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Baskaran T B P, Raghav P, Naveen KHS. Hybrid model of care for older persons for improvement of frailty index-a community-based interventional study in an urban setting. BMC Geriatr 2024; 24:772. [PMID: 39300347 DOI: 10.1186/s12877-024-05351-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 09/03/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND An older person undergoes a 'disablement' process with aging. A comprehensive geriatric assessment centered around the functional status informs the healthcare provider of their frailty status, based on which tailored interventions may be designed to help prevent/reverse frailty. This study was conducted to assess the improvement in frailty index by training older persons for self-care practices using a multi-domain behavioural intervention, assisted by their caregivers. METHODS It is a community-based interventional trial among older persons aged ≥ 60 years and their primary caregivers conducted in an urban community for a period of 15 months. A hybrid model, which exploits the advantages of every indigenous geriatric model of care, in providing a holistic care to old persons, was developed and adopted. Intervention was designed to incorporate all domains of frailty assessed, based upon self-efficacy and social interdependence theory. Frail-VIG scale and SPPB scores were used to measure the outcomes. RESULTS 128 older persons and their primary caregivers were recruited. Median age was 70 and 67 years in the intervention and control group respectively, with majority being males. The median frailty index at baseline was 0.36 in both the groups, with improvement in intervention group (0.20) and worsening in control group (0.44) at end-line. From the DID analysis, a reduction of 0.19 points of frailty index was observed (even after adjustment for co-variates) in the intervention group, as compared to the control group. Also, it was observed that age and gender of the old person, their per capita income and the family support played an interactive effect in improvement of the frailty index. There was a significant difference in SPPB scores as well, between the groups [5 (1) in CG vs. 7 (2) in IG, p < 0.001]. CONCLUSION Frailty could be reversed with appropriate interventions designed on the pillars of self-efficacy, and social interdependence among family members. The hybrid model of care delineates the role of caregivers, who reinforce the old persons to follow prescribed interventions.
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Affiliation(s)
- Pritish Baskaran T B
- Department of Community Medicine and Family Medicine, AIIMS Jodhpur, Jodhpur, Rajasthan, India
- Department of Community Medicine, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India
| | - Pankaja Raghav
- Department of Community Medicine and Family Medicine, AIIMS Jodhpur, Jodhpur, Rajasthan, India.
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Feng Y, Su M, Wang J, Liu L, Shao D, Sun X. Unveiling the multi-dimensional frailty network among older cancer survivors in China: A network analysis study. J Geriatr Oncol 2024; 15:101833. [PMID: 39003117 DOI: 10.1016/j.jgo.2024.101833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 06/17/2024] [Accepted: 07/02/2024] [Indexed: 07/15/2024]
Abstract
INTRODUCTION Frailty has a significant impact on the overall quality of life of older cancer survivors, but the relationships among frailty symptoms are not well understood. This study aims to explore the specific associations among multidimensional symptoms of frailty among older cancer survivors by employing network analysis to provide supportive evidence for targeted interventions in the future. MATERIALS AND METHODS Data were obtained by cluster sampling from three large Grade-A tertiary hospitals in Shandong Province, China, and collected through face-to-face interviews by trained investigators. We included patients who were diagnosed with a solid malignant tumor at the age of 60 years or older. Frailty indicators were measured by the Groningen Frailty Indicator (GFI) and analyzed primarily through network analysis, including network estimation, centrality, and stability analysis. The relative importance of a node in a network was tested by centrality analyses, and Spearman correlations were applied to estimate the relationships between symptom pairs (symptom score) and symptom clusters (standardized symptom score) in the symptom network. In terms of centrality, the indexes of strength, closeness, and betweenness were adopted to measure the importance of nodes. RESULTS Five hundred and eight older cancer survivors were included, with an average age of 68.4 years (standard deviation [SD] = 5.4), and a higher proportion were male (n = 307[60.4%]). The prevalence of frailty among older cancer survivors was 58.9% (n = 299), with a mean GFI score of 4.46 (SD = 2.87). The strongest edge was between "dressing and undressing" and "going to the toilet" (r = 0.58). The nodes with the higher strength centrality were "going to the toilet" (rS=1.09), "walking around outside" (rS=0.97), and "part of social network" (rS=0.96); and the nodes with the higher closeness centrality were "mark physical fitness" (rC=0.005), "calm and relaxed" (rC=0.005), and "nervous or downhearted" (rC=0.005). DISCUSSION This study demonstrated that older cancer survivors in China have a high prevalence of frailty, with self-care and social participation-related symptoms playing a key role in the multidimensional network of frailty symptoms. Psychological symptoms can rapidly influence other symptoms within this network. Therefore, prioritizing psychological symptoms in the assessment of older adults with cancer is essential for effective frailty management.
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Affiliation(s)
- Yujia Feng
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China; National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Mingzhu Su
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China; National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China.
| | - Jiamin Wang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China; National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Li Liu
- Cardial Surgery Intensive Care Unit of Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Di Shao
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China; National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Xiaojie Sun
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China; National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China; Institute of State Governance, Shandong University, Jinan, China.
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Bozkurt ME, Erdogan T, Kilic C, Ozalp H, Ozalp G, Asci E, Fetullahoglu Z, Aydın CO, Bahat G, Karan MA. Comparison of two different frailty screening scales for predicting mortality due to all causes in older inpatients. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e20240250. [PMID: 39166674 PMCID: PMC11329245 DOI: 10.1590/1806-9282.20240250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 05/20/2024] [Indexed: 08/23/2024]
Abstract
OBJECTIVE This study examines the relationship between two frailty screening tools and 90-day all-cause mortality in geriatric inpatients. METHODS The study included patients aged ≥60 years who were admitted to the geriatrics unit of a university hospital between June 2021 and August 2022 and whose mortality status and duration of hospitalization data were obtained from the Health Ministry System. During hospitalization, the patients were screened using two different frailty scales: the Simpler Modified Fried Frailty Scale (sMFS) and the Clinical Frailty Scale (CFS). Patients scoring ≥5 on the CFS and ≥3 on the sMFS were considered frail. RESULTS A total of 84 participants with a mean age of 78.3±7.6 years were included in this study, of which 36.9% were male. Of the total, 60.7% and 89.3% were considered frail according to the CFS and sMFS, respectively, and the prevalence of all-cause mortality within 90 days was 19%. A univariate analysis using the Kaplan-Meier survival method revealed CFS scores to be statistically significantly related to 90-day all-cause mortality (p<0.001), while sMFS scores were not found to be statistically significant (p=0.849). Furthermore, a statistically significant relationship was identified between CFS score and all-cause mortality in multivariate analysis with Cox regression analysis [(p<0.001), hazard ratio (HR): 3.078; (95% confidence interval: 1.746-5.425)]. CONCLUSION An evaluation of frailty in hospitalized older adults using two different scales revealed the CFS to be superior to the sMFS in predicting all-cause mortality within 90 days.
