Ahead of print articles
QUALITY OF LIFE IN OLDER ADULTS ATTENDING A UNIVERSITY FAMILY PRACTICE CENTRE IN SRI LANKA
R.E. Ediriweera de Silva, M.S.A. Perera
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Background: This study aimed to assess the quality of life (QoL) and identify factors influencing it in older adults attending a University Family Practice situated in a semi-urban area in Sri Lanka, a lower middle income country. Objectives: To describe the QoL among older adults attending the Family Practice Centre, University of Sri Jayewardenepura. Design: A descriptive cross sectional study. Setting Family Practice Centre, University of Sri Jayewardenepura, Sri Lanka. Participants: 140 registered older adults >60years who attended the centre over 3 months in 2012. Results: The majority of participants (51.4%) were between 60-69years, females (65%), 67.9% were married, and (88.6%) lived with their families. QoL was satisfactory, with spiritual and functional aspects being the most satisfactory and physical QoL being the least satisfactory, however latter too had a mean score (>50). Better QoL was seen in males, with better education, married and living with spouse, and perceived adequacy of income. Poorer QoL was seen in participants living alone, presence of 3 or more health problems, being admitted to hospital or, and accidents and falls in the past one year. Conclusions: QoL in this group of older adults was satisfactory with spiritual and functional aspects being the most satisfactory and the physical aspect being the least. Preventing unnecessary hospital admissions and accidents could help to improve QoL in older adults.
R.E. Ediriweera de Silva ; M.S.A. Perera (2018): Quality of life in older adults attending a University Family Practice Centre in Sri Lanka. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.8
THE UTILITY OF THE FRAILTY INDEX IN CLINICAL DECISION MAKING
K. Khatry, N.M. Peel, L.C. Gray, R.E. Hubbard
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Using clinical vignettes, this study aimed to determine if a measure of patient frailty would impact management decisions made by geriatricians regarding commonly encountered clinical situations. Electronic surveys consisting of three vignettes derived from cases commonly seen in an acute inpatient ward were distributed to geriatricians. Vignettes included patients being considered for intensive care treatment, rehabilitation, or coronary artery bypass surgery. A frailty index was generated through Comprehensive electronic Geriatric Assessment. For each vignette, respondents were asked to make a recommendation for management, based on either a brief or detailed amount of clinical information and to reconsider their decision after the addition of the frailty index. The study suggests that quantification of frailty might aid the clinical judgment now employed daily to proceed with usual care, or to modify it based on the vulnerability of the person to whom it is aimed.
K. Khatry ; N.M. Peel ; L.C. Gray ; R.E. Hubbard (2018): The Utility of the Frailty Index in Clinical Decision Making. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.7
EFFECTS OF FERMENTED PAPAYA PREPARATION (FPP) ON SAFETY OUTCOMES IN OLDER ADULTS – A SHORT REPORT OF A PLACEBO-CONTROLLED CLINICAL TRIAL
R.T. Mankowski, C. Leeuwenburgh, T.M. Manini, A.J. Woods, S.D. Anton
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Fermented Papaya Preparation (FPP®) has shown antioxidative and anti-inflammatory effects in preclinical and clinical aging studies. However, clinical trials are needed to fully evaluate the safety of FPP® in moderate-functioning, generally healthy older adults. In this randomized (9g/day of FPP® or placebo), crossover design study, we enrolled 30 older moderate-functioning older adults (70-100 years old). The participants completed both a treatment and a placebo condition. After eight (8) weeks on each of these regimens (with a 4-week wash-out period in between), participants had their venous blood drawn for assessment of blood chemistries, metabolic outcomes and inflammatory biomarkers. Participants were asked to report any adverse events during the course of the study and complete post-treatment outcome assessments for anthropometric and metabolic outcomes. The major finding related to safety was that there were no adverse changes in blood chemistries and few adverse events in the FPP® condition, which did not differ from placebo (p>0.05). There were no serious adverse effects in either condition. Twenty-nine (29) participants (mean age 78.2±5.3 yrs) completed the study with 94% adherence to the dosing regimen. There were no significant effects of FPP® on anthropometric and metabolic outcomes. In addition, no effects on markers of inflammation were observed. Our trial demonstrates FPP® supplementation is safe and feasible in adults ages 70 years and older. Based on these findings and the positive effects FPP has demonstrated in previous trials, future trials should examine the effects of FPP® in older adults with impaired health status and/or older adults who may have insufficient anti-oxidant protection due to their genetic background.
