Sarcopenia in patients with hip fracture: A multicenter cross-sectional study

BACKGROUND

Sarcopenia is prevalent in older persons and is a risk factor for falls, fractures, and mortality. The aim of this study was to determine a) the feasibility of determining sarcopenia in patients with acute hip fracture, b) the prevalence of sarcopenia and c) associations of sarcopenia with nutritional status and comorbidities.

METHODS

A multicenter cross-sectional study on sarcopenia in male and female patients with acute hip fracture. Participants were previously ambulatory and living in the community. Sarcopenia was assessed postoperatively with muscle mass estimated by anthropometry using triceps skinfold, arm circumference, height, weight and sex. Grip strength was measured by Jamar dynamometer and pre-fracture mobility was by self-report using the New Mobility Score.

RESULTS

Out of 282 patients, 202 were assessed for sarcopenia of whom 74 (37%) were diagnosed as sarcopenic. Sarcopenia was associated with age, odds ratio (OR) 1.4 per 5 years, 95% confidence interval (CI) [1.1, 1.8], ASA Physical Status Classification System score, OR 2.3 per point, 95% CI [1.3, 4.3] and number of medications at discharge, OR 1.2 per medication, 95% CI [1.0, 1.3] and inversely associated with BMI, OR 0.8, 95% CI [0.7, 0.9] and serum albumin, OR 0.9, 95% CI [0.8,1.0].

CONCLUSIONS

Thirty-seven percent of assessed subjects were diagnosed with sarcopenia. Our data demonstrates that the prevalence of sarcopenia is associated with older age, malnutrition and comorbidities. Determining sarcopenia at the bedside was feasible in postoperative hip fracture patients by using grip strength, estimation of muscle mass by anthropometry and self-reported mobility.

Does sarcopenia predict change in mobility after hip fracture? a multicenter observational study with one-year follow-up

BACKGROUND

Patients with hip fracture frequently have sarcopenia and are at great risk of loss of mobility. We have investigated if sarcopenia predicts change in mobility after hip fracture.

METHODS

This is a prospective, multicenter observational study with one-year follow-up. Patients with hip fracture who were community-living and capable of walking before the fracture were included at three hospitals in Norway (2011-2013). The primary outcome of the study was change in mobility, measured by the New Mobility Score (NMS). Sarcopenia was determined postoperatively by anthropometry, grip strength, and NMS.

RESULTS

We included 282 participants and sarcopenia status was determined in 201, of whom 38% (77/201) had sarcopenia, 66% (128/194) had low muscle mass, 52% (116/222) had low grip strength and 8% (20/244) had low pre-fracture mobility (NMS < 5). Sarcopenia did not predict change in mobility (effect 0.2 points; 95% CI -0.5 to 0.9, P = 0.6), but it was associated with having lower mobility at one-year (NMS 5.8 (SD 2.3) vs. 6.8 (SD 2.2), P = 0.003), becoming a resident of a nursing home (odds ratio 3.2, 95% CI 0.9 to 12.4, P = 0.048), and the combined endpoint of becoming a resident of a skilled nursing home or death (odds ratio 3.6, 95% CI 1.2 to 12.2, P = 0.02).

CONCLUSIONS

Sarcopenia did not predict change in mobility in the year after hip fracture.

Reduced Walking Speed in Subjective and Mild Cognitive Impairment: A Cross-Sectional Study

BACKGROUND AND PURPOSE

Walking speed is reduced in people with dementia, but less is known about predementia conditions. We, therefore, studied the relationship between walking speed, cognition, and cerebrospinal fluid biomarkers in persons with subjective (SCI) and mild cognitive impairment (MCI).

METHODS

We conducted a cross-sectional study of 22 healthy controls, 30 SCI and 17 MCI (N = 69). Walking speed was measured by a 10-m gait test at usual and fast pace. We analyzed the association between walking speed and the ordered categories of controls, SCI, and MCI in a generalized proportional odds model. Neuropsychological tests, Consortium to Establish a Registry for Alzheimer's Disease (delayed recall), and Trail Making (TMT) A and B, were analyzed by negative binomial, linear, and robust regression for association with walking speed.

RESULTS

Walking speed at usual pace was slower moving from controls to SCI (odds ratio: 0.46, P = 0.031) and MCI (odds ratio: 0.44, P = .019) on an ordinal scale. In MCI, walking speed was reduced at fast speed (odds ratio: 0.46, P = 0.04). There were significant associations between walking speeds and neuropsychological test performance. Usual walking speed was associated with slower test performance on TMT-A (β: -.02, P = .04) and fast pace with slower performance on TMT-B (β: -.01, P = .03). There were no associations between cerebrospinal fluid biomarkers and walking speeds.

