted of a 1-year structured program of 103 sessions of cognitive exercises, plus social and psychomotor activities. The primary efficacy measure was the cognitive subscale of the AD Assessment Scale (ADAS-cog). Secondary efficacy measures were the Mini-Mental State Examination, the Functional Activities Questionnaire, and the Geriatric Depression Scale. Evaluations were conducted at 1, 3, 6, and 12 months by blinded evaluators. RESULTS Patients in the CMI group maintained cognitive status at month 6, whereas patients in the control group had significantly declined at that time. Cognitive response was higher in the patients with fewer years of formal education. In addition, more patients in the experimental group maintained or improved their affective status at month 12 (experimental group, 75%; control group, 47%; p = 0.017). CONCLUSIONS A long-term CMI in ChEI-treated early Alzheimer disease patients produced additional mood and cognitive benefits.
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Affiliation(s)
- J M Ribera Casado
- Servico de Geriatría, Hospital Universitario San Carlos, Madrid, Spain
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Lázaro M, Cruz-Jentoft AJ, Ribera JM. The role of geriatric consultation in elderly urologic patients. Aging (Milano) 1995; 7:240-1. [PMID: 8547385 DOI: 10.1007/bf03324323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- M Lázaro
- Servicio de Geriatría, Hospital Universitario San Carlos, Madrid, Spain
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