A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission

Empowering Pre-Frail Older Adults: Assessing the Effects of a Community Nutrition Education Intervention on Nutritional Intake and Sarcopenia Markers

Background/Objectives: Early intervention combining nutrition optimisation with exercise can potentially prevent frailty progression and reverse pre-frailty in older adults. Methods: This 4-month study examined the effectiveness of nutrition education (without oral nutrition supplement use) as part of a multi-domain intervention on the nutritional status and intake of pre-frail community-dwelling older adults and its relationship with sarcopenia markers. Results: Amongst 172 participants (≥55 years), 5.8% were malnourished, with no significant change in nutritional status throughout the study. Post-intervention, participants consumed significantly higher daily calories, protein, protein per body weight (BW), and calcium (p < 0.001); protein intake at lunch (p = 0.001) and dinner (p = 0.004) also increased. However, 6-month post-intervention daily protein (p = 0.025), protein per BW (p = 0.039), and calcium (p = 0.015) decreased significantly. Sarcopenia markers (handgrip strength (HGS), five-time chair stand test (5STS), and short physical performance battery score (SPPB)) showed no significant difference post-intervention. Well-nourished participants had better HGS (p = 0.005), 5STS (p = 0.026), and SPPB (p = 0.039). Practical nutrition education effectively improved nutritional intake, but the effect was not sustained 6-months post-intervention. Conclusions: Optimising nutritional status with a focus on improving protein intake, especially at breakfast, to meet minimal intake to stimulate muscle protein synthesis can help prevent sarcopenia and frailty. Future studies should examine factors driving sustainable improvement to prevent frailty progression in this population.

Sex-based difference in functional performance and quality of life 1 year after supervised exercise training in patients with symptomatic peripheral artery disease

INTRODUCTION

The long-term effects of supervised exercise training (SET) on functional performance and health-related quality of life (HRQoL) in symptomatic peripheral artery disease (PAD) are poorly investigated, especially in women. This study investigated these outcomes 1 year after SET in both women and men.

METHODS

In this single-arm, prospective, nonrandomized study, patients with symptomatic PAD participating in the 3-month SET program were investigated. Functional performance (6-minute walking distance [6MWD], the stair-climbing test [SCT], and the short physical performance battery [SPPB]), and HRQoL (physical component summary [PCS] score of the Short Form-36 questionnaire) were assessed before and following SET, as well as at 6 and 12 months after SET completion.

RESULTS

Ninety patients (women: n = 30; men: n = 60) with chronic symptomatic PAD (ankle-brachial index 0.78 ± 0.22; mean age 65.4 ± 10.2 years) were included in the study. The 6MWD (women: before: 387.2 ± 88.6 m; after: 472.4 ± 57.0 m; 12 months: 469.9 ± 57.8 m; men: before: 431.7 ± 94.0 m; after: 477.5 ± 88.6 m; 12 months: 467.2 ± 73.4 m), SPPB score (women: before: 9.6 ± 2.4; after: 11.3 ± 1.0; 12 months: 11.2 ± 0.5; men: before: 10.6 ± 1.4; after: 11.5 ± 0.9; 12 months: 11.3 ± 0.8), and SCT (women: before: 8.6 ± 4.4 s; after: 5.6 ± 1.6 s; 12 months: 5.8 ± 1.2 s; men: before: 6.2 ± 2.3 s; after: 5.0 ± 1.9 s; 12 months: 5.3 ± 1.6 s) significantly improved over time (p ≤ 0.001), with no significant differences between women and men. The PCS score (women: before: 30.3 ± 8.0; after: 38.8 ± 8.4; 12 months: 35.7 ± 7.4; men: before: 32.4 ± 10.5; after: 35.7 ± 9.5; 12 months: 35.4 ± 7.6) significantly improved in women only (p = 0.020).

CONCLUSION

One year after SET, both women and men with PAD exhibit similar functional benefits, whereas HRQoL improvements were observed exclusively in women.

Effectiveness of HAPA-based multidomain fall risk management for older adults with declining intrinsic capacity in nursing homes: protocol of a randomised controlled trial

INTRODUCTION

Accidental falls are a common geriatric syndrome that hinders healthy ageing in older adults. Older adults who live in nursing homes (NHs) are at a greater risk of accidental falls than those who reside in communities. Intrinsic capacity (IC) decline has been shown to be an independent influencing factor for fall risk. Moreover, healthy behaviour is a prerequisite for IC. Therefore, this study considers IC as a starting point, with an aim of developing, implementing and evaluating a low-administration-cost multidomain fall risk management intervention programme based on the Health Action Process Approach.

METHODS AND ANALYSIS

The target population includes older adults with declining IC in Chinese NHs. A random lottery method will be adopted to divide the 100 participants into the control group and intervention group. The project will be conducted in three parts over 24 weeks. In the first part, a fall risk management intervention pathway and programme will be developed with the theoretical and IC framework, which will be refined via the Delphi method. In the second part, a randomised controlled trial will be implemented. The control group will receive usual care and health education, and the intervention group will complete a three-stage process to complete fall risk management behaviour intention and behaviour maintenance. In the third part, follow-up will be conducted to clarify the maintenance effectiveness of the programme in fall risk management. Behaviour change techniques and an interactive handbook will be used to increase the feasibility of the programme. The primary outcomes will include the IC composite score (cognition, locomotion, vitality, sensation and psychology) and fall risk. The secondary outcomes will include gait and balance, strength, fall efficacy, fall prevention self-management, fall management behaviour stages and healthy ageing. The outcomes will be assessed at baseline, and then after 4 weeks, 16 weeks and 24 weeks in both groups. The effectiveness of the intervention will be analysed via linear mixed models on a range of outcomes.

ETHICS AND DISSEMINATION

The trial was approved by the Huzhou University Committee (No.2023-06-06). The results will be submitted for publication in a peer-reviewed journal and presented at conferences.

TRIAL REGISTRATION NUMBER

NCT05891782.

Life-space mobility trajectory patterns and associated characteristics in older cancer survivors: a secondary data analysis

BACKGROUND

Life-space mobility (LSM) measures the size of the real-world geographic area an individual purposely transverses in their daily life. While older cancer survivors often have declines in LSM that negatively affects their quality of life, independence, and social engagement the factors that predispose to adverse outcomes are unknown. Understanding different patterns of LSM and its decline can help identify those needing support. The purpose of this study was to identify: (1) LSM trajectory patterns and (2) factors associated with those patterns in older cancer survivors.

METHODS

This paper reports a secondary data analysis of 153 participants with cancer ≥ 65 years from the University of Alabama Study of Aging. LSM was assessed using the UAB Life-Space Assessment-Composite score (LSA-C) at study entry and every 6 months for 96 months (LSA-C < 60 = restricted LSM). LSM trajectory patterns based on the LSA-C were determined using group-based trajectory analysis. A classification tree analysis revealed factors that predicted the trajectory patterns.

RESULTS

Participants (n = 153) were a mean age of 76.1 (SD 6.33), mostly male (58%), White (58%), married (55%) or widowed (37%), and had a diagnosis of prostate (37.3%), breast (20.3%), or colon (11.8%) cancer. Three LSM trajectory patterns were identified: (1) high start and stable (37.3%) with unrestricted LSM (LSA-C = 81.2) at study entry, which remained stable over time, (2) high start progressive decline (27.5%) with unrestricted LSM (LSA-C = 78.0) at study entry that progressively declined, and (3) low start progressive decline (35.3%) with restricted LSM level (LSA-C = 42.0) at study entry, which progressively declined. Each pattern was associated with a unique set of demographic and clinical characteristics. Baseline physical performance score was the most important predictor of the LSM trajectory patterns.

CONCLUSIONS

Three distinct LSM trajectory patterns, each with unique demographic and clinical characteristics, were identified. Because older cancer survivors have distinct LSM patterns, interventions should be tailored to address specific characteristics and clinical needs. LSM measurement can contribute to assessment of older adults generally and should become part of standard assessment in older cancer survivors.

Identifying Key Predictors of Sarcopenic Obesity in Italian Severely Obese Older Adults: Deep Learning Approach

Background/Objectives: Sarcopenic obesity (SO), the coexistence of sarcopenia and obesity, poses serious health risks, such as increased mortality. Despite its clinical significance, key predictors of SO remain unclear, especially in severe obesity. This study aimed to identify independent predictors of SO in Italian older adults with obesity using a deep learning neural network. Methods: A cross-sectional study was conducted with hospitalized older adults diagnosed with severe obesity. SO was defined according to the 2022 ESPEN/EASO Statement Criteria, based on skeletal muscle function assessed by the five-repetition sit-to-stand test (5-SST) and body composition parameters evaluated using Dual X-ray Absorptiometry. A total of 42 independent variables were analyzed. Data normalization was performed using MinMaxScaler, and an optimal neural network architecture was selected via grid search with stratified 5-fold cross-validation. Model performance was assessed using accuracy, precision, recall, F1-score, AUC-ROC, and AUPRC metrics. Results: The correlation analysis revealed strong negative associations between SO and handgrip strength (HGS) (r = -0.785) and appendicular lean mass (ALM) (r = -0.745), as well as moderate correlations with 5-SST (r = 0.603), 30-second chair stand test (r = -0.474), 6-minute walking test (6m-WT) (r = 0.289), and waist circumference (WC) (r = 0.127). The deep learning model achieved an average classification accuracy of 72%, with a precision of 83% and an AUC of 0.9333. Conclusions: The main key predictors of SO were HGS, ALM, 5-SST, 30s-SST, 6m-WT, and WC in the early detection of this condition. The findings highlight deep learning's potential to improve SO diagnosis, risk assessment, clinical decision-making, and prevention in severely obese older adults.

Assessing the effectiveness and cost-effectiveness of a smart home emergency call system: study protocol for a randomised controlled trial in Germany

INTRODUCTION

Falls can lead to serious health-related consequences in the older population. If an emergency occurs within the home environment of an older person living alone, the initiation of emergency care can be delayed, leading to even worse outcomes for this population. Smart home emergency call systems (HECSs) can detect falls and automatically trigger an emergency alarm, potentially reducing time to emergency care and improving outcomes. The INES (Intelligentes NotfallErkennungsSystem-smart emergency detection system) study is a prospective randomised controlled trial conducted in three German federal states that aims to investigate the effectiveness and cost-effectiveness of a smart HECS.