CONCLUSION

Usual walking speed is reduced in a graded fashion with the early symptoms of cognitive impairment. Our results suggest that reduced walking speed at both usual and fast speed is associated with impaired cognitive function, and that walking speed could be affected at very early stages of neurodegeneration.

Identifying Low Muscle Mass in Patients with Hip Fracture: Validation of Biolectrical Impedance Analysis and Anthropometry Compared to Dual Energy X-ray Absorptiometry

BACKGROUND

Older hip fracture patients often have reduced muscle mass, which is associated with adverse outcomes. Dual energy X-ray absorptiometry (DXA) can determine muscle mass, but is not practical in the acute phase. We investigated bioelectrical impedance analysis (BIA) and anthropometry compared against DXA for detecting low muscle mass in hip fracture patients.

METHODS

This was a cross-sectional validation study at two Norwegian hospitals on 162 hip fracture patients aged ≥ 65 years. Appendicular lean mass (ALM) was determined by DXA, BIA and anthropometry 3 months after hip fracture. ALM by BIA was calculated by the Kyle, Janssen, Tengvall and Sergi equations, and ALM by anthropometry by the Heymsfield and Villani equations. The area under the receiver operating characteristic curve (AUC) was used to compare BIA and anthropometry for determining low ALM (≤5.67 kg/m2 for women and ≤7.25kg/m2 for men).

RESULTS

Mean age was 79 years (SD 7.9), 74% were female. Mean ALM by DXA was 14.8 kg (SD 2.3) for women and 20.8 kg (SD 4.2) for men and 45% of women and 60% of men had low ALM. BIA (Kyle) in women (AUC 0.81, 95% confidence interval 0.72-0.89) and BIA (Sergi) in men (AUC 0.89, 95% CI 0.80-0.98) were best able to discriminate between low and normal ALM. Anthropometry (Heymsfield) was less accurate than BIA in women (AUC 0.64, 95% CI 0.54-0.75), and equal to BIA in men (AUC 0.72, 95% CI 0.72 0.56-0.87).

CONCLUSION

BIA (Sergi, Kyle and Tengvall) and anthropometry (Heymsfield) can identify low muscle mass in hip fracture patients.

Cognitive impairment influences the risk of reoperation after hip fracture surgery: results of 87,573 operations reported to the Norwegian Hip Fracture Register

Background and purpose - About one-fourth of hip fracture patients have cognitive impairment. We investigated whether patients' cognitive function affects surgical treatment, risk of reoperation, and mortality after hip fracture, based on data in the Norwegian Hip Fracture Register (NHFR).Patients and methods - This prospective cohort study included 87,573 hip fractures reported to the NHFR in 2005-2017. Hazard rate ratios (HRRs) for risk of reoperation and mortality were calculated using Cox regression adjusted for sex, age, ASA class, fracture type, and surgical method.Results - Cognitive impairment was reported in 27% of patients. They were older (86 vs. 82 years) and had higher ASA class than non-impaired patients. There were no differences in fracture type or operation methods. Cognitively impaired patients had a lower overall reoperation rate (4.7% vs. 8.9%, HRR 0.71; 95% CI 0.66-0.76) and lower risk of reoperation after osteosynthesis (HRR 0.58; CI 0.53-0.63) than non-impaired patients. Cognitively impaired hip fracture patients had an increased reoperation risk after hemiarthroplasty (HRR 1.2; CI 1.1-1.4), mainly due to dislocations (1.5% vs. 1.0%, HRR 1.7; CI 1.3-2.1). Risk of dislocation was particularly high following the posterior approach (4.7% vs. 2.8%, HRR 1.8; CI 1.2-2.7). Further, they had a higher risk of reoperation due to periprosthetic fracture after uncemented hemiarthroplasty (HRR 1.6; CI 1.0-2.6). Cognitively impaired hip fracture patients had higher 1-year mortality than those without cognitive impairment (38% vs. 16%, HRR 2.1; CI 2.1-2.2).Interpretation - Our findings support giving cognitively impaired patients the same surgical treatment as non-impaired patients. But since the risk of hemiprosthesis dislocation and periprosthetic fracture was higher in cognitively impaired patients, they should probably not have posterior approach surgery or uncemented implants.