R.T. Mankowski ; C. Leeuwenburgh ; T.M. Manini ; A.J. Woods ; S.D. Anton ; J.E. Martinelli (2018): Effects of fermented papaya preparation (FPP) on safety outcomes in older adults – a short report of a placebo-controlled clinical trial. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.6
POLYPHARMACY BUT NOT POTENTIAL INAPPROPRIATE PRESCRIPTION WAS ASSOCIATED WITH FRAILTY IN OLDER ADULTS FROM A MIDDLE-INCOME COUNTRY OUTPATIENT CLINIC
I. Aprahamian, M.M. Biella, G. Vano Aricó de Almeida, F. Pegoraro, A.V. Alves Pedrini, B. Cestari, L.H. Bignotto, B. Alvarez Ribeiro de Melo, J.E. Martinelli
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cy and pre-frailty or frailty in a middle-income country sample of older adults; and (2) evaluate the prevalence of potential inappropriate prescription (PIP) and its association with pre-frailty or frailty. Design: Cross-sectional observational study. Setting: Outpatient center at a university-based hospital in the state of São Paulo, Brazil. Participants: 629 older adults from both sexes evaluated between June 2014 and July 2016. Measurements: Frailty was identified through the FRAIL scale. All medications received were analyzed by research staff. Presence of PIP was evaluated according to the 2015 updated Beers list. Binary logistic regression tested the association between 4 definitions of polypharmacy (≥ 3, 4, 5, and 6 drugs), and presence of PIP, and the dependent variable pre-frailty and frailty. Results: 15.7% of participants were frail. Polypharmacy was present in 219 (34.8%), and PIP was observed in 184 (29.3%) older adults. All definitions of polypharmacy were significantly associated with frailty (OR between 2.05 to 2.34, p < 0.001). Polypharmacy with 4 or 5 or more drugs were associated with pre-frailty (OR 1.53 and 1.47, respectively). PIP was not associated with frailty (OR 1.47, p = 0.149). Conclusions: Several definitions of polypharmacy were associated with frailty, but only two were associated with pre-frailty. The presence of PIP was not associated with pre-frailty or frailty.
I. Aprahamian ; M.M. Biella ; G. Vano Aricó de Almeida ; F. Pegoraro ; A.V. Alves Pedrini ; B. Cestari ; L.H. Bignotto ; B. Alvarez Ribeiro de Melo ; J.E. Martinelli (2018): Polypharmacy but not potential inappropriate prescription was associated with frailty in older adults from a middle-income country outpatient clinic. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.5
ACCURACY OF BODY MASS INDEX VERSUS LEAN MASS INDEX FOR PREDICTION OF SARCOPENIA IN OLDER WOMEN
M.J. Benton, A.L. Silva-Smith
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We compared accuracy of body mass index (BMI) versus lean mass index (LMI) to predict sarcopenia in 58 community-dwelling women (74.1±0.9 years). Lean mass was measured with multi-frequency bioelectrical impedance analysis, and strength was measured with Arm Curl test, Chair Stand test, and handgrip dynamometry. Sarcopenia was defined as low LMI. When categorized by BMI, normal women had less absolute lean mass (37.6±1.0 vs. 42.6±0.9 kg; P<0.001) and less relative lean mass (14.1±0.2 vs. 16.1±0.2 kg/m2; P<0.001) compared to overweight/obese women, but no differences in strength. When categorized by LMI, normal women had more absolute lean mass (44.0±0.7 vs. 35.7±0.7 kg; P<0.001), more relative lean mass (16.2±0.2 vs. 13.8±0.2 kg/m2; P<0.001), and greater upper body strength (16.7±0.9 vs. 14.2±0.6 arm curls; P<0.05) compared to women with low LMI. BMI failed to accurately predict low values of lean mass and strength. For clinical assessment, calculation of LMI rather than BMI is appropriate.