METHODS AND ANALYSIS

Following a telephone interview, individuals aged 70 years or older, living alone, at risk of falling and willing to participate are included in the study. Participants are assigned to one of two groups depending on their previous use of a HECS. Based on the sample size calculation, the study aims to recruit n=498 participants already using a standard HECS (group A) and n=1378 participants who have not used a HECS before (group B). Within both groups, participants are randomised into the intervention arm (IA) and control arm (CA). The IA receives a smart HECS during the 21-month follow-up period. In addition to a standard HECS with a base station and a wearable radio transmitter, the smart HECS includes sensors that can detect falls and automatically trigger an alarm. The primary outcome assessed will be the days spent in the hospital after an emergency admission. Secondary outcomes include the utilisation of healthcare services and their total costs, progression of care dependency, fear of falling (Falls Efficacy Scale-International), health-related quality of life (EQ-5D-5L) and well-being (ICEpop CAPability measure for Older people).

ETHICS AND DISSEMINATION

The design and conceptualisation of the INES study were approved by the ethics committee of the Hamburg Medical Association on 26 June 2023 (2023-101032-BO-ff). Results of the INES study will be published in peer-reviewed articles.

TRIAL REGISTRATION NUMBER

Deutsches Register Klinischer Studien, German Clinical Trials Register DRKS00031408. Registered on 28 June 2023.

Associations Between 10-Year Physical Performance and Activities of Daily Living Trajectories and Physical Behaviors in Older Adults

Physical function is likely bidirectionally associated with physical activity (PA), sedentary behavior (SB), and sleep. We examined trajectories of physical function as predictors of these behaviors in community-dwelling adults aged ≥65 y without dementia from the Adult Changes in Thought cohort. Exposures were trajectories of physical performance (short Performance-Based Physical Function [sPPF]) and self-reported activities of daily living (ADL) impairment. Outcomes were device-measured PA and SB and self-reported sleep. We fit linear mixed-effects models to define trajectory slopes and intercepts for each functional measure over the prior 10 years. We used multivariable linear regression to investigate the relationship between trajectory features and outcomes, using bootstrap confidence intervals. Participants (N = 905) were 77.6 (SD = 6.9) years old, 55% female, 91% white, and had a median sPPF score of 9 (IQR = [8, 11]) and median impairment of 1 ADL (IQR = [0, 2]) at the time of activity measurement (baseline). Steeper decreases in sPPF (0.3-unit, 25% of the range) were associated with fewer steps (-1180, 95% CI = [-2853, -185]) and less moderate-to-vigorous PA (-15.7 min/day [-35.6, -2.3]). Steeper increases in ADL impairment were associated with 35.0 min/day (4.3, 65.0) additional sitting time, longer mean sitting bout duration (3.5 min/bout [0.8, 6.2]), fewer steps (-1372 [-2223, -638]), less moderate-to-vigorous PA (-13 min/day [-22.6, -5.0]), and more time-in-bed (25.5 min/day [6.5, 43.5]). No associations were observed with light PA or sleep quality. Worsening physical function is associated with lower PA and higher SB, but not with light-intensity movement or sleep quality, supporting the bidirectional nature of the relationship between physical function and physical behaviors.

Reference values for handgrip strength, five times sit-to-stand and gait speed in patients on hemodialysis

BACKGROUND

Low levels of muscle strength and physical performance predict adverse clinical outcomes in patients on hemodialysis; however, reference values remain lacking. We described reference values for handgrip strength, five times sit-to-stand (STS-5) and 4-m gait speed in a large-scale sample of patients on hemodialysis.

METHODS

Baseline data from the SARCopenia trajectories and associations with adverse clinical outcomes in patients on HemoDialysis (SARC-HD) study were analyzed. Muscle strength was evaluated using handgrip strength and the STS-5, whereas physical performance was evaluated using usual 4-m gait speed before a midweek dialysis session. Sex- and age-specific smoothed reference curves for each test at the 3rd, 15th, 50th, 85th and 97th percentiles were constructed using generalized additive models for location shape and scale. Comparisons between sex and age were also performed.

RESULTS

Data from 1004 patients (39% female; 19-96 years; 49% ≥60 years) were analyzed. Declines in muscle strength and physical performance were observed with advancing age in both sexes. However, among males, muscle strength and performance were similar between 18 and 49 years of age. Males exhibited substantially greater performance in handgrip strength [10.3 kg, 95% confidence interval (CI) 9.1 to 11.4] and 4-m gait speed (0.10 s, 95% CI 0.05 to 0.14) compared with females. Older patients, independent of sex, exhibited poorer performance on most tests. Lower handgrip strength in the arm with arteriovenous fistula was observed in both sexes (males -2.3 kg, 95% CI -2.8 to -1.7; and females -2.1 kg, 95% CI -2.6 to -1.6).

CONCLUSION

Reference values obtained in this study may be used in clinical and research settings to identify patients on hemodialysis with low physical function according to sex and age. Future studies should test these reference values as potential predictors of adverse clinical outcomes.

Effects of S-ketamine on recovery quality in elderly patients with impaired intrinsic capacity after total knee arthroplasty: a single-centre, randomised, double-blind, placebo-controlled study protocol

INTRODUCTION

Elderly patients with impaired intrinsic capacity are at increased risk for delayed or suboptimal recovery from surgery. S-ketamine has been proven to improve postoperative recovery quality. However, limited trials are studying the postoperative recovery quality in elderly patients with impaired intrinsic capacity. Therefore, the objective of this study was to evaluate the impact of S-ketamine on the quality of recovery in elderly patients with impaired intrinsic capacity following total knee arthroplasty.

METHODS AND ANALYSIS

This is a single-centre, randomised, double-blind, placebo-controlled trial. Participants undergoing total knee arthroplasty will be randomly assigned in a 1:1 ratio to either the S-ketamine group (n=80) or the placebo group (n=80). The S-ketamine group will undergo an intravenous infusion of S-ketamine administered at a dosage rate of 0.2 mg·kg⁻1·h⁻1 for 1 hour. The placebo group will receive an intravenous saline infusion at an identical rate and duration. Postoperatively, the S-ketamine group will continuously infuse S-ketamine for 48 hours using a patient-controlled intravenous device, with a fixed rate of 0.01 mg·kg⁻¹·h⁻¹, a bolus dose of 0.02 mg·kg⁻¹, a lockout period of 10 min and a maximum infusion rate of 0.13 mg·kg⁻¹·h⁻¹. In contrast, the patient-controlled intravenous device for the placebo group will not contain S-ketamine. The primary outcome is the quality of recovery scores at 24 hours following total knee arthroplasty. Secondary outcomes encompass quality of recovery scores at 48 and 72 hours postoperatively, pain scores at rest and during movement, oral morphine equivalents, sleep quality assessments, depression scores, the Barthel Index and the time to meet discharge criteria.

ETHICS AND DISSEMINATION

Approval for the trial was granted by the Medical Ethics Committee of The Affiliated Hospital of Qingdao University (QYFYEC2024-74). Written informed consent will be obtained from each patient before enrolment. The results of this trial will be presented at scientific conferences and in peer--reviewed scientific journals.

TRIAL REGISTRATION NUMBER

ChiCTR2400087028.

Association between physical function and hospitalization among older patients with pre-dialysis chronic kidney disease after educational hospitalization: A single-center prospective cohort study

INTRODUCTION

This study aimed to investigate the factors associated with hospitalization in older patients with pre-dialysis CKD, including physical function.

METHODS

This single-center, prospective cohort study included 111 patients aged ≥65 years with stage 3-5 non-hemodialyzed CKD. Physical function was assessed using the short physical performance battery (SPPB), 10-m walk test, and grip strength test. Hospitalizations and reasons for readmission were tracked from discharge to the end of the follow-up period.

RESULTS

Kaplan-Meier analysis showed significant associations between rehospitalization and SPPB, 10-meter walk speed, and grip strength. The cutoff values predicting rehospitalization were 11 points for SPPB, 1.1 m/s for 10-meter walk speed, and 31 kg for grip strength. Multivariate Cox regression revealed that SPPB, hemoglobin, and estimated glomerular filtration rate (eGFR) were independently associated with rehospitalization risk.

CONCLUSIONS

SPPB may predict hospitalization in older pre-dialysis CKD patients, emphasizing the importance of screening and preventing physical function decline.

Aerobic Exercise Preconditioning Does Not Augment Muscle Hypertrophy During Subsequent Resistance Exercise Training in Healthy Older Adults

BACKGROUND

Resistance exercise training is an effective treatment strategy to counteract the age-related loss of muscle mass and strength in older adults. However, there is a large inter-individual variation in muscle fiber hypertrophy following resistance exercise training. It has been hypothesized that a less than optimal muscle fiber capillarization and perfusion capacity may compromise muscle hypertrophy during resistance exercise training in older adults.

OBJECTIVE

We assessed whether 8 weeks of aerobic exercise preconditioning, to improve muscle fiber capillarization and perfusion capacity, augments the gains in muscle mass and strength during subsequent resistance exercise training in older adults.

METHODS

In total, 34 healthy older males and females (71 years standard deviation (SD) ± 5 years) participated in 12 weeks of progressive resistance exercise training, preceded by either 8 weeks of aerobic preconditioning (AER, n = 17) through cycle-ergometer endurance training, or a no exercise control condition (CON, n = 17). Muscle strength (one repetition maximum (1RM)) and muscle fiber characteristics (histochemistry) were assessed at baseline, following 8 weeks of AER or CON, and after 12 weeks of resistance exercise training. Femoral artery blood flow and vastus lateralis muscle microvascular perfusion kinetics were assessed at baseline and following 8 weeks of AER or CON intervention. Thigh muscle volume (magnetic resonance imaging scan) was assessed before and after the 12 weeks of resistance exercise training.

RESULTS

Aerobic exercise preconditioning increased type I (+ 19 ± 19%, P < 0.05) and type II (+ 35 ± 37%, P < 0.05) muscle capillary-to-fiber ratio, with no changes in the CON group (type I: + 0 ± 17%; type II: - 3 ± 26%). Muscle microvascular perfusion following a submaximal resistance exercise stimulus was reduced following aerobic exercise preconditioning, whereas no changes were observed in the CON group (interaction effect, P = 0.051). Resistance exercise training increased leg press 1RM (+ 16 ± 10% versus + 12 ± 8%, respectively, P < 0.001) and thigh muscle volume (+ 0.42 ± 0.69 versus + 0.31 ± 0.62 L, respectively, P < 0.001) in both the AER and CON groups, with no differences between the groups. No differences were observed in type I and type II muscle fiber hypertrophy in response to the entire intervention program between groups (interaction effect, P > 0.5).