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Affiliation(s)
- Meris Esra Bozkurt
- Mersin City Hospital, Department of Internal Medicine, Division of Geriatrics - Mersin, Turkey
| | - Tugba Erdogan
- Istanbul University, Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics - İstanbul, Turkey
| | - Cihan Kilic
- Istanbul University, Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics - İstanbul, Turkey
| | - Humeyra Ozalp
- Istanbul University, Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics - İstanbul, Turkey
| | - Gulcin Ozalp
- Istanbul University, Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics - İstanbul, Turkey
| | - Emine Asci
- Istanbul University, Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics - İstanbul, Turkey
| | - Zeynep Fetullahoglu
- Istanbul University, Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics - İstanbul, Turkey
| | - Caglar Ozer Aydın
- Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Department of Internal Medicine, Division of Geriatrics - İstanbul, Turkey
| | - Gulistan Bahat
- Istanbul University, Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics - İstanbul, Turkey
| | - Mehmet Akif Karan
- Istanbul University, Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics - İstanbul, Turkey
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Pan N, Ossowski Z, Tong J, Li D, Gao S. Effects of Exercise on Frailty in Older People Based on ACSM Recommendations: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Clin Med 2024; 13:3037. [PMID: 38892748 PMCID: PMC11173309 DOI: 10.3390/jcm13113037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/08/2024] [Accepted: 05/16/2024] [Indexed: 06/21/2024] Open
Abstract
Objectives: The objective of the study was to carry out an analysis of the methodological quality of clinical trials (effects of exercise on frailty in older people) based on ACSM recommendations. Methods: The search scope included PubMed, Embase, Web of Science, Cochrane, and literature that cannot be retrieved from the database. The topic was the impact of exercise on frailty in elderly people. Changes in five outcome measures (FP, BI, SPPB, GS, and BMI) were assessed using mean differences (MD) and 95% confidence intervals (95% CI). A random effects model (RE) was used to conduct a meta-analysis and compare the results between subgroups. Results: The intervention effects of exercise on the five outcome indicators of frailty in elderly people were all significant (p < 0.05). The effect of a high-consistency subgroup on outcome indicators FP and GS was more significant than that of the low- or uncertain-consistency subgroup (MD: -1.09 < -0.11, MD: 2.39 >1.1). There was no significant difference in the intervention effect as reflected in the outcome measures SPPB and BMI in the high-consistency subgroup (p = 0.07, p = 0.34). There was no significant difference in the impact of the intervention on the outcome measure BI between the two subgroups (p = 0.06, p = 0.14). Conclusions: Exercise prescriptions with high consistency with ACSM recommendations may be more effective in both FP and GS interventions than those with uncertain or low consistency. However, it is essential to note that the data derived from the meta-analysis is still subject to the small number of studies, the unknown degree of consistency of participants in individual studies, and the different mix of cases in the studies.
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Affiliation(s)
- Neng Pan
- Faculty of Physical Culture, Akademia Wychowania Fizycznego I Sportu, 80-336 Gdansk, Poland;
| | - Zbigniew Ossowski
- Faculty of Physical Culture, Akademia Wychowania Fizycznego I Sportu, 80-336 Gdansk, Poland;
| | - Jun Tong
- Department of Sport, Kunming Medical University, Kunming 650000, China;
| | - Dan Li
- Academy of Sport, Yunnan Normal University, Kunming 650000, China; (D.L.); (S.G.)
| | - Shan Gao
- Academy of Sport, Yunnan Normal University, Kunming 650000, China; (D.L.); (S.G.)
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Tian Y, Wang S, Zhang Y, Meng L, Li X. Effectiveness of information and communication technology-based integrated care for older adults: a systematic review and meta-analysis. Front Public Health 2024; 11:1276574. [PMID: 38249380 PMCID: PMC10797014 DOI: 10.3389/fpubh.2023.1276574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 12/06/2023] [Indexed: 01/23/2024] Open
Abstract
Background Information and communication technology (ICT) is a key factor in advancing the implementation of integrated care for older adults in the context of an aging society and the normalization of epidemics. This systematic review aims to comprehensively evaluate the effectiveness of ICT-based integrated care for older adults to provide input for the construction of intelligent integrated care models suitable for the context of an aging population in China. Methods A systematic review and meta-analysis were conducted using PubMed, Web of Science Core Collection, Scopus, MEDLINE, EBSCO, EMBASE, CINAHL with full text, ProQuest, and Cochrane Library databases, along with the Google Scholar search engine, for papers published between January 1, 2000, and July 25, 2022, to include randomized controlled trials and quasi-experimental studies of ICT-based integrated care for older adults. Two reviewers independently performed literature screening, quality assessment (JBI standardized critical appraisal tool), and data extraction. The results were pooled using a random effects model, and narrative synthesis was used for studies with insufficient outcome data. Results We included 32 studies (21 interventions) with a total of 30,200 participants (14,289 in the control group and 15,911 in the intervention group). However, the quality of the literature could be improved. The meta-analysis results showed that ICT-based integrated care significantly improved the overall perceived health status of older adults (n=3 studies, MD 1.29 (CI 0.11 to 2.46), no heterogeneity) and reduced the number of emergency department visits (n=11 studies, OR 0.46 (CI 0.25 to 0.86), high heterogeneity) but had no significant effect on improving quality of life, mobility, depression, hospital admissions and readmissions, or mortality in older adults, with a high degree of study heterogeneity. Narrative analysis showed that the overall quality of care, primary care service use, and functional status of older adults in the intervention group improved, but the cost-effectiveness was unclear. Conclusions ICT-based integrated care is effective in improving health outcomes for older adults, but the quality and homogeneity of the evidence base need to be improved. Researchers should develop intelligent integrated care programs in the context of local health and care welfare provision systems for older adults, along with the preferences and priorities of the older adults.
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Affiliation(s)
- Yutong Tian
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Shanshan Wang
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Yan Zhang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Lixue Meng
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Xiaohua Li
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
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Ran Q, Tian H, Lin J, Wang H, Wang B, Chen Z, Song D, Gong C. Mesenchymal Stem Cell-Derived Exosomes: A Novel Approach to Diabetes-Associated Cognitive Impairment. J Inflamm Res 2023; 16:4213-4228. [PMID: 37753267 PMCID: PMC10519429 DOI: 10.2147/jir.s429532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/12/2023] [Indexed: 09/28/2023] Open
Abstract
The progression of diabetes frequently results in a myriad of neurological disorders, including ischemic stroke, depression, blood-brain barrier impairment, and cognitive dysfunction. Notably, diabetes-associated cognitive impairment, a prevalent comorbidity during the course of diabetes, progressively affects patients' cognitive abilities and may reciprocally influence diabetes management, thereby severely impacting patients' quality of life. Extracellular vesicles, particularly nanoscale exosomes, have garnered considerable attention in recent years. These exosomes carry and transfer various functional molecules, such as proteins, lipids, and diverse non-coding RNAs, serving as novel regulators and communicators in intercellular interactions. Of particular interest, mesenchymal stem cell-derived exosomes (MSC-Exos) have been reported to traverse the blood-brain barrier and ameliorate intracerebral pathologies. This review elucidates the role of MSC-Exos in diabetes-related cognitive impairment, with a focus on their applications as biomarkers, modulation of neuronal regeneration and synaptic plasticity, anti-inflammatory properties, antioxidative effects, and their involvement in regulating the functionality of β-amyloid proteins during the course of cognitive impairment. The immense therapeutic potential of MSC-Exos in the treatment of diabetes-induced cognitive dysfunction is emphasized.