M.J. Benton ; A.L. Silva-Smith (2018): Accuracy of Body Mass Index versus Lean Mass Index for Prediction of Sarcopenia in Older Women. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.1
HOW TO MANAGE FRAIL OLDER ADULTS IN THE COMMUNITY? PROPOSAL OF A HEALTH PROMOTION PROGRAM EXPERIENCED IN A CITY OF 16,638 INHABITANTS IN FRANCE
J. de Kerimel, N. Tavassoli, C. Lafont, M. Soto, M. Pedra, F. Nourhashemi, C. Lagourdette, L. Bouchon, A. Chaléon, S. Sourdet, Y. Rolland, M. Cesari, B. Vellas
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Background: Health promotion programs could prevent and delay frailty and functional decline. However, in practice, the planning and establishment of such a program is a challenge for health care providers. We report an experimental model of screening and management for frail elderly conducted in Cugnaux, city of 16,638 inhabitants in France, by the Toulouse Gerontopole and the social care service of the Cugnaux City Hall. Methods: A frailty screening self-administered questionnaire (FiND questionnaire) was sent to community-dwelling residents of 70 years old and over of Cugnaux. The completed questionnaires were analyzed and the subjects were classed into three groups: robust, frail, mobility disability, based on their score. Frail subjects and those with mobility disability invited to undergo a frailty assessment in the premises of the town hall realized by a nurse in order to identify the causes of their frailty and propose them a personalized intervention plan (PIP). Results: The FiND questionnaire was sent to the residents of Cugnaux of 70 years old and over (n=2,003). After two mailings, 860 (42.9%) completed questionnaires were received. Mean age of the responders was 79.0 ± 6.2 years and 59.6% women (n= 511). According to the questionnaires analysis, 393 (45.7%) were robust, 212 (24.6%) frail, 240 (27.9%) had a mobility disability and 15 (1.7%) could not be classified due to missing data. 589 (68.5%) subjects accepted to be contacted by the Gerontopole nurse. The assessment by the nurse was proposed to frail subjects and those with mobility disability (n=313). Until 31 December 2016, 136 patients have been evaluated. The mean age was 80.1±5.4 and most patients were women (69.9%). The mean ADL score was 5.8±0.5 and the IADL showed a mean score of 6.9±1.7. According to Fried definition of frailty, 76 patients (55.9%) were pre-frail, and 35 (25.7%) frail. Concerning the frailty domains identified, 75 patients (55.1%) showed the alteration of physical performance, 70 (51.5%) thymic disorders and 46 (33.8%) sensory disorders. Preventive interventions proposed in the PIP were mostly physical interventions (86.8%, n=118) followed by cognitive (61.8%, n=84) and nutritional (39.7%, n=54) interventions. Discussion: This project shows the feasibility to implement a care model in the community. It permitted a large identification of frail elderly people in the city population, insuring their assessment and clinical follow up to maintain their capacities and referring them to social services.
J. de Kerimel ; N. Tavassoli ; C. Lafont ; M. Soto ; M. Pedra ; F. Nourhashemi ; C. Lagourdette ; L. Bouchon ; A. Chaléon ; S. Sourdet ; Y. Rolland ; M. Cesari ; B. Vellas (2017): How to Manage Frail Older Adults in the Community? Proposal of a Health Promotion Program Experienced in a City of 16,638 Inhabitants in France . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.47
IDENTIFYING EXOSOME-DERIVED MICRORNAS AS CANDIDATE BIOMARKERS OF FRAILTY
B.R. Ipson, M.B. Fletcher, S.E. Espinoza, A.L. Fisher
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Frailty is a geriatric syndrome associated with progressive physical decline and significantly increases risk for falls, disability, hospitalizations, and death. However, much remains unknown regarding the biological mechanisms that contribute to aging and frailty, and to date, there are no clinically used prognostic or diagnostic molecular biomarkers. The present study profiled exosome-derived microRNAs isolated from the plasma of young, robust older, and frail older individuals and identified eight miRNAs that are uniquely enriched in frailty: miR-10a-3p, miR-92a-3p, miR-185-3p, miR-194-5p, miR-326, miR-532-5p, miR-576-5p, and miR-760. Furthermore, since exosomes can deliver miRNAs to alter cellular activity and behavior, these miRNAs may also provide insights into the biological mechanisms underlying frailty; KEGG analysis of their target genes revealed multiple pathways implicated in aging and age-related processes. Although further validation and research studies are warranted, our study identified eight novel candidate biomarkers of frailty that may help to elucidate the multifactorial pathogenesis of frailty.