CONCLUSIONS

Aerobic exercise preconditioning increases type I and type II muscle fiber capillarization in healthy older adults. Aerobic exercise preconditioning does not further increase muscle hypertrophy during subsequent resistance exercise training in healthy older adults. Both structural and functional microvascular characteristics do not seem to restrict the skeletal muscle adaptive response to resistance-type exercise training in healthy older adults.

A phase division-based multi-segment foot model for estimating dynamic foot arch stiffness during walking

The arch of the human foot plays a significant role in bearing weight and keeping gait balance. Previous studies mainly focus on the foot arch stiffness at the static or quasi-dynamic state of a particular foot shape. The variation of the linear arch stiffness across the entire walking gait has rarely been reported. This work presents a phase division-based multi-segment foot model that considers plantar aponeurosis's tension force for calculating the dynamics of the medial longitudinal arch. Kinematics and ground reaction forces of 10 healthy young adults during walking are recorded and analyzed. The stiffness changes of the foot arch throughout the stance phase are calculated. The experimental results show that the foot arch experiences a stiff-compliant-stiff-compliant transition during a single stance phase, including an extremely low stiffness during the plantar contact phase. By comparing the foot arch stiffness results with those from previous studies, the accuracy of the proposed model is indirectly validated. This study presents a new approach to explore the variation of the linear stiffness of the foot arch across the entire stance phase during walking. The proposed multi-segment foot model provides a new method for solving foot dynamics that can be used for wearable sensing and assistive design and applications.

Improving and preserving cardiorespiratory fitness, muscle strength and adiposity through a complex lifestyle intervention in community-dwelling older adults with elevated cardiometabolic risk: study protocol for the RESTART randomised controlled trial

INTRODUCTION

As the global population ages, the incidence of cardiometabolic diseases and associated healthcare costs rise. There is a critical need for preventive interventions enabling long-lasting treatment effects to address the decline in physical performance and metabolic health among older adults. The RESTART (RE-inventing Strategies for healthy Ageing: Recommendations and Tools) randomised controlled trial (RCT) aims to evaluate whether a complex lifestyle intervention can improve and maintain cardiorespiratory fitness, muscle strength and body composition among older adults with elevated cardiometabolic risk.

METHODS AND ANALYSIS

This is the study protocol for the RESTART trial, a two-arm, open-label, parallel-group RCT conducted in Tromsø, Norway, targeting adults aged 60-75 with obesity, a sedentary lifestyle and high cardiovascular risk. Participants are block-randomised (1:1) into either an intervention or active control group. The initial intervention phase (12 months) includes: (a) supervised high-intensity aerobic and strength training (≥85% of maximum capacity) performed two times weekly, (b) behavioural counselling based on acceptance and commitment therapy during six group sessions and (c) dietary guidance based on national nutrition recommendations during two group/two individual sessions. After 12 months, participants are gradually introduced to exercise sessions offered by local organisations and fitness centres, to enable independent maintenance of lifestyle change. The primary outcome is a change in cardiorespiratory fitness (V̇O2max) at 24 months. Secondary and tertiary outcomes include additional parameters potentially sensitive to lifestyle change, such as 1-repetition maximum muscle strength, muscular power, device-measured physical activity levels, body composition, waist circumference, body weight, cognitive function and self-reported health-related quality of life. Data collection is scheduled at baseline, 6, 12 and 24 months, with health economic and qualitative analyses to evaluate the intervention's impact and participant experiences.

ETHICS AND DISSEMINATION

Ethical approval for the RESTART trial was obtained from the Regional Committee for Medical Research Ethics in Northern Norway. Results will be disseminated through peer-reviewed publications, conferences and community-based channels targeting older adults, healthcare providers and municipal health organisations. This trial will also inform public health strategies for lifestyle interventions among ageing populations.

TRIAL REGISTRATION NUMBER

NCT06122441.

Association of Cut-Point Free Metrics and Common Clinical Tests Among Older Adults After Proximal Femoral Fracture

Wearable and lightweight devices facilitate real-world physical activity (PA) assessments. MX metrics, as a cut-point-free parameter, evaluate acceleration above which the most active X minutes are accumulated. It provides insights into the intensity of PA over specific durations. This study evaluated the association of MX metrics and clinical tests in older adults recovering from proximal femoral fracture (PFF). Analyses were conducted on the PFF cohort from the baseline assessment of the Mobilise-D project using an accelerometer-based device. Participants (N = 396) were categorized into four recovery groups: acute, post-acute, extended recovery, and long-term recovery. Mobility capacity was assessed through the 6 min walking test (6MinWT), Short Physical Performance Battery (SPPB), 4-m walking test (4MWT), and hand grip (HG) strength. Mobility perception was evaluated using the Late-Life Function and Disability Instrument (LLFDI). Eight MX metrics (M1-M90) were calculated using the GGIR package in R. Results showed a moderate to strong positive correlation between M1 and M30 and lower limb mobility capacity tests and mobility perception (Lower Extremity domains) particularly in the extended and long-term recovery groups. MX metrics can be used for measuring PA intensity among older adults recovering from PFF. Hence, MX metrics have a high potential for clinical use as personalized PA targets in PFF rehabilitation.

Participation in life activities after hematopoietic cell transplantation in older adults

OBJECTIVES

This study aims to measure activity participation and describe barriers and goals for participation in older adults post-HCT.

MATERIALS AND METHODS

In a convergent mixed methods design, we quantitatively assessed four domains of participation (instrumental, low demand leisure, high demand leisure, and social) using the modified Activity Card Sort (ACSm) and described cognitive, physical, and psychosocial function using validated measures. Semi-structured interviews were used to describe barriers and goals for participation.

RESULTS

Eighteen participants with the median age of 66 years (range 60-75 years) completed the ACSm and interview. Seventeen of the 18 participants were > 6 months post-HCT and 44% of the total participants were > 12 months out from transplant. Overall, participants returned to 80% of their total activities. Mean retention was the highest in low-demand leisure activities (89%), followed by instrumental (85%), social (77%), and high-demand leisure activities (59%). Fatigue and impaired physical function were barriers for all activity domains. Participants discussed cognitive function as a barrier for many instrumental and low-demand leisure activities. Side effects, complications (i.e., osteoporosis and GVHD) and immune suppression were barriers to high-demand leisure activities. Participants talked about the meaning and purpose behind activity participation, highlighting the centrality of returning to life activities despite ongoing symptoms. There were multiple goals discussed related to activity participation.

CONCLUSION

Older adults undergoing HCT have diminished functional reserve and need more time to recover from activities that require sustained energy. Physical activity promotion programs targeting activity limitations and participation restrictions in cancer survivors are particularly salient for older adults undergoing HCT.

Resting state brain network segregation is associated with walking speed and working memory in older adults

Older adults exhibit larger individual differences in walking ability and cognitive function than young adults. Characterizing intrinsic brain connectivity differences in older adults across a wide walking performance spectrum may provide insight into the mechanisms of functional decline in some older adults and resilience in others. Thus, the objectives of this study were to: (1) determine whether young adults and high- and low-functioning older adults show group differences in brain network segregation, and (2) determine whether network segregation is associated with working memory and walking function in these groups. The analysis included 21 young adults and 81 older adults. Older adults were further categorized according to their physical function using a standardized assessment; 54 older adults had low physical function while 27 were considered high functioning. Structural and functional resting state magnetic resonance images were collected using a Siemens Prisma 3T scanner. Working memory was assessed with the NIH Toolbox list sorting test. Walking speed was assessed with a 400 m walk test at participants' self-selected speed. We found that network segregation in mobility-related networks (sensorimotor, vestibular) was higher in older adults with higher physical function compared to older adults with lower physical function. There were no group differences in laterality effects on network segregation. We found multivariate associations between working memory and walking speed with network segregation scores. The interaction of left sensorimotor network segregation and age groups was associated with higher working memory function. Higher left sensorimotor, left vestibular, right anterior cingulate cortex, and interaction of left anterior cingulate cortex network segregation and age groups were associated with faster walking speed. These results are unique and significant because they demonstrate higher network segregation is largely related to higher physical function and not age alone.

Clinical Tools to Diagnose Frailty in Women With Geriatric Urinary Incontinence

IMPORTANCE

Establishing an efficient and accurate frailty measure in older women with bothersome urinary incontinence (UI) is necessary because frailty increases the risk of UI treatment failure and postoperative morbidity.

OBJECTIVE

This study aimed to primarily observe associations between the clinical frailty measure of gait speed and the electronic frailty index (eFI) to determine if the eFI may be a proxy in determining presence of frailty in older women with moderate-to-severe UI symptoms.

STUDY DESIGN

This was a secondary data analysis of a prospective cohort study of women, older than 70 years, seeking treatment for UI between 2016 and 2023. Participants underwent functional geriatric assessment to determine 4-m gait speed, chair stand pace, and UI symptom assessment. Participants with ≥2 UI episodes per day defined severe UI symptoms present with geriatric UI. Those with <2 UI episodes per day defined controls. Univariate analyses compared clinical and functional characteristics based on UI severity. Spearman rank correlated the association between the eFI, UI severity, and functional geriatric impairments. Logistic regression analyses determined the odds of having severe UI based on eFI frailty risk, adjusted for age and body mass index (BMI).

RESULTS

Eighty-one participants were included. The eFI was negatively correlated with gait speed ([r] = -0.29, P = 0.02) and did not correlate with chair stand pace. The eFI did not correlate with UI severity ([r] = 0.05, P = 0.74). The odds of having severe UI and at least mild frailty risk based on the eFI was OR of 1.15 (95% CI, 0.71-1.88]).

CONCLUSION

The eFI may have limited clinical utility in frailty risk assessment in women with geriatric UI.

Reliability and validity of a full-body function Get-Up test in older adults

Identifying deficiencies in physical function in older adults is critical to evaluate important health outcomes like sarcopenia, but current protocols are expensive and require complex equipment. This study evaluates the reliability and validity of an inexpensive, simple new Get-Up test in older adults. It involves participants moving quickly from standing upright, to lying flat, then rising to a standing position unassisted. A total of 293 relatively healthy older adults without severe health conditions (e.g., cardiovascular, psychological, degenerative, or physical impairments) completed the Get-Up test twice for familiarization and twice for timed trials on two separate days alongside numerous validated clinical tests commonly used to assess strength, function, and fitness in older adults. ANOVA with post-hoc analysis and intraclass correlation (0.928 (95% CI [0.914, 0.940])) indicated strong reliability, with the second timed trial comparable to trials on a separate day. The Get-Up test was significantly (p <.0001) negatively correlated with all referenced measures of strength (Biodex peak torque, r = -.41, 1-repetition maximum, r = -.26, handgrip, r = -.38) and function (Short Physical Performance Battery, r = -.49, gait speed, r = -.39) and significantly (p <.0001) positively correlated with fitness (400-m walk, r =.70), which strongly predicted Get-Up test performance, suggesting good validity. Poor performance was associated with baseline sarcopenia prevalence (bottom tertile vs. top tertile: odds ratio 3.99 (95% CI 1.64-9.67)) and sarcopenia incidence after 1-year follow-up (hazard ratio 3.47 (1.10, 10.98)), suggesting potential to evaluate sarcopenia. This simple and safe Get-Up test requires minimal equipment, personnel, and expertise, yet it has good reliability and validity as a potential novel tool for full-body physical function in older adults that is associated with sarcopenia prevalence and incidence.