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Affiliation(s)
- Qingsen Ran
- Department of Science and Education, Shenzhen Pingle Orthopedic Hospital (Shenzhen Pingshan Traditional Chinese Medicine Hospital), Shenzhen, Guangzhou Province, 518118, People’s Republic of China
| | - He Tian
- Department of Science and Education, Shenzhen Pingle Orthopedic Hospital (Shenzhen Pingshan Traditional Chinese Medicine Hospital), Shenzhen, Guangzhou Province, 518118, People’s Republic of China
| | - Jian Lin
- Department of Science and Education, Shenzhen Pingle Orthopedic Hospital (Shenzhen Pingshan Traditional Chinese Medicine Hospital), Shenzhen, Guangzhou Province, 518118, People’s Republic of China
| | - Han Wang
- Department of Gastroenterology, Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, Jilin Province, 130021, People’s Republic of China
| | - Bo Wang
- Department of Science and Education, Shenzhen Pingle Orthopedic Hospital (Shenzhen Pingshan Traditional Chinese Medicine Hospital), Shenzhen, Guangzhou Province, 518118, People’s Republic of China
| | - Zhixin Chen
- Department of Science and Education, Shenzhen Pingle Orthopedic Hospital (Shenzhen Pingshan Traditional Chinese Medicine Hospital), Shenzhen, Guangzhou Province, 518118, People’s Republic of China
| | - Da Song
- Department of Science and Education, Shenzhen Pingle Orthopedic Hospital (Shenzhen Pingshan Traditional Chinese Medicine Hospital), Shenzhen, Guangzhou Province, 518118, People’s Republic of China
| | - Chunzhu Gong
- Department of Science and Education, Shenzhen Pingle Orthopedic Hospital (Shenzhen Pingshan Traditional Chinese Medicine Hospital), Shenzhen, Guangzhou Province, 518118, People’s Republic of China
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Yutong T, Yan Z, Qingyun C, Lixue M, Mengke G, Shanshan W. Information and Communication Technology Based Integrated Care for Older Adults: A Scoping Review. Int J Integr Care 2023; 23:2. [PMID: 37033366 PMCID: PMC10077997 DOI: 10.5334/ijic.6979] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 03/09/2023] [Indexed: 04/05/2023] Open
Abstract
Background Integrated care is an important initiative to respond positively to the ageing of society and information and communication technology(ICT) plays an important role in facilitating the integration of functional and normative health and social care. The scoping review aims to synthesize evidence on the experience and practice of ICT-based implementation of integrated care for older adults. Methods This study followed the research framework developed by Arksey and O'malley for the scoping review and systematically searched for relevant studies published between 1 January 2000 and 30 March 2022 from nine electronic databases, three specialist journals, three key institutional websites, 11 integrated care project websites, google scholar and references of the studies to be included. Two reviewers independently screened and extracted data and used thematic analysis to sort out and summarize the core elements, hindrances and facilitators of ICT-based integrated care. Results A total of 77 studies were included in this study, including 36 ICT-based practice models of integrated care with seven core elements of implementation including single entry point, comprehensive geriatric assessment, personalized care planning, multidisciplinary case conferences, coordinated care, case management and patient empowerment, which generally had a positive effect on improving quality of life, caregiver burden and primary care resource utilization for older adults, but effectiveness evaluations remained Heterogeneity exists. The barriers and facilitators to ICT-based implementation of integrated care were grouped into four themes: demand-side factors, provider factors, technology factors and system factors. Conclusion The implementation of ICT-based integrated care for the elderly is expected to improve the health status of both the supply and demand of services, but there is still a need to strengthen the supply of human resources, team training and collaboration, ICT systems and financial support in order to promote the wider use of ICT in integrated care.
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Taylor JA, Greenhaff PL, Bartlett DB, Jackson TA, Duggal NA, Lord JM. Multisystem physiological perspective of human frailty and its modulation by physical activity. Physiol Rev 2023; 103:1137-1191. [PMID: 36239451 PMCID: PMC9886361 DOI: 10.1152/physrev.00037.2021] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
"Frailty" is a term used to refer to a state characterized by enhanced vulnerability to, and impaired recovery from, stressors compared with a nonfrail state, which is increasingly viewed as a loss of resilience. With increasing life expectancy and the associated rise in years spent with physical frailty, there is a need to understand the clinical and physiological features of frailty and the factors driving it. We describe the clinical definitions of age-related frailty and their limitations in allowing us to understand the pathogenesis of this prevalent condition. Given that age-related frailty manifests in the form of functional declines such as poor balance, falls, and immobility, as an alternative we view frailty from a physiological viewpoint and describe what is known of the organ-based components of frailty, including adiposity, the brain, and neuromuscular, skeletal muscle, immune, and cardiovascular systems, as individual systems and as components in multisystem dysregulation. By doing so we aim to highlight current understanding of the physiological phenotype of frailty and reveal key knowledge gaps and potential mechanistic drivers of the trajectory to frailty. We also review the studies in humans that have intervened with exercise to reduce frailty. We conclude that more longitudinal and interventional clinical studies are required in older adults. Such observational studies should interrogate the progression from a nonfrail to a frail state, assessing individual elements of frailty to produce a deep physiological phenotype of the syndrome. The findings will identify mechanistic drivers of frailty and allow targeted interventions to diminish frailty progression.
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Affiliation(s)
- Joseph A Taylor
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, United Kingdom
| | - Paul L Greenhaff
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, United Kingdom.,NIHR Nottingham Biomedical Research Centre, University of Nottingham, Queen's Medical Centre, Nottingham, United Kingdom
| | - David B Bartlett
- Division of Medical Oncology, Department of Medicine, Duke University, Durham, North Carolina.,Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Thomas A Jackson
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Institute of Inflammation and Ageing, https://ror.org/03angcq70University of Birmingham, Birmingham, United Kingdom
| | - Niharika A Duggal
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Institute of Inflammation and Ageing, https://ror.org/03angcq70University of Birmingham, Birmingham, United Kingdom
| | - Janet M Lord
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Institute of Inflammation and Ageing, https://ror.org/03angcq70University of Birmingham, Birmingham, United Kingdom.,NIHR Birmingham Biomedical Research Centre, University Hospital Birmingham and University of Birmingham, Birmingham, United Kingdom
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Shi Y, Stanmore E, McGarrigle L, Todd C. Non-pharmacological interventions for possible sarcopenia or sarcopenia in community-dwelling older adults: a scoping review protocol. BMJ Open 2023; 13:e067079. [PMID: 36810172 PMCID: PMC9944664 DOI: 10.1136/bmjopen-2022-067079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
INTRODUCTION Early prevention of sarcopenia is a recommendation to reduce morbidity, mortality and improve quality of life. Several non-pharmacological interventions to reduce the risk of sarcopenia in community-dwelling older people have been proposed. Therefore, there is a need to identify the scope and differences of these interventions. This scoping review will summarise the nature and extent of the existing literature that describes and examines non-pharmacological interventions for community-dwelling older adults with possible sarcopenia or sarcopenia. METHODS AND ANALYSIS The seven-stage review methodology framework will be used. Searches will be conducted in the following databases: Embase, Medline, PsycINFO, CINAHL, All EBM Reviews, Web of Science, Scopus, CBM, CNKI, WANFANG and VIP. Grey literature will also be identified from Google scholar. Search dates will be restricted to January 2010 to December 2022, in English and Chinese language only. Screening will be focused on published research, including both quantitative and qualitative study designs, and prospectively registered trials. Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews will be followed when delineating the search decision process. Findings will be synthesised quantitatively and qualitatively as appropriate and classified using key conceptual categories. We will identify whether studies identified have been included in systematic reviews or meta-analyses, and research gaps and opportunities will be identified and summarised. ETHICS AND DISSEMINATION As this is a review, ethical approval will not be sought. The results will be published in peer-reviewed scientific journals and also disseminated in relevant disease support groups and conferences. The planned scoping review will help us identify the current status of research and gaps in the literature, so as to develop a future research agenda.