B.R. Ipson ; M.B. Fletcher ; S.E. Espinoza ; A.L. Fisher (2017): Strong Relationship between Malnutrition and Cognitive Frailty in the Singapore Longitudinal Ageing Studies (SLAS-1 and SLAS-2). The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.45
EDUCATING MEDICAL STUDENTS IN COUNSELLING OLDER ADULTS ABOUT EXERCISE: THE IMPACT OF A PHYSICAL ACTIVITY MODULE
A.D. Jadczak, K.L. Tam, R. Visvanathan
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Background: Exercise courses during medical school contribute to medical students’ confidence in promoting physical activity to their patients. However, there is still a lack of uniform physical activity education across medical school curricula to equip medical students with the necessary skills and knowledge to counsel their patients about exercise. Objective: To determine the effects of a 1.5-hour physical activity module including a one-hour exercise tutorial combined with a 30-minute practical counselling session on senior medical students’ perceptions of the importance of exercise and their perceived competence in advising older people about exercise. Design: Pre-post survey. Setting: University campus. Participants: 161 senior medical students taking part in the Queen Elizabeth Hospital Geriatric Medicine course in 2015 (control group) and 2016 (intervention group). Measurement: The modified Exercise and Physical Activity Competence Questionnaire (EPACQ) was administered before and after a 4.5-week Geriatric Medicine Course. Scores ranged from 1 (not important or competent) to 6 (very important or competent). The independent T-Test and repeated-measures ANOVA was used to determine differences between intervention and control group. Results: Medical students perceived exercise-related skills to be highly important (score ≥4) in both the intervention (4.85 ± 0.37) and control group (4.78 ± 0.67), pre-course. The overall perceived importance could not be significantly increased by the physical activity module (P=0.082). The physical activity module, however, improved medical students’ perceived competence in six out of ten exercise-related skills, and increased their overall perceived competence in counselling older people about exercise (P<0.001). Conclusion: A 1.5-hour physical activity module improves senior medical students’ perceived competence in counselling older people about exercise. This research proves that little teaching space is needed to impact positively on medical students’ exercise counselling abilities.
A.D. JADCZAK ; K.L. TAM ; R. VISVANATHAN ; (2017): EDUCATING MEDICAL STUDENTS IN COUNSELLING OLDER ADULTS ABOUT EXERCISE: THE IMPACT OF A PHYSICAL ACTIVITY MODULE . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.44
DEVELOPMENT OF THE NUTRITION AND FUNCTIONALITY ASSESSMENT (NFA) AMONG OLDER ADULTS IN JAPAN
Y. Okubo, M. Nemoto, Y. Osuka, S. Jung, S. Seino, R. Figueroa, G. Vinyes-Pares, E.A. Offord, M. Shevlyakova, D. Breuille, K. Tanaka
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Objective: Develop and evaluate the feasibility and validity of the Nutrition and Functionality Assessment (NFA) which identifies “target” older adults who could benefit from a personalized program following evaluation of their nutrition status and physical functionality. Design: Cross-sectional study. Setting: Community and geriatric day-care centers and university in Japan. Participants: 267 older adults aged 65-90. Measurements: The “target” individuals were screened based on gait speed (0.6-1.5 m/s). Nutrition (Mini Nutrition Assessment-short form and protein intake), strength (30s chair sit-to-stand and hand-grip strength) and endurance (6-minute walk) were assessed. Physical activity was monitored using a tri-axil accelerometer for a week. Fried frailty phenotype was also assessed. Results: Out of 267 individuals, 185 (69%) had gait speed between 0.6-1.5 m/s, corresponding to our “target” group from which, 184 (95%) completed the nutrition and physical functionality assessments with the physical activity monitoring. The NFA was completed in approximately 30 minutes. No adverse events directly due to the NFA were reported. NFA physical functionality and global scores were significantly related to frailty phenotype but nutrition score was not related to frailty phenotype. Conclusion: The study demonstrated that the NFA is a safe and feasible tool to screen target older adults and simultaneously evaluate their nutritional status and physical functionality. Validity of the NFA was partially confirmed by the significant association of the global and physical functionality scores with frailty phenotype. More studies are required to validate and maximize the applicability of the NFA in communities and institutions in Japan and elsewhere.