Markers of Inflammation and Hypofibrinolysis Are Associated with Cognitive Dysfunction and Motor Performances in Atrial Fibrillation Patients on Oral Anticoagulant Therapy: Insights from the Strat-AF Study

Background: Atrial fibrillation (AF) is the most common supraventricular arrythmia and one of the most commonly encountered heart conditions in clinical practice. Emerging evidence suggests a significant role of inflammation in the pathogenesis of AF. Population studies have also suggested an association between AF and cognitive impairment and dementia. The aim of this study is therefore to assess, in a population of AF patients on oral anticoagulant therapy, the association between circulating biomarkers involved in the pathogenesis of AF and the cognitive and motor performances of the enrolled patients. Methods: The Strat-AF study is an observational, prospective, single-center, hospital-based study enrolling elderly patients with AF. Results refer to 180 subjects who underwent a complete clinical, biohumoral, cognitive, and functional evaluation. Results: At multivariate logistic regression, Clot Lysis Time (CLT) and circulating levels of von Willebrand Factor (vWF) remained significantly associated with pathological performances at the Stroop test (expressed as execution time) [OR 95% CI 1.54 (1.02-2.35), p = 0.042 and 1.75 (1.08-2.82), p = 0.023, respectively]. With regard to the Short Physical Performance Battery (SPPB), the circulating levels of IL-8 remained significantly associated with the clinical endpoint [OR 95% CI 2.19 (1.13-4.25), p = 0.020]. Conclusions: Our results suggest a potential innovative tool able to identify AF patients at risk of worse prognosis in terms of cognitive and motor performances. The clinical relevance of these results is due to the fact that we have no efficient methods to predict a deterioration in the cognitive performance and, consequently, the possible onset of dementia in AF patients undergoing oral anticoagulant therapy.

Assessment of Gait Parameters Using Wearable Sensors and Their Association With Muscle Mass, Strength, and Physical Performance in Korean Older Adults: Cross-Sectional Study

Background

Gait speed indicates the onset or decline of physical performance in sarcopenia. However, real-time measurements of other gait parameters, such as step length, stride length, step width, and support time, are limited. The advent of wearable technology has facilitated the measurement of these parameters, necessitating further investigation into their potential applications.

Objective

This study aimed to investigate the relationship between gait parameters measured using wearable sensors and muscle mass, strength, and physical performance in community-dwelling older adults.

Methods

In a cross-sectional study of 91 participants aged ≥65 years, gait parameters, such as step count, step length, cadence, single and double support times, vertical oscillation, and instantaneous vertical loading rate (IVLR), measured using a wireless earbud device, were analyzed on the basis of the appendicular skeletal muscle mass index (SMI), calf circumference, handgrip strength, 5-time chair stand test, short physical performance battery (SPPB), and the SARC-F (strength, assistance with walking, rise from a chair, climb stairs and fall frequency) questionnaire. This study was conducted from July 10 to November 1, 2023, at an outpatient clinic of a university hospital in Seoul, Korea. Multiple regression analysis was performed to investigate independent associations after adjusting for age, sex, BMI, and comorbidities.

Results

Among 91 participants (45 men and 46 women; mean age 74.1 years for men and 73.6 years for women), gait speed and vertical oscillation showed negative associations with their performance in the 5-time chair stand test (P<.001) and SARC-F and positive associations with their performance in the SPPB (P<.001). Vertical oscillations were also associated with grip strength (P=.003). Single and double support times were associated with performance in the 5-time chair stand test and SPPB (P<.001). In addition, double support time was associated with SARC-F scores (P<.001). Gait speed, support time, vertical oscillation, and IVLR showed independent associations with performance in the 5-time chair stand test and SPPB (P<.001), both related to muscle strength or physical performance. Gait speed, double support time, and vertical oscillation all had significant associations with SARC-F scores.

Conclusions

This study demonstrated a significant association between gait monitoring using wearable sensors and quantitative assessments of muscle strength and physical performance in older people. Furthermore, this study substantiated the extensive applicability of diverse gait parameters in predicting sarcopenia.

Effectiveness of an Early Intervention in Mild Hyponatremia to Prevent Accidental Falls in Hospitalized Older Adults-A Crossover Ecological Clinical Trial

Background: Falls in hospitalized patients cause injuries of varying severity and even death. There is a link between falls and low blood sodium levels in older patients. Identifying and treating hyponatremia could help prevent falls and reduce hospital stays. The purpose of this study was to evaluate the effectiveness of the correction of hyponatremia on reducing the incidence of falls and the mean stay of hospitalized patients aged more than 65 years. Methods: A crossover ecological clinical trial was conducted in adult hospitalization units of a hospital in Madrid (Spain) over 12 months. Patients meeting inclusion criteria were divided into two randomized groups. The intervention was applied in two six-month phases, alternating between groups with a 15-day washout period. Early diagnosis and treatment of hyponatremia were implemented in the intervention group, while the control group received standard care. Primary outcomes included fall incidence and length of hospital stay. Data were collected using REDCap and analyzed with SPSS v.21. Statistical significance was set at p < 0.05 (ClinicalTrials identifier of the manuscript: NCT03265691). Results: A total of 1925 patients were included (408 intervention, 1517 control). Fall incidence was significantly lower in the intervention group (6.7 vs. 9.8, p = 0.000). Hyponatremia was corrected in 72% of cases. No significant differences were found in functional scores. The intervention effectively reduced falls compared to standard care. Conclusions: Early hyponatremia treatment reduces falls and hospital stay in older patients, supporting its inclusion in fall prevention strategies.

Low-volume resistance training: a feasible, cost-effective strategy for musculoskeletal frailty in older adults attending daycare centers

Introduction

Frailty is a prevalent geriatric syndrome, posing significant health risks for older adults attending daycare centers or residing in institutional settings. Addressing frailty with interventions that are feasible and cost effective and also promote high adherence within these environments is crucial.

Objective

This study aimed to evaluate the impact of a low-volume, remotely supervised resistance training protocol on physical frailty among frail older adults attending daycare centers. Secondary outcomes included changes in sarcopenia prevalence and fall risk.

Methods

Thirty-one frail older adults participated in a 12-week usual care period, followed by a 12-weeks intervention featuring low-volume (10-minute sessions) resistance training three times weekly. The program was delivered locally by non-specialized staff under remote supervision. Musculoskeletal, functional, and clinical assessments were conducted at three-time points: baseline, pre-intervention, and post-intervention.

Results

During the usual care period, a decline was observed in handgrip strength (19.2-18.5 kg) and sit-to-stand time (14.5-17.4s) (p < 0.05). However, these measures were preserved during the intervention. Relative muscle power decreased during the usual care but improved with training (4.3-5.2 W/Kg, p < 0.001). While body composition, physical function, gait speed, and Short Performance Physical Battery scores remained stable, reductions were observed in exhaustion and physical inactivity prevalence (p < 0.05). Frailty prevalence showed a decreasing trend (48%-26%, p = 0.099), with significant reductions in sarcopenia prevalence (29%-10%, p = 0.045), and fall frequency (p = 0.022).

Conclusion

The low-volume strength training protocol was a feasible, cost-effective strategy for mitigating musculoskeletal frailty criteria, sarcopenia and fall risk among older adults in daycare centers, potentially delaying the progression of these conditions.

Easy-to-Use Guidelines on Protein Intake and Physical Activity Recommendations Derived from the COGFRAIL Study and the Toulouse Frailty Clinic

BACKGROUND/OBJECTIVES

In primary care, tailored physical activity and nutritional counselling are scarce for older adults. Several challenges contribute to this issue, the primary obstacle being limited access to expert healthcare providers. The purpose of this study was to propose a quick, easy-to-implement case-finding tool offering straightforward nutritional and physical activity counselling to overcome these barriers.

METHODS

Cross-sectional, baseline analysis was performed on 277 participants of the Cognitive Function and Amyloid Marker in Frail Older Adults (COGFRAIL) study, aged 70 years and older with mild cognitive impairment (mini-mental state examination score ≥ 20) and autonomy in daily living activities (ADL ≥ 4). Body composition was assessed using dual-energy X-ray absorptiometry, physical function was assessed using the short physical performance battery (SPPB), and nutrition was assessed using the mini nutritional assessment (MNA). A structured dietary interview was conducted to collect data on a typical daily intake pattern. A second database of 725 autonomous frail older adults from the Frailty clinic was used to test the robustness of the findings.

RESULTS

Participants with MNA scores < 24/30 and SPPB scores < 6/12 presented a high percentage of protein (74.1%) and caloric (66.7%) deficiency compared to the other categories. Based on standard daily protein and caloric recommendations, age, and weight, this category had a daily protein-caloric deficit of -19.4 ± 22.7 g and -225.5 ± 430.1 Kcal.

CONCLUSIONS

Based on the data, an easy-to-use algorithm using MNA and SPPB scores is suggested. This algorithm could serve as an effective tool for guiding nutritional and physical activity counselling for community-dwelling older adults.

Returning Individualized Wearable Sensor Results to Older Adult Research Participants: A Pilot Study

BACKGROUND

Wearable sensors that monitor physical behaviors are increasingly adopted in clinical research. Older adult research participants have expressed interest in tracking and receiving feedback on their physical behaviors. Simultaneously, researchers and clinical trial sponsors are interested in returning results to participants, but the question of how to return individual study results derived from research-grade wearable sensors remains unanswered. In this study, we (1) assessed the feasibility of returning individual physical behavior results to older adult research participants and (2) obtained participant feedback on the returned results.

METHODS

Older adult participants (N = 20; ages 67-96) underwent 14 days of remote monitoring with 2 wearable sensors. We then used a semiautomated process to generate a 1-page report summarizing each participant's physical behaviors across the 14 days. This report was delivered to each participant via email, and they were asked to evaluate the report.