Validation of orthopaedic surgeons' assessment of cognitive function in patients with acute hip fracture

BACKGROUND

About one fourth of patients with hip fracture have cognitive impairment. These patients are at higher risk of surgical and medical complications and are often excluded from participating in clinical research. The aim of the present study was to investigate orthopaedic surgeons' ability to determine the cognitive status of patients with acute hip fracture and to compare the treatment given to patients with and without cognitive impairment.

METHODS

The cognitive function of 1474 hip fracture patients reported by the orthopaedic surgeons to the nationwide Norwegian Hip Fracture Register was compared with data registered in quality databases in two hospitals with orthogeriatric service on the same patients. Cognitive function registered in the quality databases was determined either by the short form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) or by pre-fracture diagnosis of dementia. The information registered in the quality databases was defined as the reference standard. Cognitive function in the Norwegian Hip Fracture Register was reported as: Chronic cognitive impairment? "Yes", "Uncertain" or "No" by the orthopaedic surgeons. Sensitivity, specificity, negative and positive predictive values for chronic cognitive impairment reported to the Norwegian Hip Fracture Register by the orthopaedic surgeons was calculated. Baseline data and treatment of hip fractures in patients with and without cognitive impairment in the Norwegian Hip Fracture Register were compared.

RESULTS

Orthopaedic surgeons reported chronic cognitive impairment in 31% of the patients. Using documented dementia or IQCODE > 4.0 as the reference, this assessment of cognitive impairment by the orthopaedic surgeons had a sensitivity of 69%, a specificity of 90%, a positive predictive value of 78%, and a negative predictive value of 84% compared to information registered in the two hospital quality databases. There were no differences in type of hip fracture or type of surgical treatment by cognitive function.

CONCLUSION

The treatment of hip fractures was similar in patients with chronic cognitive impairment and cognitively well-functioning patients. The surgeons had an acceptable ability to identify and report chronic cognitive impairment in the peri-operative period, indicating that the Norwegian Hip Fracture Register is a valuable resource for future registry-based research also on hip fracture patients with chronic cognitive impairment.

Severe Neurological Sequelae after a Recreational Dose of LSD

A young man with an unremarkable medical history suffered a seizure with subsequent cardiorespiratory arrest and severe neurological sequelae after ingesting a blotter. Analysis of a similar blotter and a serum sample obtained 3 h after the event detected lysergic acid diethylamide (LSD) at an amount of 300 µg in the blotter and at a concentration of 4.0 ng/mL (12.4 nmol/L) in the serum. No other drugs were present in concentrations which may confer significant effects. In addition, no individual traits which would make the patient particularly susceptible to adverse LSD effects have subsequently been identified. This suggests that LSD may confer toxic effects in previously healthy individuals.

Case report: Pain in anti-DPPX encephalitis

Encephalitis due to antibodies targeting dipeptidyl-peptidase-like protein 6 (DPPX), a potassium channel subunit, is rare. The illness is typically characterized by a triad of weight loss, CNS hyperexcitability and cognitive symptoms, but recent reports suggest that the clinical picture may be more heterogeneous. Here, we describe the case of a 63-year-old female who was admitted to the hospital with severe extremity pain, which had been preceded by diarrhea and weight loss. She later developed cognitive changes, and her general condition rapidly deteriorated. Extensive workup did not reveal gastrointestinal illness or underlying malignancies. MRI of the brain was normal. Analyses of blood and cerebrospinal fluid showed normal cell counts but high titres of DPPX antibodies in blood and cerebrospinal fluid. The patient was treated with intravenous methylprednisolone followed by rituximab. At 1-year follow-up, she was without pain and had completely recovered. In this case, DPPX-associated autoimmune encephalitis was dominated by severe extremity pain, illustrating that sensory symptoms may be one of the main complaints in these patients. It is important for clinicians to be aware of the heterogeneous clinical picture in this serious condition, since correct diagnosis and treatment with immunosuppressants are associated with favorable prognosis.

Selecting a smartwatch for trials involving older adults with neurodegenerative diseases: A researcher's framework to avoid hidden pitfalls

BACKGROUND

Increased prevalence of neurodegenerative diseases complicates care needs for older adults. Sensing technologies, such as smartwatches, are one available solution which can help address the challenges of aging. Knowledge of the possibilities and pitfalls of these sensing technologies is of key importance to researchers when choosing a device for a trial and considering the sustainability of these technologies in real-world settings.

OBJECTIVE

This study aims to uncover hidden truths related to the suitability of smartwatches for use in clinical trials which include older adults with neurodegenerative diseases, including end-of-life and palliative care studies.