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Affiliation(s)
- Ya Shi
- School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK
- School of Nursing & School of Public Health, Yangzhou University, Yangzhou, Jiangsu province, China
- Manchester Institute for Collaborative Research on Ageing, Manchester, UK
| | - Emma Stanmore
- School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK
- Manchester Institute for Collaborative Research on Ageing, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Lisa McGarrigle
- School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK
- Manchester Institute for Collaborative Research on Ageing, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | - Chris Todd
- School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK
- Manchester Institute for Collaborative Research on Ageing, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
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Zhou T, Qu Z, Ge S, Wu X, Zhang X, Wang A, Tang X. Frailty knowledge level and its influencing factors among older adults in China. Geriatr Nurs 2023; 50:247-254. [PMID: 36809700 DOI: 10.1016/j.gerinurse.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/03/2023] [Accepted: 01/03/2023] [Indexed: 02/21/2023]
Abstract
Raising older adults' frailty knowledge level and encouraging them to actively engage in the prevention and treatment of frailty is essential to promote healthy aging. This cross-sectional study investigated frailty knowledge level and its influencing factors in community-dwelling older adults in China. A total of 734 older adults were included in the analysis. About half of them misjudged their frailty state (42.50%), and 17.17% obtained frailty knowledge in the community. Those who were female, lived in rural areas, lived alone, had not attended school, had a monthly income <3,000RMB, were at risk for malnutrition, were depressed, and were socially isolated were more likely to have lower frailty knowledge level. Those with advanced age and pre-frailty or frailty stage were more knowledgeable about frailty. The group with the highest proportion of low frailty knowledge level was those who had never attended school or completed primary school and had loose friend ties (98.7%). It is crucial to develop tailored intervention to raise frailty knowledge level in older adults in China.
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Affiliation(s)
- Tian Zhou
- School of Nursing, Xuzhou Medical University, Xuzhou, No. 209 Tongshan Road, Xuzhou, Jiangsu 221000, China; Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221000, China
| | - Zhe Qu
- School of Nursing, Xuzhou Medical University, Xuzhou, No. 209 Tongshan Road, Xuzhou, Jiangsu 221000, China
| | - Song Ge
- Department of Natural Sciences, University of Houston-Downtown, Texas 77002, United States
| | - Xiang Wu
- School of Medical Informatics and Engineering, Xuzhou Medical University, Xuzhou, No. 209 Tongshan Road, Xuzhou, Jiangsu 221000, China
| | - Xiao Zhang
- School of Medical Informatics and Engineering, Xuzhou Medical University, Xuzhou, No. 209 Tongshan Road, Xuzhou, Jiangsu 221000, China.
| | - Aming Wang
- School of Medical Informatics and Engineering, Xuzhou Medical University, Xuzhou, No. 209 Tongshan Road, Xuzhou, Jiangsu 221000, China
| | - Xianping Tang
- School of Nursing, Xuzhou Medical University, Xuzhou, No. 209 Tongshan Road, Xuzhou, Jiangsu 221000, China; Aging Studies Institute of Xuzhou Medical University, Xuzhou, Jiangsu 221000, China.
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11
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Zhu L, Zong X, Shi X, Ouyang X. Association between Intrinsic Capacity and Sarcopenia in Hospitalized Older Patients. J Nutr Health Aging 2023; 27:542-549. [PMID: 37498101 DOI: 10.1007/s12603-023-1946-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 06/11/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVES This study aimed to clarify the association between intrinsic capacity (IC) and sarcopenia in hospitalized older patients. DESIGN A cross-sectional study. SETTING Hospital-based. PARTICIPANTS This study included 381 inpatients aged ≥ 60 years (225 men and 156 women). MEASUREMENTS IC was evaluated in five domains defined by the World Health Organization: cognition (Mini-Mental State Examination), locomotion (Short Physical Performance Battery test), vitality (Short-Form Mini Nutritional Assessment), sensory (self-reported hearing and vision) and psychological (5-item Geriatric Depression Scale) capacities. IC composite score (0-5) was calculated based on five domains, with lower scores representing greater IC. Sarcopenia was defined in accordance with the criteria recommended by the Asian Working Group for Sarcopenia (AWGS) 2019. Multiple linear and logistic regressions were performed to explore the associations between IC composite score and IC domains with sarcopenia and its defining components. RESULTS The mean age of 381 patients included was 81.95±8.42 years. Of them, 128 (33.6%) patients had sarcopenia. The median IC composite score was 1 (1, 2). Cognition, locomotion, vitality, sensory and psychological capacities were impaired in 22.6%, 63.5%, 18.9%, 27.3% and 11.3% of patients. Multiple linear regression analyses showed that favorable IC domain scores in cognition, locomotion and vitality were associated with a stronger handgrip strength. A higher vitality score was associated with a greater appendicular skeletal muscle mass index (ASMI), and a higher locomotion score was associated with a greater gait speed. The multiple logistic regression analysis showed that only vitality impairment was associated with sarcopenia. A higher IC composite score was associated with higher risks of sarcopenia, as well as low ASMI, handgrip strength and gait speed. CONCLUSION This study indicated that a more serious impairment of IC was associated with a greater risk of sarcopenia. Vitality was the domain most strongly associated with sarcopenia. IC may be employed to detect and manage sarcopenia.