RESULTS

Participants found the reports easy to understand, health-relevant, interesting, and visually pleasing. They had valuable suggestions to improve data interpretability and raised concerns such as comparisons with measures derived from their consumer-grade sensors.

CONCLUSIONS

We have demonstrated the feasibility of returning individual physical behavior results from research-grade devices to older research participants, and our results indicate that this practice is well-received. Further research to develop more efficient and scalable systems to return results to participants, and to understand the preferences of participants in larger, more representative samples, is warranted.

Intrinsic Capacity Trajectories: Implications for Subsequent Falls and Hospitalizations Among Older Adults

BACKGROUND

Intrinsic capacity (IC) is the composite of an individual's physical and mental capacities. However, the association between IC trajectories and falls and hospitalizations remains uncertain. This study aimed to determine the IC trajectories among older adults, investigating its association with subsequent risk of falls and hospitalizations.

METHODS

This study enrolled 3 902 older adults aged ≥65 from the National Health and Aging Trends Study (Wave 2015-2019). A bifactor model was used for repeated measurements of the 5 IC domains to generate IC scores for 4 time points (Wave 2015-2018). IC trajectories were identified using group-based trajectory modeling, and modified Poisson regression was used to analyze the associations between IC trajectories and subsequent fall and hospitalization risk.

RESULTS

The mean age of the participants was 76.70 years (standard deviation = 6.78), and the majority were female (57.3%). Three IC trajectories were identified, including persistently low (17.86%), persistently moderate (33.96%), and persistently high (48.18%). Compared with the persistently low class, the moderate and high classes have significantly lower fall and hospitalization risks. Multivariate-adjusted rate ratios fall occurrence were 0.87 (95% confidence interval [CI]: 0.78-0.98) and 0.74 (95% CI: 0.65-0.85), for multiple falls were 0.81 (95% CI: 0.68-0.96) and 0.52 (95% CI: 0.41-0.66), for hospitalization occurrence were 0.76 (95% CI: 0.66-0.87) and 0.48 (95% CI: 0.39-0.58), and for multiple hospitalizations were 0.65 (95% CI: 0.53-0.80) and 0.37 (95% CI: 0.28-0.48), respectively.

CONCLUSIONS

IC trajectories were associated with falls and hospitalizations. Strategies focusing on improving and maintaining IC at a higher level over time could help reduce the subsequent risk of falls and hospitalizations.

Effects of a multicomponent training and a detraining period on cognitive and functional performance of older adults at risk of frailty

AIMS

This study analyzes the effects of a 6-month multicomponent exercise program (MCT) followed by a 4-month detraining period on functional and cognitive status in pre-frail and frail older adults.

METHODS

A total of 108 pre-frail and frail adults aged 65 and older participated in the study. They were assigned by convenience to either a control group (CG) or an intervention group (IG). The IG underwent a 6-month MCT followed by a 4-month detraining period. Assessments included a DT test, the Timed Up and Go (TUG) test, the Mini-Mental State Examination (MMSE), and evaluations of basic and instrumental activities of daily living. Data were analyzed using repeated-measures ANOVA.

RESULTS

Significant group-by-time interactions were observed for the DT test (p < 0.05). The IG showed improved DT performance after the 6-month MCT (4.0, 95% CI: 2.2 to 5.7 s), followed by a decline after the detraining period (-1.1, 95% CI: -2.1 to -0.2 s). However, performance after detraining remained higher than at baseline (2.9, 95% CI: 1.0 to 4.6 s, p < 0.05). No statistically significant changes were observed in the CG. Additionally, no significant effects were found for MMSE scores or daily activity questionnaires.

CONCLUSION

MCT had beneficial effects on functional and cognitive performance in older adults, as assessed by the DT test. However, improvements in DT performance did not translate into better daily life activities. Although the 4-month detraining period negatively impacted DT performance, the results remained superior to baseline levels.

TRIAL REGISTRATION NUMBER

NCT03831841 and date of registration: 5th of November 2018.

WHO ICOPE Programme Adherence of 8672 Older Age People Over 2-Years of Follow-Up

AIM

To compare the characteristics of participants who discontinued prematurely with those who remained in the ICOPE program (Integrated Care for Older PEople) in France and to compare completely adherent participants with partially adherent ones after 2 years of follow-up.

DESIGN

Retrospective observational study.

METHODS

We analysed the data of older age people participating during 2 years from the ICOPE MONITOR database. The study compared the population that discontinued follow-up with the population currently in follow-up. Among the population in follow-up, a comparison was made between the completely adherent and partially adherent populations.

RESULTS

In total, 8672 participants had a follow-up period of at least 2 years. After 2 years, three-quarters of the participants were still in follow-up with varying levels of adherence. Participants who discontinued follow-up are older and had more compromised Step 1 levels across all domains of intrinsic capacity (IC). Partially adherent participants were older and generally more compromised in IC than completely adherent participants. Those participants least adherent to ICOPE presented higher declines in clinical parameters.

CONCLUSION

Among autonomous older age people, the most impaired in intrinsic capacity domains and aged participants were more likely to discontinue follow-up, highlighting the need to focus efforts on this group. On the other hand, younger robust and healthier older age people represent a good target for ICOPE program, in terms of adherence and primary prevention.

REPORTED METHOD

EQUATOR guidelines: STROBE.

PATIENT OF PUBLIC CONTRIBUTION

No patient or public contribution.

A Prospective Controlled Study on the Longitudinal Effects of Rehabilitation in Older Women with Primary Sarcopenia

Sarcopenia, defined as a progressive loss of skeletal muscle mass, strength, and function, is a leading contributor to disability, dependence, and reduced quality of life (HRQoL) in older adults. This study aimed to evaluate the impact of a personalized six-month rehabilitation program, centered on tailored kinetic therapy, on physical performance and HRQoL in older women with primary sarcopenia.

METHODS

This prospective controlled study included 80 women aged ≥65 years, allocated into a Study Group (SG, n = 40), who followed a supervised personalized kinetic program, and a control group (CG, n = 40), who received general advice regarding physical activity and nutrition. Physical performance was measured using the short physical performance battery (SPPB), while HRQoL was assessed with the disease-specific SarQoL questionnaire. Evaluations were conducted at baseline and after six months.

RESULTS

At baseline, both groups had comparable scores (SPPB: SG = 5.75 ± 0.86 vs. CG = 5.8 ± 0.88, p = 0.798; SarQoL: SG = 54.42 ± 8.76 vs. CG = 55.59 ± 4.61, p = 0.457). After six months, the SG showed significant improvements (SPPB = 8.05 ± 0.90, p < 0.001; SarQoL = 62.55 ± 7.00, p < 0.001). Significant gains were observed in domains related to physical and mental health, locomotion, functionality, and leisure activities (p < 0.05). In contrast, the CG showed only minor, non-significant changes (SPPB = 6.17 ± 0.78; SarQoL = 56.51 ± 5.51).

CONCLUSIONS

A structured, personalized kinetic program significantly improves physical performance and HRQoL in older women with primary sarcopenia. These results support the need for individualized, supervised rehabilitation programs in optimizing functional recovery and enhancing patient-centered outcomes in sarcopenia management.

Implications of intrinsic capacity subtypes for post-PCI patients older than 45

We aim to explore the contributing factors to intrinsic capacity (IC) in middle-aged and older patients after percutaneous coronary intervention (PCI). Intrinsic capacity comprises six core domains: cognition, locomotion, vitality, psychology, vision, and hearing. Each domain was assessed in detail using different scales, based on which the composite IC score was calculated. The study employed latent class analysis (LCA) to identify the various IC subtypes. Logistic regression analyses were used to determine the effect variables of IC subtypes. 318 middle-aged and older post-PCI patients filled out the assessments. Three distinct IC subtypes were found: 47.8% poor audition-vision group (class 1), 38% high cognition-psychology group (class 2), and 14.2% low locomotion-vitality group (class 3). The IC subtype classification may be impacted by factors such as cTnI, NT proBNP, cardiac function, exercise frequency, and comorbidities. Examining IC subtypes may be helpful for focused intervention, and further empirical research is still needed to determine their drivers.

Willingness to engage in self-care impacts clinical outcomes at discharge in hospitalized pneumonia patients: a descriptive study

BACKGROUND

The objective of this study was to evaluate the association between willingness to engage in self-care and clinical outcomes in patients hospitalized with community-acquired pneumonia (CAP).

METHODS

An observational study in patients hospitalized with CAP was conducted. Patients were divided into two groups according to the willingness to engage in self-care, that was assessed with the Patient Activation Measure (PAM). Participants with scores ≤ 47.0 points were included in the unwillingness to engage in self-care group, and patients with PAM score > 47 points were included in the willingness to engage in self-care group. Main variables were assessed at hospital discharge and included clinical symptoms (cough, dyspnea, pain and fatigue), physical status, activity levels, psychological inflexibility and restrictions in daily life activities and social participation.

RESULTS

A total of 66 patients were included in the study (34 in the patients unwilling to engage and 32 in the patients willing to engage). Significant differences were found in clinical symptoms, psychological inflexibility, and restrictions in daily life activities and social participation in favor to patients' willingness to engage in self-care at hospital discharge.

CONCLUSIONS

Patients with CAP willing to engage in self-care showed improvements in clinical symptoms, psychological flexibility, and fewer limitations in daily activities and social participation at discharge.

Impact of medication use on olfactory performance in older adults

Introduction

Olfactory dysfunction impacts quality of life, safety, and nutrition. Despite its relevance among older adults, the role of medications in influencing olfactory performance remains understudied. This research investigates whether olfactory alterations in older adults are associated with the type or number of medications prescribed.

Methods

An observational cross-sectional study was conducted with 107 participants (mean age of 86.1 ± 5.1 years). Olfactory performance was evaluated using the Sniffin' Sticks Test (SST). Functional capacity, cognitive function and the number and type of medications were also assessed.

Results

The analysis demonstrated a correlation between better olfactory performance and higher cognitive function. An inverse correlation was found between the age of participants and olfactory identification. While polypharmacy (intake of five or more medications) did not show a significant association with olfactory dysfunction, the intake of laxatives was associated with poorer olfactory threshold performance (-1.21, 95% CI -2.07 to -0.34; p = 0.008). In contrast, proton pump inhibitors (PPIs) (1.14, 95% CI 0.07 to 2.21; p = 0.04) and vitamin D (1.09, 95% CI 0.03 to 2.15; p = 0.04) intake were linked to improved olfactory identification.

Discussion

These findings suggest that certainmedications influence olfactory performance; however, further research is needed to clarify the effects of different drug classes on olfaction.