METHOD

We perform an analysis of smartwatch features vs. user and researcher needs and provide an overview of hidden expenses which should be considered by the research team. Investigative research on 11 smartwatches is presented, selected based on previous use in clinical studies and recommendations from fellow researchers.

RESULTS

We found that expenses, battery life, choice of research vs. commercial grade devices, data management, study methodology, and participant demographics are principal factors in selecting a smartwatch for a clinical trial involving older adults with neurodegenerative diseases. A revised framework based on our findings, and concepts from Connely (2021), Mattison (2023), and Espay (2019) et al.'s previous work, is presented as a tool for researchers in evaluation of smartwatches and future sensing technologies.

CONCLUSION

Careful consideration must be given to the fitness of technologies for future research, especially considering that this is a rapidly changing field. The process of selection of a smartwatch for a clinical trial should be thoughtful, scrutinous, and include interdisciplinary collaboration.

Detection of delirium in older patients-A point prevalence study in surgical and non-surgical hospital wards

AIMS AND OBJECTIVES

To (i) determine the prevalence of delirium and identify delirium subtypes in surgical and non-surgical patients aged ≥65 years, (ii) determine whether certain precipitating factors affect the prevalence of delirium and (iii) review patients' medical records for description of delirium symptoms and the presence of International Classification of Diseases (ICD-10) coding for delirium in discharge summaries.

METHODOLOGICAL DESIGN AND JUSTIFICATIONS

Despite being a robust predictor of morbidity and mortality in older adults, delirium might be inadequately recognised and under-reported in patients' medical records and discharge summaries. A point prevalence study (24-h) of patients ≥65 years from surgical and non-surgical wards was therefore conducted in a tertiary university hospital.

ETHICAL ISSUES AND APPROVAL

The study was approved by the Data Protection Officer at the university hospital (2018/3454).

RESEARCH METHODS, INSTRUMENTS AND/OR INTERVENTIONS

Patients were assessed for delirium with 4AT and delirium subtypes with the Delirium Motor Subtype Scale. Information about room transfers, need and use of sensory aids and medical equipment was collected onsite. Patients' medical records were reviewed for description of delirium symptoms and of ICD-10 codes.

RESULTS

Overall, 123 patients were screened (52% female). Delirium was identified in 27% of them. Prevalence was associated with advanced age (≥85 years). The uncharacterised delirium subtype was most common (36%), followed by hypoactive (30%), hyperactive (24%) and mixed (9%). There were significant associations between positive screening tests and the need and use of sensory aids. Delirium symptoms were described in 58% of the patients who tested positive for delirium and the ICD-10 code for delirium was registered in 12% of these patients' discharge summaries.

CONCLUSIONS

The high prevalence of delirium and limited use of discharge codes highlight the need to improve the identification of delirium in hospital settings and at discharge. Increased awareness and detection of delirium in hospital settings are vital to improve patient care.

Epistaxis after testing for COVID-19

BACKGROUND

Testing for airway microbes has increased during the current COVID-19 pandemic. This case report demonstrates that testing can lead to complications.

CASE PRESENTATION

A man in his seventies was transferred to our hospital for coronary angiography. On admission he underwent testing with nasopharyngeal swab for COVID-19. He started bleeding profusely from the nostril insertion site. The haemorrhage was controlled by bilateral anterior and posterior balloon tamponade, the coronary angiography was postponed, he was given a transfusion of packed red blood cells and had to spend a total of nine days in hospital.

INTERPRETATION

The World Health Organization recommends screening of all patients for COVID-19 upon admission to hospital. The risk of every procedure must be carefully considered in relation to the benefits, especially when large numbers of patients are affected. For our patient, the likelihood of COVID-19 infection was low, and the risk of complications was high.

Activity and Behavioral Recognition Using Sensing Technology in Persons with Parkinson's Disease or Dementia: An Umbrella Review of the Literature

BACKGROUND

With a progressively aging global population, the prevalence of Parkinson's Disease and dementia will increase, thus multiplying the healthcare burden worldwide. Sensing technology can complement the current measures used for symptom management and monitoring. The aim of this umbrella review is to provide future researchers with a synthesis of the current methodologies and metrics of sensing technologies for the management and monitoring of activities and behavioral symptoms in older adults with neurodegenerative disease. This is of key importance when considering the rapid obsolescence of and potential for future implementation of these technologies into real-world healthcare settings.