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Affiliation(s)
- L Zhu
- Xiaojun Ouyang, Department of Geriatrics, Geriatric Hospital of Nanjing Medical University, Nanjing, China, E-mail:
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12
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González-Rocha A, Mendez-Sanchez L, Ortíz-Rodríguez MA, Denova-Gutiérrez E. Effect Of Exercise on Muscle Mass, Fat Mass, Bone Mass, Muscular Strength and Physical Performance in Community Dwelling Older Adults: Systematic Review and Meta-Analysis. Aging Dis 2022; 13:1421-1435. [PMID: 36186132 PMCID: PMC9466973 DOI: 10.14336/ad.2022.0215] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/15/2022] [Indexed: 11/23/2022] Open
Abstract
The demographic transition makes it necessary to establish new recommendations about the components that are most affected by aging, such as: muscle mass, fat mass, bone mass, muscle strength, and physical performance. Exercise has been identified as a factor that improves those conditions. The aim of this review is to synthetize and analyze the results of exercise interventions on muscle mass, fat mass, bone mass, strength and physical performance in community dwelling older adults (OA). A systematic search was carried out in eleven databases, using validated terms as "aged", "exercise" and others. For the meta-analysis, we differentiated by type of exercise and outcome. Twenty-nine randomized clinical trials were obtained for the review and 24 clinical trials for meta-analysis. This study identified an increase of 1.0 kg (95% Confidence Interval [CI] 0.3 -1.7) in total muscle mass (TMM) and 0.4 kg (95%CI 0.0,0.7) in appendicular muscle mass (AMM); a decrease of -3.7 kg (95% CI -5.8, -1.5) in total fat mass and -3.7% (95%CI -5.8, -1.5) in fat percentage after the resistance exercise intervention by 2-3 times per week. A -3.0% (95%CI -4.6, -1.3) decrease was observed in fat percentage after the aerobic exercise intervention. The quality of the evidence was ranked from high to very low; the risk of bias most common was performance bias and other bias. This study suggests that resistance exercise is the intervention that shows a positive effect on muscle fat mass, and bone mass. More research is needed for other exercise interventions.
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Affiliation(s)
- Alejandra González-Rocha
- Universidad Iberoamericana, Ciudad de México, México.
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, México.
| | - Lucia Mendez-Sanchez
- Unidad de Investigación en Epidemiología Clínica, Hospital Infantil de México Federico Gómez-UNAM, Ciudad de México, México.
| | | | - Edgar Denova-Gutiérrez
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, México.
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13
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Kregel HR, Puzio TJ, Adams SD. Frailty in the Geriatric Trauma Patient: a Review on Assessments, Interventions, and Lessons from Other Surgical Subspecialties. CURRENT TRAUMA REPORTS 2022. [DOI: 10.1007/s40719-022-00241-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Effectiveness of a Hybrid Exercise Program on the Physical Abilities of Frail Elderly and Explainable Artificial-Intelligence-Based Clinical Assistance. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19126988. [PMID: 35742237 PMCID: PMC9223164 DOI: 10.3390/ijerph19126988] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/30/2022] [Accepted: 06/01/2022] [Indexed: 02/01/2023]
Abstract
Background: Due to the low physical fitness of the frail elderly, current exercise program strategies have a limited impact. Eight-form Tai Chi has a low intensity, but high effectiveness in the elderly. Inspired by it, we designed an exercise program that incorporates eight-form Tai Chi, strength, and endurance exercises, to improve physical fitness and reverse frailty in the elderly. Additionally, for the ease of use in clinical practice, machine learning simulations were used to predict the frailty status after the intervention. Methods: For 24 weeks, 150 frail elderly people completed the experiment, which comprised the eight-form Tai Chi group (TC), the strength and endurance training group (SE), and a comprehensive intervention combining both TC and SE (TCSE). The comparison of the demographic variables used one-way ANOVA for continuous data and the chi-squared test for categorical data. Two-way repeated measures analysis of variance (ANOVA) was performed to determine significant main effects and interaction effects. Eleven machine learning models were used to predict the frailty status of the elderly following the intervention. Results: Two-way repeated measures ANOVA results before the intervention, group effects of ten-meter maximum walking speed (10 m MWS), grip strength (GS), timed up and go test (TUGT), and the six-minute walk test (6 min WT) were not significant. There was a significant interaction effect of group × time in ten-meter maximum walking speed, grip strength, and the six-minute walk test. Post hoc tests showed that after 24 weeks of intervention, subjects in the TCSE group showed the greatest significant improvements in ten-meter maximum walking speed (p < 0.05) and the six-minute walk test (p < 0.05) compared to the TC group and SE group. The improvement in grip strength in the TCSE group (4.29 kg) was slightly less than that in the SE group (5.16 kg). There was neither a significant main effect nor a significant interaction effect for TUGT in subjects. The stacking model outperformed other algorithms. Accuracy and the F1-score were 67.8% and 71.3%, respectively. Conclusion: A hybrid exercise program consisting of eight-form Tai Chi and strength and endurance exercises can more effectively improve physical fitness and reduce frailty among the elderly. It is possible to predict whether an elderly person will reverse frailty following an exercise program based on the stacking model.
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15
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Ni HJ, Hsu TF, Chen LK, Chou HL, Tung HH, Chow LH, Chen YC. Effects of Exercise Programs in older adults with Muscle Wasting: A Systematic Review and Meta-analysis. Arch Gerontol Geriatr 2022; 99:104605. [DOI: 10.1016/j.archger.2021.104605] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/21/2021] [Accepted: 11/29/2021] [Indexed: 12/14/2022]
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16
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Cheong MJ, Kang Y, Kim S, Kang HW. Systematic Review of Diagnostic Tools and Interventions for Sarcopenia. Healthcare (Basel) 2022; 10:healthcare10020199. [PMID: 35206814 PMCID: PMC8871976 DOI: 10.3390/healthcare10020199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/01/2021] [Accepted: 11/23/2021] [Indexed: 02/04/2023] Open
Abstract
Diagnosis of rare incurable diseases is important. Specific evaluation methods and standards for sarcopenia differ according to each sarcopenia-related medical association. This study aimed to identify the tools that are currently used to diagnose sarcopenia and to systematically review various interventions for sarcopenia. We intended to provide basic information to help establish standard diagnostic and therapeutic methods for sarcopenia. We collected and analyzed published journal articles, including gray literature and dissertations, from 11 domestic and international databases. The search terms were “sarcopenia/sarcopenic”, “combined (complex/circuit) exercise”, “resistance (muscle) exercise”, and “aerobic exercise”. The tools used for sarcopenia diagnosis were inconsistent across the studies. Circuit exercise combined with aerobic exercise and strength training was the most common intervention method, followed by strength training and aerobic exercise. We identified several diagnostic and evaluation criteria across the articles. Essentially, this systematic review confirms the importance of diagnostic criteria for sarcopenia and compares interventions. Hopefully, the criteria for the diagnosis and evaluation of sarcopenia will become clear in the future. In addition, the results of this study may provide basic information for rehabilitation treatment for rare and incurable diseases.
