01/2018 journal articles
MAXIMUM WALKING SPEED CAN IMPROVE THE DIAGNOSTIC VALUE OF FRAILTY AMONG COMMUNITY-DWELLING OLDER ADULTS A CROSS-SECTIONAL STUDY
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This study investigates the diagnostic accuracy of the combination of usual walking speed (UWS) and maximum walking speed (MWS) to identify frailty in community-dwelling older adults. A population-based study with 758 participants aged 65 and older was conducted. Frailty syndrome was determined using the Fried phenotype. UWS and MWS were evaluated in a 4.6-meter path. Both measures were categorized using the 1.0 m/s cut points, and participants were categorized into three groups: those with “very good”, “good” and “insufficient” walking reserve capacity (WRC). Of all participants, 9% were identified as frail and 47% as prefrail. The “insufficient” WRC presented a low sensitivity of 0.55, high specificity of 0.91 and moderately useful likelihood ratios (LR+ 6.57, LR- 0.48) to identify frailty. Based on Fagan’s nomogram, an elder’s corresponding post-test probability of being frail with an “insufficient” WRC would be around 40%, which substantially increased the diagnostic accuracy of frailty.
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.
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
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
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