METHODS

Seven medical and technical databases were searched for systematic reviews (2018-2024) that met our inclusion/exclusion criteria. Articles were screened independently using Rayyan. PRISMA guidelines, the Cochrane Handbook for Systematic Reviews, and the Johanna Briggs Institute Critical Appraisal Checklist for Systematic Reviews were utilized for the assessment of bias, quality, and research synthesis. A narrative synthesis combines the study findings.

RESULTS

After screening 1458 articles, 9 systematic reviews were eligible for inclusion, synthesizing 402 primary studies. This umbrella review reveals that the use of sensing technologies for the observation and management of activities and behavioral symptoms is promising, however diversely applied, heterogenous in the methods used, and currently challenging to apply within clinical settings.

CONCLUSIONS

Human activity and behavioral recognition requires true interdisciplinary collaborations between engineering, data science, and healthcare domains. The standardization of metrics, ethical AI development, and a culture of research-friendly technology and support are the next crucial developments needed for this rising field.

The effect of removing hearing aids on postural sway in older adults with age-related hearing loss: an experimental study

Background

Studies show that there is an association between age-related hearing loss (HL) and balance in older individuals. Several studies have indicated that the use of hearing aids (HAs) may have a positive impact on balance. However, the effect of HAs on postural sway in standing is still debated and unclear. The aim of this study was to examine differences in postural sway with and without the use of HAs, and the association between hearing threshold on balance and controlling for confounders, when comparing the use of HAs to not using them.

Methods

In this study, balance was tested in standing position on a force platform in individuals ≥70 years (N = 50) with HL (>30 dB) under four conditions (on a firm surface with eyes open and closed, and on a foam surface eyes open and closed). Postural sway was registered with and without using HAs, and the difference between the two conditions was examined by paired sample t-test. Associations between postural sway and hearing threshold was examined separately with and without using HAs by multiple regression analysis.

Results

There was a statistically significant reduced postural sway (better balance) on a firm surface with eyes open with an effect size of 0.43 (95% CI 0.15 to 0.73, p = 0.003) using HAs compared to not using them. Multiple regression analyses did not show any significant associations between postural sway and hearing threshold after adjustments for cofounding factors, including age, sex, education, diabetes, cardiovascular diseases, and dizziness.

Discussion

In this study, participants demonstrated significantly better balance when standing on a firm surface with eyes open while using HAs, compared to standing without them. However, this improvement was not observed when standing on foam surface. Further research is necessary to examine the impact of HAs on balance across various conditions and surfaces. Future studies should also investigate the underlying mechanisms of these effects, including how HAs may influence proprioception and postural control, particularly in environments that challenge balance, such as foam surfaces.

Walking and balance in older adults with age-related hearing loss: A cross-sectional study of cases and matched controls

BACKGROUND

Hearing loss (HL) is prevalent in older individuals. It is suggested that there is an association between age-related HL, walking and balance, leading to poorer function and increased risk of falls in older individuals.

RESEARCH QUESTION

Is HL associated with physical performance, gait variability, and postural sway in older adults, and will additional dizziness moderate the effect of HL on balance?

METHODS

In this cross-sectional study we examined 100 older individuals (age ≥70 years, 60 % females), divided in two groups, with or without age-related HL. Physical function and balance were evaluated by the Short Physical Performance Battery (SPPB), postural sway measured on a force platform (posturography), and balance in walking (gait variability) measured with a body-worn sensor. Multiple linear regression was used to examine the relationships between the variables, with physical function and balance as outcomes and HL as a dichotomous exposure (>30 dB). For all analyses, we further tested if associations were modified by self-reported dizziness.

RESULTS

Multiple regression analysis with HL, age, sex, education, diabetes, and cardiovascular disease revealed a significant association between reduced SPPB and HL. Multiple linear regression analysis also showed that HL was associated with increased postural sway on firm surface with eyes open and closed after adjusting for age, sex, education, diabetes, and cardiovascular disease. There was significant association between HL and increased gait variability during dual task walking in all directions after adjusting for age, sex, education, diabetes, and cardiovascular disease. Further, we found that the association between HL and SPPB was significantly stronger in those with dizziness compared with those without dizziness. Dizziness also modified the association of HL with the other SPPB sub-scores but not for the other outcomes of postural sway or gait variability.

SIGNIFICANCE

In this study, age-related HL was associated with worse physical performance as measured by SPPB, postural sway, and gait variability. This relationship illustrates the importance of assessing physical performance in people with HL to prevent risk of falls and disability.