Y. Okubo ; M. Nemoto ; Y. Osuka ; S. Jung ; S. Seino ; R. Figueroa ; G. Vinyes-Pares ; E.A. Offord ; M. Shevlyakova ; D. Breuille ; K. Tanaka (2017): Development of the Nutrition and Functionality Assessment (NFA) among older adults in Japan . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.38
JFA N°01 - 2018
IMPLICATIONS OF ICD-10 FOR SARCOPENIA CLINICAL PRACTICE AND CLINICAL TRIALS: REPORT BY THE INTERNATIONAL CONFERENCE ON FRAILTY AND SARCOPENIA RESEARCH TASK FORCE
B. Vellas, R.A. Fielding, C. Bens, R. Bernabei, P.M. Cawthon, T. Cederholm, A.J. Cruz-Jentoft, S. del Signore, S. Donahue, J. Morley, M. Pahor, J.-Y. Reginster, L. Rodriguez Mañas, Y. Rolland, R. Roubenoff, A. Sinclair, M. Cesari, on behalf of the International Conference on Frailty and Sarcopenia Research Task Force
J Frailty Aging 2018;7(1):2-9Show summaryHide summary
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.
B. Vellas ; R.A. Fielding ; C. Bens ; R. Bernabei ; P.M. Cawthon ; T. Cederholm ; A.J. Cruz-Jentoft ; S. del Signore ; S. Donahue ; J. Morley ; M. Pahor ; J.-Y. Reginster ; L. Rodriguez Mañas ; Y. Rolland ; R. Roubenoff ; A. Sinclair ; M. Cesari ; on behalf of the International Conference on Frailty and Sarcopenia Research Task Force (2017): IMPLICATIONS OF ICD-10 FOR SARCOPENIA CLINICAL PRACTICE AND CLINICAL TRIALS: REPORT BY THE INTERNATIONAL CONFERENCE ON FRAILTY AND SARCOPENIA RESEARCH TASK FORCE . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.30
AN INTERNATIONAL POSITION STATEMENT ON THE MANAGEMENT OF FRAILTY IN DIABETES MELLITUS: SUMMARY OF RECOMMENDATIONS 2017
A.J. Sinclair, A. Abdelhafiz, T. Dunning, M. Izquierdo, L. Rodriguez Manas, I. Bourdel-Marchasson, J.E. Morley, M. Munshi, J. Woo, B. Vellas
J Frailty Aging 2018;7(1):10-20Show summaryHide summary
Aim: the the International Position Statement provides the opportunity to summarise all existing clinical trial and best practice evidence for older people with frailty and diabetes. It is the first document of its kind and is intended to support clinical decisions that will enhance safety in management and promote high quality care. Methods: the Review Group sought evidence from a wide range of studies that provide sufficient confidence (in the absence of grading) for the basis of each recommendation. This was supported by a given rationale and key references for our recommendations in each section, all of which have been reviewed by leading international experts. Searches for any relevant clinical evidence were generally limited to English language citations over the previous 15 years. The following databases were examined: Embase, Medline/PubMed, Cochrane Trials Register, Cinahl, and Science Citation. Hand searching of 16 key major peer-reviewed journals was undertaken by two reviewers (AJS and AA) and these included Lancet, Diabetes, Diabetologia, Diabetes Care, British Medical Journal, New England Journal of Medicine, Journal of the American Medical Association, Journal of Frailty & Aging, Journal of the American Medical Directors Association, and Journals of Gerontology - Series A Biological Sciences and Medical Sciences. Results: two scientific supporting statements have been provided that relate to the area of frailty and diabetes; this is accompanied by evidence-based decisions in 9 clinical domains. The Summary has been supported by diagrammatic figures and a table relating to the inter-relations between frailty and diabetes, a frailty assessment pathway, an exercise-based programme of intervention, a glucose-lowering algorithm with a description of available therapies. Conclusions: we have provided an up to date evidence-based approach to practical decision-making for older adults with frailty and diabetes. This Summary document includes a user-friendly set of recommendations that should be considered for implementation in primary, community-based and secondary care settings.