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Affiliation(s)
- Moon Joo Cheong
- Rare Diseases Integrative Treatment Research Institute, Wonkwang University Jangheung Integrative Medical Hospital, Iksan 59338, Korea;
| | - Yeonseok Kang
- Department of Medical History, College of Korean Medicine, Wonkwang University, Iksan 54538, Korea;
| | - Sungchul Kim
- Department of Neuropsychiatry of Korean Medicine & Inam Neuroscience Research Center, Wonkwang University Sanbon Hospital, Gunpo City 15865, Korea;
| | - Hyung Won Kang
- Rare Diseases Integrative Treatment Research Institute, Wonkwang University Jangheung Integrative Medical Hospital, Iksan 59338, Korea;
- Department of Neuropsychiatry of Korean Medicine & Inam Neuroscience Research Center, Wonkwang University Sanbon Hospital, Gunpo City 15865, Korea;
- Correspondence: ; Tel.: +82-31-390-2762; Fax: +82-31-390-2319
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17
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Bambrick P, Phelan N, Grant E, Byrne T, Harrison M, Mulcahy R, Cooke J. Diet and Exercise for FRAILty (DEFRAIL): protocol for a study to examine the effect of a novel community-based group exercise and nutritional intervention, designed to reverse frailty in older adults. BMJ Open 2021; 11:e042408. [PMID: 34130954 PMCID: PMC8207997 DOI: 10.1136/bmjopen-2020-042408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Frailty refers to a multifaceted age-related loss of physiological reserve. Aside from the immediate challenges it presents, it is also associated with various adverse health outcomes. Given our ageing population, the healthcare and societal costs resulting from frailty present a significant and growing public health challenge. Rapidly accumulating evidence suggests that resistance exercise combined with protein supplementation can reverse frailty in older adults. However, translation of these findings into practice has proven difficult, due to either a lack of clarity regarding the interventions used or the use of interventions not suitable for widespread implementation. There remains an absence of evidence-based programmes suitable for delivery to frail older adults in the community. METHODS AND ANALYSIS This paper outlines the protocol for a study to examine the effect of a novel programme of exercise and protein supplementation. This intervention has been developed by an expert consensus group, specifically for delivery to frail older adults in a group setting in the community. The study will take the form of a within-subjects non-randomised trial. Participants will be assessed at baseline, then following an 8-week period of regular activity, then following the 8-week intervention. Frailty (according to the Fried Frailty criteria) will be the primary outcome measure, along with a range of secondary outcome measures (including physical performance measures, body mass composition, psychosocial assessments and frailty-related biomarkers). If shown to be feasible to implement and effective at reversing frailty, the Diet and Exercise for FRAILty (DEFRAIL) intervention may facilitate more widespread participation in resistance exercise for frail older adults. ETHICS AND DISSEMINATION This study received ethical approval from the Research Ethics committees of both the Health Service Executive South-Eastern Area and Waterford Institute of Technology. Its findings will be disseminated through journal publications, conference presentations and other forms of public engagement. TRIAL REGISTRATION NUMBER ISRCTN46458028; Pre-results.
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Affiliation(s)
- Pádraig Bambrick
- Department of Geriatric Medicine, University Hospital Waterford, Waterford, Ireland
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Niamh Phelan
- Department of Geriatric Medicine, University Hospital Waterford, Waterford, Ireland
| | - Emma Grant
- Department of Geriatric Medicine, University Hospital Waterford, Waterford, Ireland
| | - Thomas Byrne
- Department of Sport & Exercise Science, Waterford Institute of Technology, Waterford, Ireland
| | - Michael Harrison
- Department of Sport & Exercise Science, Waterford Institute of Technology, Waterford, Ireland
| | - Ríona Mulcahy
- Department of Geriatric Medicine, University Hospital Waterford, Waterford, Ireland
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - John Cooke
- Department of Geriatric Medicine, University Hospital Waterford, Waterford, Ireland
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
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18
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Chen AT, Chu F, Teng AK, Han S, Lin SY, Demiris G, Zaslavsky O. Promoting Problem Solving About Health Management: A Mixed-Methods Pilot Evaluation of a Digital Health Intervention for Older Adults With Pre-Frailty and Frailty. Gerontol Geriatr Med 2021; 7:2333721420985684. [PMID: 33457461 PMCID: PMC7797575 DOI: 10.1177/2333721420985684] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 11/12/2020] [Accepted: 11/22/2020] [Indexed: 11/15/2022] Open
Abstract
Background: There is a need for interventions to promote health management of older adults with pre-frailty and frailty. Technology poses promising solutions, but questions exist about effective delivery. Objectives: We present the results of a mixed-methods pilot evaluation of Virtual Online Communities for Older Adults (VOCALE), an 8-week intervention conducted in the northwestern United States, in which participants shared health-related experiences and applied problem solving skills in a Facebook group. Methods: We performed a mixed-methods process evaluation, integrating quantitative and qualitative data, to characterize the intervention and its effects. We focus on four areas: health-related measures (health literacy and self-efficacy), participation, problem solving skills enacted, and subjective feedback. Results: Eight older adults with pre-frailty and frailty (age = 82.7 ± 6.6 years) completed the study. There was an upward trend in health literacy and health self-efficacy post-intervention. Participants posted at least two times per week. Content analysis of 210 posts showed participants were able to apply the problem solving skills taught, and exit interviews showed participants' increased awareness of the need to manage health, and enjoyment in learning about others. Conclusion: This mixed-methods evaluation provides insight into feasibility and design considerations for online interventions to promote health management among vulnerable older adults.
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19
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van den Helder J, Mehra S, van Dronkelaar C, Ter Riet G, Tieland M, Visser B, Kröse BJA, Engelbert RHH, Weijs PJM. Blended home-based exercise and dietary protein in community-dwelling older adults: a cluster randomized controlled trial. J Cachexia Sarcopenia Muscle 2020; 11:1590-1602. [PMID: 33103379 PMCID: PMC7749597 DOI: 10.1002/jcsm.12634] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 08/07/2020] [Accepted: 09/16/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Effective and sustainable interventions are needed to counteract the decline in physical function and sarcopenia in the growing aging population. The aim of this study was to determine the 6 and 12 month effectiveness of blended (e-health + coaching) home-based exercise and a dietary protein intervention on physical performance in community-dwelling older adults. METHODS This cluster randomized controlled trial allocated 45 clusters of older adults already engaged in a weekly community-based exercise programme. The clusters were randomized to three groups with ratio of 16:15:14; (i) no intervention, control (CON); (ii) blended home-based exercise intervention (HBex); and (iii) HBex with dietary protein counselling (HBex-Pro). Both interventions used a tablet PC with app and personalized coaching and were targeting on behaviour change. The study comprised coached 6 month interventions with a 6 month follow-up. The primary outcome physical performance was assessed by modified Physical Performance Test (m-PPT). Secondary outcomes were gait speed, physical activity level (PAL), handgrip muscle strength, protein intake, skeletal muscle mass, health status, and executive functioning. Linear mixed models of repeated measured were used to assess intervention effects at 6 and 12 months. RESULTS The population included 245 older adults (mean age 72 ± 6.5 (SD) years), 71% female, and 54% co-morbidities observed. Dropout of the intervention was 18% at 6 months and 26% at 12 months. Participants were well functioning, based on an m-PPT score of 33.9 (2.8) out of 36. For the primary outcome m-PPT, no significant intervention effects (HBex, +0.03, P = 0.933; HBex-Pro, -0.13, P = 0.730) were found. Gait speed (+0.20 m/s, P = 0.001), PAL (+0.06, P = 0.008), muscle strength (+2.32 kg, P = 0.001), protein intake (+0.32 g/kg/day, P < 0.001), and muscle mass (+0.33 kg, P = 0.017) improved significantly in the HBex-Pro group compared with control group after 6 month intervention. The protein intake, muscle mass, and strength remained significantly improved after 12 months as compared with those of control. Health change and executive functioning improved significantly in both intervention groups after 6 months. CONCLUSIONS This HBex and dietary protein interventions did not change the physical performance (m-PPT) in community-dwelling older adults. Changes were observed in gait speed, PAL, muscle mass, strength, and dietary protein intake, in response to this combined intervention.