Muscle power predicts frailty and other adverse events across different settings

OBJECTIVES

To evaluate the association between lower-limb muscle power (MP) and frailty, measured using eight different scales, in older adults from four clinical settings. Additionally, to examine the predictive capacity of MP for adverse health events.

DESIGN

A cross-sectional and longitudinal analysis using data from the Spanish cohort of the Frailtools project.

SETTING

Nursing homes, primary care clinics, geriatric inpatient wards, and outpatient clinics.

PARTICIPANTS

245 older adults (mean age 82 ± 4.6 years, 64% women).

MEASUREMENTS

MP measures were estimated using the five-time sit-to-stand (5STS) test and validated equations to obtain absolute (AMP), relative to body weight (RMP), and allometric (ALMP) values. Frailty was evaluated using eight scales, including the Frailty Phenotype and the Frailty Trait Scale. The incidence of adverse events (e.g., frailty, hospitalization, falls, and disability) was recorded over 12 months.

RESULTS

Frailty prevalence varied significantly across scales and settings, with the lowest rates observed in primary care and the highest in nursing homes. Cross-sectional analysis revealed significant associations between all MP measures and frailty for most scales. RMP demonstrated the strongest associations, particularly with the Frailty Trait Scale-5 and FRAIL scale, across primary care, nursing homes, and outpatient clinics. Longitudinally, RMP was significantly associated with incident frailty and several adverse events, including hospitalizations (AUC: 0.71) and disability in activities of daily living (AUC: 0.71). Sex-specific MP cut-off points were identified for predicting health events. No significant differences were observed among MP measurements.

CONCLUSION

Lower-limb MP is a valid clinical biomarker associated with frailty and negative health events in older adults. The degree of associations varied according to frailty scale and clinical context, but no significant differences were observed when we compared their predictive ability. The proposed MP cut-off points may enhance frailty assessment and screening, particularly in primary care, nursing homes, and outpatient clinics. These findings highlight the clinical potential of incorporating MP measures into frailty tools and stress the need for further research to refine age-specific cut-off points and explore the influence of body composition.

Effects of Taekwondo training on thigh muscle cross-sectional area, health-related physical fitness, HbA1c, and GLP-1 in sedentary older women

Background

Sedentary lifestyles in older individuals are associated with reduced physical function and an increased risk of metabolic diseases such as type 2 diabetes. Physical exercise can enhance muscle mass, insulin sensitivity, and metabolic health. Taekwondo, a martial art that integrates both aerobic and resistance components, may improve strength, balance, and metabolic health in older individuals. This study investigated the effect of long-term Taekwondo training on thigh muscle cross-sectional area, health related physical fitness, and metabolic indicators in sedentary older women.

Methods

Seventeen participants (aged 65 years and older, sedentary time 8 h and more per day) were randomly assigned to a Taekwondo group (n = 9) and a control group (n = 8). Outcomes, including thigh muscle cross-sectional area, health-related physical fitness, Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), and Glucagon-like peptide-1 (GLP-1) were measured before and after the Taekwondo program. The Taekwondo group underwent 60 min of training, three times per week for 12 weeks. Variable changes over time and between groups were analyzed using two-way repeated measures ANOVA performed for significant interactions.

Results

The Taekwondo group exhibited a significant reduction in body weight, body mass index, body fat, and mean arterial blood pressure (p < 0.05), as well as increased thigh muscle cross-sectional area, lean body mass and lower limb muscle mass (p < 0.05). Improvements in balance and gait speed, stride were observed (p < 0.05), indicating reduced fall risk and enhanced mobility. Laboratory analyses revealed reduced triglyceride and free fatty acids and elevated HDL-cholesterol and GLP-1 levels (p < 0.05). Increased thigh muscle cross-sectional area was inversely correlated with fasting glucose, insulin, and HOMA-IR, suggesting improved insulin sensitivity and glucose regulation.

Conclusion

Long-term Taekwondo training improved thigh muscle cross-sectional area, health-related physical fitness and insulin resistance markers in sedentary older women, providing evidence for its use as an effective intervention to promote metabolic health in this population.

Resistance and Impact Training During Weight Loss Improves Physical Function and Body Composition in Older Adults With Obesity

BACKGROUND

Weight loss achieved via energy restriction leads to significant losses in muscle and bone mass, potentially increasing risk for sarcopenia and osteoporosis. High-intensity resistance and impact training (HiRIT) might attenuate weight loss-induced musculoskeletal declines. Our objective was to compare changes in physical function and body composition in older adults with obesity undertaking dietary weight loss combined with HiRIT or aerobic training (AT).

METHODS

Sixty older adults (aged ≥ 60 years) with obesity (dual-energy x-ray absorptiometry determined body fat percentage ≥ 30% in men and ≥ 40% in women) and a mobility limitation (Short Physical Performance Battery [SPPB] score ≤ 11) were randomly assigned to either 12 weeks of supervised, centre-based HiRIT or self-directed, home-based AT while consuming a hypocaloric diet (750-1000 kcal/day reduction in energy intake). Changes in physical function (primary outcome: gait speed) and body composition were compared between groups.

RESULTS

A total of 49/60 randomised participants (mean age: 69.6 ± 6 years; 58% women; mean BMI: 32.9 ± 4.1 kg/m2) completed the trial. Gait speed increased following HiRIT compared with AT (mean difference: 0.07 m/s [95% CI: 0.01, 0.13]). Chair stand times decreased in both groups (HiRIT: -1.3 s [95% CI: -2.1, -0.4] vs. AT: -0.8 s [95% CI: -1.6, -0.04]) and HiRIT, but not AT, increased handgrip strength (HiRIT: 2.2 kg [95% CI: 0.6, 3.9] vs. AT: 0.7 kg [95% CI: -0.9, 2.3]) and SPPB scores (HiRIT: 0.9 [95% CI: 0.4, 1.3] vs. AT: 0.4 [95% CI: -0.04, 0.8]). Similar decreases in total body mass (HiRIT: -5.1 kg [95% CI: -6.7, -3.4] vs. AT: -4.9 kg [95% CI: -6.5, -3.3]), fat mass (HiRIT: -3.6 kg [95% CI: -5.0, -2.2] vs. AT: -3.3 kg [95% CI: -4.7, -2.0]), visceral fat (HiRIT: -32.1 cm2 [95% CI: -47.4, -16.8] vs. AT: -31.4 cm2 [95% CI: -46.1, -16.8]) and appendicular lean mass (HiRIT: -0.8 kg [95% CI: -1.4, -0.2] vs. AT: -1.2 kg [95% CI: -1.8, -0.6]) were observed. HiRIT was well tolerated with only seven minor adverse events compared with five reported in those who completed AT.

CONCLUSION

HiRIT appears to be safe and more effective than AT for improving gait speed in older adults with obesity undertaking dietary weight loss. Additional trials with larger sample sizes and longer durations are warranted to explore whether HiRIT can attenuate weight loss-related muscle and bone mass declines.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials: ACTRN12618001146280.

Physical activity complexity, cognition, and risk of cognitive impairment and dementia in the Baltimore Longitudinal Study of Aging

INTRODUCTION

Studies on physical activity (PA) and dementia mainly focus on activity quantity or intensity. Yet PA requires neuro-coordination of movement, and it is unclear whether complexity of daily activity varies by cognitive status. Thus, we examined the association between PA complexity, using multiscale entropy, and cognitive function, mild cognitive impairment (MCI), and dementia in older adults in the Baltimore Longitudinal Study of Aging (BLSA).

METHODS

A total of 637 older adults (age 73.9 ± 11.3 years) in the BLSA completed a 7-day wrist-worn accelerometer assessment and neuropsychological tests from 2015 to 2020. Using logistic regression and structural equation modeling, we examined cross-sectional associations of PA complexity with MCI/dementia and cognition. Cross-lagged panel models (CLPMs) were used to assess bidirectional associations at baseline and 2-year follow-up. Multivariable models were adjusted for age, sex, race, education years, body mass index, and comorbidities.

RESULTS

Participants in the lowest tertile of PA complexity had over double the odds of MCI/dementia (odds ratio = 2.63, 95% confidence interval [CI]: 1.02 to 6.79, p = 0.045) compared to those in the highest tertile in the fully adjusted model. Structural equation modeling showed that PA complexity was associated with global cognitive function (standardized B [SB] = 0.102, 95% CI: 0.033 to 0.171, p = 0.004), executive function (SB = 0.119, 95% CI: 0.049 to 0.189, p = 0.001), and visuospatial ability (SB = 0.096, 95% CI: 0.026 to 0.167, p = 0.008). CLPMs showed bidirectional associations between lower PA complexity and poorer executive function.

DISCUSSION

Lower complexity of accelerometry-detected movement is associated with poorer cognition and higher risk of MCI/dementia. Future studies should explore whether low PA complexity is an early indicator of dementia.

Highlights

Prior studies mainly focused on quantity or intensity of physical activity.Poorer cognitive function was associated with lower complexity of daily activity.Lower complexity of physical activity may be an early indicator of dementia.

Long COVID-19: Impact of a personalized rehabilitation program

INTRODUCTION

Several guidelines have proposed specific rehabilitation programs to treat symptoms/sequelae in patients with post-acute COVID syndrome (PACS). Only a few studies show that rehabilitation reduce disability after COVID-19.

OBJECTIVE

To describe the response to a personalized rehabilitation program in terms of exercise tolerance, muscle function, dyspnea, quality of life, and frailty state in a cohort of patients with PACS.

METHODS

Observational prospective cohort study of community-dwelling patients. The rehabilitation program included three modalities (outpatient, home-based, and self-administered), optionally supplemented with respiratory muscle training.

STUDY VARIABLES

6-minute walking distance (6MWD), inspiratory muscle strength (PImax), dyspnea, muscle strength (estimated with the Medical Research Council scale and handgrip), health-related quality of life (HRQoL), and frailty estimated with the Short Physical Performance Battery (SPPB) and at 3- and 6-months following baseline.

RESULTS

Of 178 patients with PACS, 101 (56.7%) were enrolled in a rehabilitation program: 41.6% home-based, 27.7% outpatient, and 24.8% self-administered. Inspiratory muscle training (IMT) was provided to 56 patients, with 50 included in the rehabilitation program and 6 (5.9%) receiving IMT alone. Significant improvements were observed at 3 months in mMRC strength (p=0.001), SPPB (p<0.0001), handgrip strength (p=0.017), mMRC dyspnea, PImax (p<0.0001), and 6-MWD (p=0.008). Improvements persisted at 6 months for mMRC strength (p=0.048), SPPB (p=0.002), PImax (p<0.0001), and 6MWD (p=0.048). HRQoL mental and physical component scores improved only at 3 months.