A.J. Sinclair ; A. Abdelhafiz ; T. Dunning ; M. Izquierdo ; L. Rodriguez Manas ; I. Bourdel-Marchasson ; J.E. Morley ; M. Munshi ; J. Woo ; B. Vellas (2017): An International Position Statement on the Management of Frailty in Diabetes Mellitus: Summary of Recommendations 2017. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.39
THE VICIOUS CYCLE OF MYOSTATIN SIGNALING IN SARCOPENIC OBESITY: MYOSTATIN ROLE IN SKELETAL MUSCLE GROWTH, INSULIN SIGNALING AND IMPLICATIONS FOR CLINICAL TRIALS
L.A. Consitt, B.C. Clark
J Frailty Aging 2018;7(1):21-27Show summaryHide summary
The age-related loss of skeletal muscle (sarcopenia) is a major health concern as it is associated with physical disability, metabolic impairments, and increased mortality. The coexistence of sarcopenia with obesity, termed ‘sarcopenic obesity’, contributes to skeletal muscle insulin resistance and the development of type 2 diabetes, a disease prevalent with advancing age. Despite this knowledge, the mechanisms contributing to sarcopenic obesity remain poorly understood, preventing the development of targeted therapeutics. This article will discuss the clinical and physiological consequences of sarcopenic obesity and propose myostatin as a potential candidate contributing to this condition. A special emphasis will be placed on examining the role of myostatin signaling in impairing both skeletal muscle growth and insulin signaling. In addition, the role of myostatin in regulating muscle-to fat cross talk, further exacerbating metabolic dysfunction in the elderly, will be highlighted. Lastly, we discuss how this knowledge has implications for the design of myostatin-inhibitor clinical trials.
L.A. Consitt ; B.C. Clark (2017): The vicious cycle of myostatin signaling in sarcopenic obesity: myostatin role in skeletal muscle growth, insulin signaling and implications for clinical trials. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.33
NEW SIMPLIFIED SCREENING METHOD FOR POSTPRANDIAL HYPOTENSION IN OLDER PEOPLE
R. Abbas, A. Tanguy, D. Bonnet-Zamponi, R. Djedid, A. Lounis, M.-L. Gaubert-Dahan
J Frailty Aging 2018;7(1):28-33Show summaryHide summary
Background: Postprandial hypotension (PPH) is an important disorder in the older people that remain underdiagnosed. The reference PPH diagnostic method is too demanding, because blood pressure (BP) needs to be measured 8 times in 2 hours. Objectives: Our primary objective was to define a new simplified PPH diagnostic method and to evaluate its performances. Design: We conducted a cross-sectional study. Setting: Two geriatric rehabilitation units in France. Participants: 104 patients (70 women, 34 men) with high risk of PPH were included. Measurements: BP was measured twice before the midday meal in seated position at the table, and every 15 minutes for 90 minutes after the end of the meal. Receiver Operating Characteristic curves were plotted for each postprandial BP measure to determine the best postprandial measure in terms of sensitivity and specificity. The optimal diagnostic threshold was calculated with Youden’s index according to BP difference before and after the meal. Results: A new simplified diagnostic method is proposed: a decrease of at least 10 mmHg systolic BP between BP measures before the meal and 75 minutes after the end of the meal. This new method had a sensitivity of 82% (95%CI 66 – 92) and a specificity of 91% (95%CI 81 – 97). Conclusion: This new diagnostic method is fast, efficient and suitable for everyday use. It could improve PPH diagnosis in older people. Larger studies are needed to validate it.