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Affiliation(s)
- Jantine van den Helder
- Center of Expertise Urban Vitality, Faculty of Sports and Nutrition (room B1.28), Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.,Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Sumit Mehra
- CREATE-IT Applied Research, Faculty of Digital Media and Creative Industries, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.,Applied Psychology, Faculty of Applied Social Sciences and Law, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.,Informatics Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Carliene van Dronkelaar
- Center of Expertise Urban Vitality, Faculty of Sports and Nutrition (room B1.28), Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Gerben Ter Riet
- Center of Expertise Urban Vitality, Faculty of Sports and Nutrition (room B1.28), Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.,Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.,Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Michael Tieland
- Center of Expertise Urban Vitality, Faculty of Sports and Nutrition (room B1.28), Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Bart Visser
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.,Amsterdam Movement Sciences, Amsterdam University Medical Centers, VU University, Amsterdam, The Netherlands
| | - Ben J A Kröse
- CREATE-IT Applied Research, Faculty of Digital Media and Creative Industries, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.,Informatics Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Raoul H H Engelbert
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.,Amsterdam Movement Sciences, Amsterdam University Medical Centers, VU University, Amsterdam, The Netherlands.,Department of Rehabilitation, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Peter J M Weijs
- Center of Expertise Urban Vitality, Faculty of Sports and Nutrition (room B1.28), Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.,Amsterdam Movement Sciences, Amsterdam University Medical Centers, VU University, Amsterdam, The Netherlands.,Department of Nutrition and Dietetics, Amsterdam University Medical Centers, VU University, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, VU University, Amsterdam, The Netherlands
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20
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Anton SD, Cruz-Almeida Y, Singh A, Alpert J, Bensadon B, Cabrera M, Clark DJ, Ebner NC, Esser KA, Fillingim RB, Goicolea SM, Han SM, Kallas H, Johnson A, Leeuwenburgh C, Liu AC, Manini TM, Marsiske M, Moore F, Qiu P, Mankowski RT, Mardini M, McLaren C, Ranka S, Rashidi P, Saini S, Sibille KT, Someya S, Wohlgemuth S, Tucker C, Xiao R, Pahor M. Innovations in Geroscience to enhance mobility in older adults. Exp Gerontol 2020; 142:111123. [PMID: 33191210 PMCID: PMC7581361 DOI: 10.1016/j.exger.2020.111123] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/15/2020] [Accepted: 10/16/2020] [Indexed: 02/07/2023]
Abstract
Aging is the primary risk factor for functional decline; thus, understanding and preventing disability among older adults has emerged as an important public health challenge of the 21st century. The science of gerontology - or geroscience - has the practical purpose of "adding life to the years." The overall goal of geroscience is to increase healthspan, which refers to extending the portion of the lifespan in which the individual experiences enjoyment, satisfaction, and wellness. An important facet of this goal is preserving mobility, defined as the ability to move independently. Despite this clear purpose, this has proven to be a challenging endeavor as mobility and function in later life are influenced by a complex interaction of factors across multiple domains. Moreover, findings over the past decade have highlighted the complexity of walking and how targeting multiple systems, including the brain and sensory organs, as well as the environment in which a person lives, can have a dramatic effect on an older person's mobility and function. For these reasons, behavioral interventions that incorporate complex walking tasks and other activities of daily living appear to be especially helpful for improving mobility function. Other pharmaceutical interventions, such as oxytocin, and complementary and alternative interventions, such as massage therapy, may enhance physical function both through direct effects on biological mechanisms related to mobility, as well as indirectly through modulation of cognitive and socioemotional processes. Thus, the purpose of the present review is to describe evolving interventional approaches to enhance mobility and maintain healthspan in the growing population of older adults in the United States and countries throughout the world. Such interventions are likely to be greatly assisted by technological advances and the widespread adoption of virtual communications during and after the COVID-19 era.
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Affiliation(s)
- Stephen D Anton
- University of Florida, Department of Aging and Geriatric Research, 2004 Mowry Road, Gainesville, FL 32611, United States.
| | - Yenisel Cruz-Almeida
- University of Florida, Department of Community Dentistry and Behavioral Science, 1329 SW Archer Road, Gainesville, FL 32610, United States.
| | - Arashdeep Singh
- University of Florida, Department of Pharmacodynamics, College of Pharmacy, 1345 Center Drive, Gainesville, FL 32610, United States.
| | - Jordan Alpert
- University of Florida, College of Journalism and Communications, Gainesville, FL 32610, United States.
| | - Benjamin Bensadon
- University of Florida, Department of Aging and Geriatric Research, 2004 Mowry Road, Gainesville, FL 32611, United States.
| | - Melanie Cabrera
- University of Florida, Department of Aging and Geriatric Research, 2004 Mowry Road, Gainesville, FL 32611, United States.
| | - David J Clark
- University of Florida, Department of Aging and Geriatric Research, 2004 Mowry Road, Gainesville, FL 32611, United States.
| | - Natalie C Ebner
- University of Florida, Department of Psychology, 945 Center Drive, Gainesville, FL 32611, United States.
| | - Karyn A Esser
- University of Florida, Department of Physiology and Functional Genomics, 1345 Center Drive, Gainesville, FL, United States.
| | - Roger B Fillingim
- University of Florida, Department of Community Dentistry and Behavioral Science, 1329 SW Archer Road, Gainesville, FL 32610, United States.
| | - Soamy Montesino Goicolea
- University of Florida, Department of Community Dentistry and Behavioral Science, 1329 SW Archer Road, Gainesville, FL 32610, United States.
| | - Sung Min Han
- University of Florida, Department of Aging and Geriatric Research, 2004 Mowry Road, Gainesville, FL 32611, United States.
| | - Henrique Kallas
- University of Florida, Department of Aging and Geriatric Research, 2004 Mowry Road, Gainesville, FL 32611, United States.
| | - Alisa Johnson
- University of Florida, Department of Aging and Geriatric Research, 2004 Mowry Road, Gainesville, FL 32611, United States.
| | - Christiaan Leeuwenburgh
- University of Florida, Department of Aging and Geriatric Research, 2004 Mowry Road, Gainesville, FL 32611, United States.
| | - Andrew C Liu
- University of Florida, Department of Physiology and Functional Genomics, 1345 Center Drive, Gainesville, FL, United States.
| | - Todd M Manini
- University of Florida, Department of Aging and Geriatric Research, 2004 Mowry Road, Gainesville, FL 32611, United States.
| | - Michael Marsiske
- University of Florida, Department of Clinical & Health Psychology, 1225 Center Drive, Gainesville, FL 32610, United States.