CONCLUSIONS

Personalized rehabilitation for patients with PACS improved muscle parameters, dyspnoea, and exercise capacity, but not HRQoL, up to 6 months. Improvements in respiratory muscle strength were associated with reductions in dyspnoea and increased exercise capacity.

Utility of the Short Physical Performance Battery for Determining Walking Independence in Patients With Stroke

Introduction The Short Physical Performance Battery (SPPB) is a functional assessment tool comprising three components: balance, gait, and muscle strength. It is easier to administer than the Berg Balance Scale (BBS), which has been used to determine walking independence. However, the cutoff value of the SPPB for determining walking independence in patients with stroke remains unknown. Therefore, this study aimed to compare the utility and cutoff values of the SPPB and BBS for determining walking independence in patients with stroke. Methods A total of 301 patients with stroke (mean age: 71.8±12.3 years) who were admitted to the convalescent rehabilitation ward of our center between July 2021 and June 2024 were included in this study. The SPPB, BBS, Stroke Impairment Assessment Set (SIAS), Mini-Mental State Examination (MMSE), and Functional Ambulation Categories (FAC) were administered at discharge. Walking independence was defined as FAC ≥4, and non-independence was defined as FAC ≤3. Logistic regression analysis was performed to examine the relationship between walking independence and the SPPB and BBS, with adjustments for age, sex, body mass index, days since onset, history of stroke, SIAS, and MMSE as covariates. The cutoff values of the SPPB and BBS for determining walking independence were calculated by receiver operating characteristic curve analysis, and the areas under the curve (AUC) for both measures were compared. The significance level was set at 0.05. Results Of the 301 patients, 184 were classified as walking independent, and 117 were classified as non-independent. The SPPB (odds ratio (OR)=2.15; 95% confidence interval (CI): 1.69-2.73) and BBS (OR=1.14; 95% CI: 1.25-1.56) were significantly associated with walking independence at discharge (p<0.001). The cutoff values for walking independence were ≥10 points for the SPPB (AUC: 0.948, sensitivity: 0.940, and specificity: 0.855) and ≥49 points for the BBS (AUC: 0.945, sensitivity: 0.967, and specificity: 0.821), without significant difference in AUC. Conclusions The SPPB demonstrated high discriminative accuracy comparable to the BBS, indicating its usefulness as a simple and practical evaluation tool.

Power exercises with elastic bands combined with endurance training improve pulse pressure, systolic blood pressure, and functional parameters in older adults

OBJECTIVE

This study aimed to investigate the effects of power training (PT) using elastic bands combined with endurance training (ET) on pulse pressure (PP), systolic (SBP) and diastolic blood pressures (DBP), autonomic response (AR), and functional parameters in older adults.

METHODS

Thirty participants were randomly assigned to the control group ( n  = 15) and the intervention group (IG) ( n  = 15). IG participants performed PT with elastic bands combined with ET twice weekly for 8 weeks. PP, SBP, DBP, AR, and functional parameters were assessed before and after 8 weeks.

RESULTS

PP, SBP, and functional parameters significantly improved after 8 weeks in the IG ( P  < 0.05). The study also found a clinically significant reduction in the SBP (Δ = -16.5 mmHg; η2p  = 0.36) and DBP (Δ = -4.3 mmHg; η2p  = 0.26), and a clinical reduction in the 5-Repetition Sit-To-Stand test ( η2p  = 0.63) and the elbow flexion test ( η2p  = 0.51).

CONCLUSION

Our findings indicate that PT with elastic bands combined with ET improves PP, SBP, and functional parameters in older adults. Hence, our combined training protocol can be an easily accessible, low-cost, nonpharmacological strategy for strength, and conditioning professionals to prescribe as an exercise intervention to older adults.

Trazodone and Risk of Orthostatic Hypotension, Syncope and Falls in Geriatric Outpatients with Hypertension

INTRODUCTION

In older adults, trazodone is frequently prescribed for anxiety and insomnia owing to its perceived greater tolerability in comparison with benzodiazepines. However, it may have hypotensive effects.

AIM

The aim of this study is to investigate the effects of trazodone on orthostatic blood pressure (BP) response and risk of syncope and falls in hypertensive older adults.

PATIENTS AND METHODS

A longitudinal observational study involving patients ≥ 75 years was conducted in two geriatric outpatient clinics in Florence, Italy. At baseline, participants underwent a 3-min active stand test, office BP measurement and home and ambulatory BP monitoring. At follow-up, syncope and falls were recorded.

RESULTS

Among 123 participants (mean age 81 years, 59% female), 12 (10%) reported regular trazodone use. Trazodone users showed lower office diastolic BP (71.8 versus 80.1 mmHg, p = 0.042), a greater systolic and diastolic BP reduction immediately after standing (ΔsystolicT0 23.8 versus 14.3 mmHg, p = 0.037; ΔdiastolicT0 8.9 versus 1.6 mmHg, p = 0.004) and a greater diastolic BP reduction after 1-min standing (ΔdiastolicT1 6.5 versus 0 mmHg, p = 0.029). No differences were reported for home or ambulatory BP. Incidence of syncope and falls was 25%, with a significantly higher rate in patients receiving trazodone (58.3% versus 21.2%, p = 0.001). Trazodone use predicted syncope and falls independently of age, disability and fall history. This association was not confirmed when adjusting for dementia diagnosis. BP values were not associated with the study outcome.

CONCLUSIONS

In older hypertensive outpatients, trazodone is associated with a greater orthostatic BP drop and may predispose them to an increased risk of syncope and falls.

Feasibility of a Multidomain Intervention for Safe Mobility in People With Parkinson's Disease and Recurrent Falls

OBJECTIVE

Mobility limitations and falls are common in people with Parkinson's disease (PwP). Compared with exercise alone, a tailored, multidomain intervention has the potential to be more effective in improving mobility safety and preventing falls. This study aimed to explore the feasibility and potential effectiveness of a multidomain fall prevention intervention (Integrate) designed for PwP who experience frequent falls.

METHODS

The home-based intervention was delivered over a span of 6 months by occupational therapists and physiotherapists. The personalized intervention included home fall hazard reduction, exercise, and safer mobility behavior training. The participants received 8 to 12 home visits and were supported by care-partners (when necessary) to participate in the intervention.

RESULTS

Twenty-nine people (recruitment rate: 49%; drop-out rate: 10%) with moderate to advanced Parkinson's disease, a history of recurrent falls, and mild to moderate cognitive impairment participated in the study, with 26 people completing the study. A moderate-to-high adherence to the intervention was observed, and there were no adverse events related to the intervention. Twenty-one (81%) participants met or exceeded their safer mobility goal based on the Goal Attainment Scale. The participants exhibited a median 1.0-point clinically meaningful improvement according to the Short Physical Performance Battery. An exploratory analysis revealed that fall rates were reduced by almost 50% in the 6-month follow-up period (incidence rate ratio: 0.51; 95% confidence interval 0.28-0.92).

CONCLUSION

A multidomain occupational therapy and physiotherapy intervention for PwP experiencing recurrent falls was feasible and appeared to improve mobility safety. A randomized trial powered to detect the effects of the intervention on falls and mobility is warranted.

Limitations in Activities of Daily Living Among Individuals With Systemic Lupus Erythematosus

OBJECTIVE

We aimed to estimate the burden and identify potential correlates of limitations in activities of daily living (ADLs) among persons with systemic lupus erythematosus (SLE).

METHODS

Individuals with SLE were recruited from a population-based cohort (October 2019 to May 2022) and reported their ability to independently perform various instrumental ADLs (IADLs) and basic ADLs (BADLs) via survey. Limitations were defined as having at least some difficulty performing at least one of the IADLs or BADLs. Descriptive statistics were calculated, and associations (adjusted odds ratios [aORs]) of various participant characteristics with IADL and BADL limitations were assessed with logistic regression adjusting for age, sex, and race.

RESULTS

The mean age of the 436 participants was 46.2 years; most were female (91.7%) and Black (82.8%). More than half (56.2%) reported limitations in IADLs, most commonly housekeeping (50.7%), laundry (37.2%), and shopping (33.0%); 43.8% reported limitations in independently performing BADLs, most commonly transferring (26.6%), bathing (25.3%), dressing (24.4%), and continence (22.0%). Higher disease activity (greater than or equal to vs less than the median) was strongly associated with IADLs (aOR 6.49, 95% confidence interval [CI] 4.15-10.2) and BADLs (aOR 7.35, 95% CI 4.70-11.5), along with higher depression and perceived stress scores, lower educational attainment and income, and older age.

CONCLUSION

IADL and BADL limitations may be common in individuals with SLE and more prevalent among those who report higher disease activity, depressive symptoms, and lower income and among those who are older. Research to support evidence-based strategies for improvement in quality of life and maintenance of independence in the older SLE population is warranted.

Applying both the 30-s and the 5-repetition sit-to-stand tests captures dissimilar groups and a broader spectrum of physical abilities in mobility-limited older individuals: results from the BIOFRAIL study

PURPOSE

We aimed to assess differences among older patients demonstrating low STS performance in the 30 s-STS and/or the 5r-STS.

METHODS

30 s-STS and 5r-STS were used to assess lower limb muscle strength and function in older adults. Analysis involved 376 patients (≥ 65 years) from a geriatric outpatient clinic for fall assessment.

RESULTS

The mean age of patients was 79.8 (± 6.1) years (67% female). In total, 40.6% had low STS performance with 9.3% presenting only low 30 s-STS, 9.8% only low 5r-STS, and 21.5% low STS performance in both tests. Patients with low STS performance in both tests had lower gait speed, were more often frail, and had more prior falls compared to patients with low STS performance in one test only.

CONCLUSION

The two STS tests are not interchangeable, and the use of both STS tests capture a wider range of physical abilities in mobility-limited older adults.

CLINICAL TRIAL REGISTRATION

NCT05795556.

Mediterranean Diet and Change in Physical Function Over Time In Older Women

The Mediterranean diet has been linked to preserving physical function, but studies on its impact on physical function decline in older adults have shown mixed results. This longitudinal study used a large sample of community-dwelling older women from the Women's Health Initiative Long Life Study to examine this relationship. We assessed 4516 older women (mean age at baseline = 78.97), including a subsample of 849 women who reported currently having diabetes. Data on physical function, measured by the SF-36 Physical Function subscale, were collected annually from 2012-2019. Adherence to the Mediterranean diet was measured using alternative Mediterranean diet (aMED) scores between 2012 and 2013. Results indicated that higher aMED scores were associated with better physical function at baseline in the general sample (4.89 to 8.23 points) and in the diabetes subsample (5.37 to 8.97 points) over eight years. However, adherence to the Mediterranean diet did not affect the rate of physical function decline. Future research should include longitudinal dietary assessments, a broader age range, and detailed information on diabetes duration.