R. Abbas ; A. Tanguy ; D. Bonnet-Zamponi ; R. Djedid ; A. Lounis ; M.-L. Gaubert-Dahan (2018): New simplified screening method for postprandial hypotension in older people . The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.2
PRECIPITANTS OF DELIRIUM IN OLDER INPATIENTS ADMITTED IN SURGERY FOR POST-FALL HIP FRACTURE: AN OBSERVATIONAL STUDY
E. Levinoff, A. Try, J. Chabot, L. Lee, D. Zukor, O. Beauchet
J Frailty Aging 2018;7(1):34-39Show summaryHide summary
Background: Hip fractures precipitate several acute adverse outcomes in elderly people, thus leading to chronic adverse outcomes. Objectives: The objective of our study was to examine the clinical characteristics associated with incident delirium in community dwelling elderly individuals who have a hip fracture. Design: Retrospective observational cohort study. Setting: Data was collected from an academic tertiary hospital affiliated with McGill University. Participants: 114 elderly individuals who were above 65 years of age, who underwent surgery for a fractured hip. Measurements: The main outcome variable was incident delirium, which was assessed by chart reviews of notes and observations recorded by nurses and physicians when patients were admitted post operatively to the surgical unit. Covariates included age, sex, length of stay, delay to surgery, number of medical comorbidities, number of medications and hip fracture location, and were extracted from medical records. Baseline mobility and functional status, preoperative cognitive impairment, postoperative complications, regular psychotropic medications, psychotropic medications in hospital, and location of discharge were also assessed through chart review. Results: The results demonstrated that 17.5% of participants with a diagnosis of delirium had a longer length of hospitalization (p = 0.01), a lower baseline functional status (p = 0.03) and pre-operative cognitive impairment (p = 0.01). Patients receiving new psychotropic medications in hospital were more likely to have delirium (OR = 4.6, p = 0.01) which was independent of pre-operative cognitive impairment. Conclusion: We have shown that an association exists between psychotropic medication prescription and incident delirium in patients with hip fractures, even when adjusting for cognitive impairment. Hence, the prescription of psychotropic drugs should be judicious in these patients so as minimize the risk of adverse outcomes.
E. Levinoff ; A. Try ; J. Chabot ; L. Lee ; D. Zukor ; O. Beauchet (2017): Precipitants of delirium in older inpatients admitted in surgery for post-fall hip fracture: An observational study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.37
IMPACT OF SARCOPENIA ON ONE-YEAR MORTALITY AMONG OLDER HOSPITALIZED PATIENTS WITH IMPAIRED MOBILITY
M. Pourhassan, K. Norman, M. J Müller, R. Dziewas, R. Wirth
J Frailty Aging 2018;7(1):40-46Show summaryHide summary
Objectives: However, the information regarding the impact of sarcopenia on mortality in older individuals is rising, there is a lack of knowledge concerning this issue among geriatric hospitalized patients. Therefore, aim of the present study was to investigate the associations between sarcopenia and 1-year mortality in a prospectively recruited sample of geriatric inpatients with different mobility and dependency status. Design and setting: Sarcopenia was diagnosed using the criteria of the European Working Group on Sarcopenia in Older People (EWGSOP). Hand grip strength and skeletal muscle mass were measured using Jamar dynamometer and bioelectrical impedance analysis, respectively. Physical function was assessed with the Short Physical Performance Battery. Dependency status was defined by Barthel-Index (BI). Mobility limitation was defined according to walking ability as described in BI. The survival status was ascertained by telephone interview. Results: The recruited population comprised 198 patients from a geriatric acute ward with a mean age of 82.8 ± 5.9 (70.2% females). 50 (25.3%) patients had sarcopenia, while 148 (74.7%) had no sarcopenia. 14 (28%) patients died among sarcopenic subjects compared with 28 (19%) non-sarcopenic subjects (P=0.229). After adjustment for potential confounders, sarcopenia was associated with increased mortality among patients with limited mobility prior to admission (n=138, hazard ratio, HR: 2.52, 95% CI: 1.17-5.44) and at time of discharge (n=162, HR: 1.93, 95% CI: 0.67-3.22). In a sub-group of patients with pre-admission BI<60 (n=45), <70 (n=73) and <80 (n=108), the risk of death was 3.63, 2.80 and 2.55 times higher in sarcopenic patients, respectively. In contrast, no significant relationships were observed between sarcopenia and mortality across the different scores of BI during admission and at time of discharge. Conclusion: Sarcopenia is significantly associated with higher risk of mortality among sub-groups of older patients with limited mobility and impaired functional status, independently of age and other clinical variables.
M. Pourhassan ; K. Norman ; M. J Müller ; R. Dziewas ; R. Wirth (2017): Impact of sarcopenia on one-year mortality among older hospitalized patients with impaired mobility. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.35
PRELIMINARY STUDY ON PREVALENCE AND ASSOCIATED FACTORS WITH SARCOPENIA IN A GERIATRIC HOSPITALIZED REHABILITATION SETTING
K. Pongpipatpaiboon, I. Kondo, K. Onogi, S. Mori, K. Ozaki, A. Osawa, H. Matsuo, N. Itoh, M. Tanimoto
J Frailty Aging 2018;7(1):47-50Show summaryHide summary
The reported prevalence of sarcopenia has shown a wide range, crucially based on the diagnostic criteria and setting. This cross-sectional study evaluated the prevalence of sarcopenia and sought to identify factors associated with sarcopenia on admission in a specialized geriatric rehabilitation setting based on the newly developed the Asian Working Group for Sarcopenia algorithm. Among 87 participants (mean age, 76.05 ± 7.57 years), 35 (40.2%) were classified as showing sarcopenia on admission. Prevalence was high, particularly among participants ≥80 years old, with tendencies toward lower body mass index, smoking habit, lower cognitive function, and greater functional impairment compared with the non-sarcopenic group. Identification of sarcopenia in elderly patients before rehabilitation and consideration of risk factors may prove helpful in achieving rehabilitation outcomes.
K. Pongpipatpaiboon ; I. Kondo ; K. Onogi ; S. Mori ; K. Ozaki ; A. Osawa ; H. Matsuo ; N. Itoh ; M. Tanimoto (2017): Preliminary study on prevalence and associated factors with sarcopenia in a geriatric hospitalized rehabilitation setting. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.40
MUSCLE QUALITY IMPROVES WITH EXTENDED HIGH-INTENSITY RESISTANCE TRAINING AFTER HIP FRACTURE
R.A. Briggs, J.R. Houck, M.J. Drummond, J.M. Fritz, P.C. LaStayo, R.L. Marcus
J Frailty Aging 2018;7(1):51-56Show summaryHide summary
Background: Muscle mass deficits endure after hip fracture. Strategies to improve muscle quality may improve mobility and physical function. It is unknown whether training after usual care yields muscle quality gains after hip fracture. Objectives: To determine whether muscle quality improves after hip fracture with high-intensity resistance training and protein supplementation. Design: Case series. Setting: University of Utah Skeletal Muscle Exercise Research Facility. Participants: 17 community-dwelling older adults, 3.6+/-1.1 months post-hip fracture, recently discharged from usual-care physical therapy (mean age 77.0+/-12.0 years, 12 female), enrolled. Intervention: Participants underwent 12 weeks (3x/week) of unilaterally-biased resistance training. Methods/Materials: Participants were measured via a 3.0 Tesla whole-body MR imager for muscle lean and intramuscular adipose tissue (IMAT) of the quadriceps before and after resistance training. Peak isometric knee extension force output was measured with an isokinetic dynamometer. Muscle quality was calculated by dividing peak isometric knee extension force (N) by quadriceps lean muscle mass (cm2). In addition, common physical function variables were measured before and after training. Results: Surgical and nonsurgical lean quadriceps muscle mass improved among participants (mean change: 2.9 cm2+/-1.4 cm2, and 2.7 cm2+/-1.3 cm2, respectively), while IMAT remained unchanged. Peak force improved in the surgical limb by 43.1+/-23N, with no significant change in the nonsurgical limb. Significant gains in physical function were evident after training. Conclusion: Participants recovering from hip fracture demonstrated improvements in muscle mass, muscle strength, and muscle quality in the surgical limb after hip fracture. These were in addition to gains made in the first months after fracture with traditional care. Future studies should determine the impact that muscle quality has on long-term functional recovery in this population.
FRAILTY AND NEURODEGENERATIVE DISEASE: ANTICIPATING THE FUTURE, EXPANDING THE FRAMEWORK
J Frailty Aging 2018;7(1):57-59Show summaryHide summary
D.M. Lyreskog (2017): Frailty and neurodegenerative disease: Anticipating the future, expanding the framework. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2017.46
ICFSR: 8th International Conference on Frailty & Sarcopenia Research, March 1-3, 2018, Miami – USA
Symposia, Conference, Oral communication
J Frailty Aging 2018;7(S1):61-91Show summaryHide summary
Symposia ; Conference ; Oral communications (2018): ICFSR: 8th International Conference on Frailty & Sarcopenia Research, March 1-3, 2018, Miami – USA. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.3
ICFSR: 8th International Conference on Frailty & Sarcopenia Research, March 1-3, 2018, Miami – USA
Poster, ONLINE EXCLUSIVE
J Frailty Aging 2018;7(S1):92-173Show summaryHide summary
Poster (2018): ICFSR: 8th International Conference on Frailty and Sarcopenia Research, March 1-3, 2018, Miami – USA. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.4