Association between dysphagia and social isolation in community-dwelling older people

PURPOSE

This cross-sectional study aimed to clarify the relationship between dysphagia and social isolation among community-dwelling older people.

METHODS

The study participants were 238 community-dwelling older people (168 women; mean age, 74.0 ± 5.2 years; independent in instrumental activities of daily living, 97%) who lived independently and didn't have a history of cerebrovascular disease. Swallowing function was assessed using the Eating Assessment Tool-10, with a score of ≥ 3 defined as dysphagia. Tongue pressure and oral diadochokinesis (ODK) were assessed as swallowing-related functions. Social isolation was assessed using the 6-item Lubben Social Network Scale. Physical function, cognitive function, and basic attributes were investigated as confounding factors. The relationship between social isolation and dysphagia was examined by logistic regression analysis with social isolation as the dependent variable and swallowing function as the independent variable, adjusted for confounding factors.

RESULTS

Twenty-one percent of the participants were classified as social isolation group. A significantly higher percentage of participants with dysphagia were in the social isolation group than in the nonsocial isolation group (odds ratio [OR]: 3.3, 95% confidence interval [CI] 1.4-7.9). No significant association was found between social isolation and either tongue pressure or ODK. Dysphagia was significantly associated with social isolation (OR: 2.8, 95% CI 1.1-6.9), even after adjusting for confounders (physical function, cognitive function, and basic attributes).

CONCLUSION

Dysphagia may be an independent risk factor for social isolation in community-dwelling older people. These findings suggest that dysphagia should be assessed in community-dwelling older people at risk of social isolation.

Supporting older adults with cancer and their support person through geriatric assessment and remote exercise and education: The SOAR study protocol

INTRODUCTION

Frail older adults receiving cancer treatment are at heightened risk of adverse outcomes. Despite the known benefits of exercise during cancer treatment to improve well-being, few exercise studies focus on frail older adults receiving cancer treatment and their support person. Geriatric assessment (GA) is often recommended prior to the start of treatment for frail adults with cancer, but combining the GA with a planned exercise regimen remains unexplored. This study aims to determine the feasibility and acceptability of implementing geriatric assessment and management (GAM) in combination with virtual chair-based exercise (CBE) and health education for frail older adults with cancer and their support persons.

MATERIALS AND METHODS

This phase 2 randomized controlled trial will include patients aged 70 years and above with a lung, gastrointestinal, or genitourinary cancer referred for first- or second-line chemotherapy, immunotherapy, or targeted therapy. Patients must be frail (≥3 on the Vulnerable Elders Survey), sedentary on the Godin Leisure Time Activity Questionnaire (<90 min of moderate/intense activity per week), have English proficiency with ability to consent, a physician-estimated life expectancy of at least six months, and deemed safe to exercise. Each older adult will be invited to bring a support person to participate in the study. Patients will be randomized 1:1 to GAM combined with online CBE and health education for 12 weeks or waitlist control. Participating support persons will follow the same intervention group. Primary endpoints for feasibility and acceptability will be recruitment rate, retention, adherence, and data collection. Outcome measures include physical activity, function, fatigability, quality of life, treatment toxicity, and unplanned hospital visits. Outcome measures will be used to obtain estimates of the effect size and feasibility analysis needed for designing a phase 3 study. The study will take place at two hospitals in Toronto, Canada.

DISCUSSION

This study will investigate the feasibility, acceptability, and obtain preliminary estimates of the outcomes of GAM plus CBE and health education in preventing functional decline and improving quality of life in frail older adults receiving cancer treatment and their support persons. The results will help to design a definitive phase 3 randomized controlled trial.

TRIAL REGISTRATION

The trial is registered at ClinicalTrials.gov (Registration Number: NCT05509751).

Sociodemographic and clinical factors associated with low muscle mass and composition in people treated with (chemo)radiotherapy for lung cancer

BACKGROUND

This study examined (1) associations between sociodemographic and clinical variables with low muscle mass and radiodensity and their loss relative to treatment commencement in patients with lung cancer; and (2) the magnitude of change in muscle mass and association with treatment outcomes and survival.

METHODS

Prospective study in patients planned for curative (chemo)radiotherapy for lung cancer. Low skeletal muscle mass and radiodensity and muscle loss were determined from pre- and post-treatment computed tomography images. Sociodemographic, clinical, functional, nutritional, physical activity and alternate body composition were assessed pre-treatment. Logistic and linear regression and Fisher's exact tests were used to assess associations between variables and study outcomes. Cox proportional hazards models were fitted to examine associations with survival.

RESULTS

Overall, 53 patients (62.3% male) with a mean age of 69 ± 9.3 years and 54.8% with stage III disease were included. Pre-treatment low calf circumference was associated with pre-treatment low muscle mass (p = 0.006). Higher comorbidity scores pre-treatment were associated with normal muscle radiodensity pre- and post-treatment (p = 0.015, p = 0.027, respectively). Pre-treatment low energy and protein intake were associated with low muscle radiodensity post-treatment. Muscle mass and radiodensity were not associated with survival or treatment outcomes.

CONCLUSIONS

In patients with lung cancer, there is some evidence anthropometric measures of muscle mass are suggestive of low muscle mass pre-radiotherapy, while low energy intake pre-treatment may indicate low muscle radiodensity after treatment. However, these findings are limited by the small sample size and further prospective studies with larger samples are required.

Comparative analysis of frailty identification tools in community services across the Asia-Pacific: A systematic review and meta-analysis

OBJECTIVES

This study aimed to compare various frailty screening and assessment tools with the Frailty Phenotype (FP), Frailty Index (FI), and Comprehensive Geriatric Assessment (CGA), which are considered the current gold standards, among the Asia-Pacific population in community settings.

DESIGN

Systematic review and meta-analysis.

SETTING AND PARTICIPANTS

This review included studies evaluating frailty identification tools based on the criteria of population, index and reference tests, and diagnosis of interest.

METHODS

A diagnostic test accuracy review was conducted to assess frailty instruments recommended by the Asia-Pacific Clinical Practice Guidelines. Comprehensive electronic database searches and manual searches were conducted up to August 20, 2024. Study quality, including risks of bias and applicability, was assessed using the QUADAS-2 tool. Hierarchical analysis and Youden's index were employed to identify the optimal tool and cutoff points, and pooled frailty prevalence was calculated.

RESULTS

Fourteen studies were included: 10 for the FRAIL scale, 3 for TUG, and 2 for the SOF index (screening tools), and 2 each for the CFS and KCL, and 1 for the REFS (assessment tools). All studies demonstrated a high risk of bias. The pooled sensitivity and specificity for screening tools were 0.63 and 0.89, respectively, whereas for assessment tools, they were 0.79 and 0.85. The pooled prevalence of frailty and pre-frailty was 19.7% and 31.7%, respectively. The pooled diagnostic odds ratios were highest for the FRAIL scale (15.72) and CFS (35.03) among the screening and assessment tools. The subgroup analysis revealed that the setting had no significant impact on screening tool performance (p = 0.58), but a borderline significant effect was observed for assessment tools (p = 0.06), although this result is limited by the small number of studies, with only one conducted in a community setting. The FRAIL scale, with a cutoff of 2, had a Youden's index of 0.60, signifying optimal screening performance.

CONCLUSION

Among the frailty instruments recommended by the Asia-Pacific Clinical Practice Guidelines, this meta-analysis identifies the FRAIL scale as the most robust tool for distinguishing frailty, with a cutoff of 2 significantly enhancing diagnostic accuracy. Furthermore, the estimated prevalence of frailty in the Asia-Pacific region is 19.7% across various community settings, underscoring the need for further research and the development of validated assessment tools tailored to this population.

Plasma triacylglycerol length and saturation level mark healthy aging groups in humans

Complex lipids, essential components in biological processes, exhibit conserved age-related changes that alter membrane properties and cellular functions and are implicated as biomarkers and contributors to longevity and age-related diseases. While physical activity alleviates age-related comorbidities and physical impairments, comprehensive exploration of the underlying biological mechanisms, particularly at the level of complex lipids, remains limited. However, clinical studies suggest that physical activity may counteract these age-related lipidomic changes, presenting a promising avenue for intervention. We performed lipidomic profiling of plasma from an extensively characterized cohort of young and aged individuals. Annotating 1446 unique lipid species across 24 lipid classes, we found the most prominent difference in older adults was an accumulation of triacylglycerols (TGs), with lower physical activity levels associated with higher TG levels in plasma and reduced physical functionality. Remarkably, lipid species in the TG class did not accumulate uniformly. Rather, our study unveiled a negative correlation between higher physical activity levels and TGs with shorter chain lengths and more double bonds in this demographic. Overall, our research highlights that plasma TG length and saturation level can help mark healthy aging groups in humans. These findings deepen our understanding of how aging affects complex lipids and the influence of physical activity on this process.

Associations Between Cognitive Performance and Self-Efficacy for Pain Management in Older Adults With Chronic Pain

BACKGROUND

Self-efficacy for pain management is the key to successful pain management, yet little is known about the effect of cognitive performance on self-efficacy for pain management. This study aimed to examine to what extent cognitive performance is related to self-efficacy for pain management in older adults with chronic pain.

METHODS

The analyses utilized data from the baseline assessment of the MOBILIZE Boston Study. Five neuropsychological tests-the Clock in the Box Test, Letter Fluency Test, Trail-making Test, Hopkins Verbal Learning Test, and WORLD Test-were performed to measure the cognitive performance domains of 458 participants, aged 70 years and reporting chronic pain and self-efficacy for pain management. We measured self-efficacy for pain management using the Chronic Pain Self-Efficacy Scale. Statistical analyses were done using multiple linear regression analysis.

RESULTS

After adjusting for sociodemographic factors, general cognitive performance, executive function, as measured by the Clock in the Box Test, and attention, as measured by the Trail-Making Test Part A, were significantly associated with self-efficacy for pain management in older adults with chronic pain. However, after controlling for sociodemographic factors, chronic conditions, pain interference, and physical performance, the associations between cognitive performance measures and self-efficacy for pain management weakened.

CONCLUSION

Greater cognitive performance in attention and executive function might be associated with better self-efficacy for pain management. Future longitudinal research is required to investigate the long-term implications of cognitive performance changes on the progress of self-efficacy for pain management in community-dwelling older adults.