| | - Frederick Moore
- University of Florida, Department of Surgery, Gainesville, FL 32610, United States.
| | - Peihua Qiu
- University of Florida, Department of Biostatistics, Gainesville, FL 32611, United States.
| | - Robert T Mankowski
- University of Florida, Department of Aging and Geriatric Research, 2004 Mowry Road, Gainesville, FL 32611, United States.
| | - Mamoun Mardini
- University of Florida, Department of Aging and Geriatric Research, 2004 Mowry Road, Gainesville, FL 32611, United States.
| | - Christian McLaren
- University of Florida, Department of Aging and Geriatric Research, 2004 Mowry Road, Gainesville, FL 32611, United States.
| | - Sanjay Ranka
- University of Florida, Department of Computer & Information Science & Engineering, Gainesville, FL 32611, United States.
| | - Parisa Rashidi
- University of Florida, Department of Biomedical Engineering. P.O. Box 116131. Gainesville, FL 32610, United States.
| | - Sunil Saini
- University of Florida, Department of Aging and Geriatric Research, 2004 Mowry Road, Gainesville, FL 32611, United States.
| | - Kimberly T Sibille
- University of Florida, Department of Aging and Geriatric Research, 2004 Mowry Road, Gainesville, FL 32611, United States.
| | - Shinichi Someya
- University of Florida, Department of Aging and Geriatric Research, 2004 Mowry Road, Gainesville, FL 32611, United States.
| | - Stephanie Wohlgemuth
- University of Florida, Department of Aging and Geriatric Research, 2004 Mowry Road, Gainesville, FL 32611, United States.
| | - Carolyn Tucker
- University of Florida, Department of Psychology, 945 Center Drive, Gainesville, FL 32611, United States.
| | - Rui Xiao
- University of Florida, Department of Aging and Geriatric Research, 2004 Mowry Road, Gainesville, FL 32611, United States.
| | - Marco Pahor
- University of Florida, Department of Aging and Geriatric Research, 2004 Mowry Road, Gainesville, FL 32611, United States.
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Huang ST, Tange C, Otsuka R, Nishita Y, Peng LN, Hsiao FY, Tomida M, Shimokata H, Arai H, Chen LK. Subtypes of physical frailty and their long-term outcomes: a longitudinal cohort study. J Cachexia Sarcopenia Muscle 2020; 11:1223-1231. [PMID: 32558267 PMCID: PMC7567152 DOI: 10.1002/jcsm.12577] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 03/26/2020] [Accepted: 04/07/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Components of physical frailty cluster into subtypes, but it remains unknown how these might be associated with age-related functional declines and multimorbidities. This study aims to investigated associations of physical frailty subtypes with functional declines and multimorbidity in a 10 year longitudinal cohort survey. METHODS Complementary longitudinal cohort study used group-based multitrajectory modelling to verify whether frailty subtypes discovered in Taiwan are presented in another aging cohort, then investigated associations of these subtypes with cognitive decline and multimorbidity. Participants aged ≥50 years were recruited from the third to sixth waves (May 2002 to July 2010) of the National Institute for Longevity Sciences-Longitudinal Study of Aging, in Japan. People with incomplete data, pre-frail/frail status before their index wave, and those with incomplete data or who died during follow-up, were excluded. Group-based trajectory analysis denoted five established physical frailty criteria as time-varying binary variables in each wave during follow-up. Incident frailty was classified as mobility subtype (weakness/slowness), non-mobility subtype (weight loss/exhaustion), or low physical activity subtype. General linear modelling investigated associations of these frailty subtypes with activities of daily living, digit symbol substitution test (DSST) and Charlson Comorbidity Index (CCI) at 2 year follow-up. RESULTS We identified four longitudinal trajectories of physical frailty, which corroborated the distinct subtypes we discovered previously. Among 940 eligible participants, 38.0% were robust, 18.4% had mobility subtype frailty, 20.7% non-mobility subtype, and 20.1% low physical activity subtype. People with mobility subtype frailty were older than those with other frailty subtypes or robust status and had higher prevalence of hypertension, diabetes, and heart failure. In the multivariable-adjusted general linear models, mobility-subtype frailty was associated with a significantly lower DSST score (point estimate -2.28, P = 0.03) and higher CCI (point estimate 0.82, P < 0.01) than the other groups. CONCLUSIONS Mobility-subtype frailty was associated with functional declines and progression of multimorbidity; the long-term effects of physical frailty subtypes deserve further investigation.
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Affiliation(s)
- Shih-Tsung Huang
- Graduate Institute of Clinical Pharmacy, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chikako Tange
- Section of NILS-LSA, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Rei Otsuka
- Section of NILS-LSA, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Yukiko Nishita
- Department of Epidemiology of Aging, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Li-Ning Peng
- Department of Geriatrics, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Aging and Health Research Center, National Yang-Ming University, Taipei, Taiwan.,Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Fei-Yuan Hsiao
- Graduate Institute of Clinical Pharmacy, National Taiwan University College of Medicine, Taipei, Taiwan.,School of Pharmacy, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
| | - Makiko Tomida
- Section of NILS-LSA, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hiroshi Shimokata
- Graduate School of Nutritional Sciences, Nagoya University of Arts and Sciences, Nisshin, Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Japan
| | - Liang-Kung Chen
- Department of Geriatrics, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Aging and Health Research Center, National Yang-Ming University, Taipei, Taiwan.,Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
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22
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Gender and Exercise in Relation to Obesity in Greek Elderly Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186575. [PMID: 32917002 PMCID: PMC7557396 DOI: 10.3390/ijerph17186575] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 09/01/2020] [Accepted: 09/04/2020] [Indexed: 12/20/2022]
Abstract
Purpose: The prevalence of sarcopenic obesity is increasing in older adults (>65 years) and older. Sarcopenic obesity is also related to reduced muscle synthesis, due to low physical activity levels. The purpose of the present study is to investigate possible risk factors, and effects of habitual activity status on different types of obesity in an elderly population. Methods: One hundred and two (n = 102) free living participants, aged >60 years, were randomly selected from Rehabilitation Centers for the Elderly in Thessaloniki and from municipal gymnasiums of Thessaloniki, Greece with a mean age of 68.11 ± 6.40 years. The response rate of the participants was 51%. For the purpose of this study, all the participants selected were healthy and did not receive any medication. Specifically, 46 subjects (19 men and 27 women) were members of Rehabilitation Centers for the Elderly in Thessaloniki, while 56 individuals (31 men and 25 women were members of the municipal gymnasiums of Thessaloniki and exercised 2 to 3 times per week). Anthropometric measurements were taken for all subjects. Body composition was assessed with bioelectrical impedance. Body Mass Index (BMI) was categorized according to the World Health Organization (WHO) (2000) standards. Central obesity was defined as a waist circumference of >102 cm in men and >88 cm in women. All participants completed a specific questionnaire regarding their health status, physical activity and previous weight status. Risk of sarcopenic obesity was diagnosed in the participants with co-existing sarcopenia and obesity resulting in high fat mass concurrent with low lean body mass. Results: Women had more than double risk of developing abdominal obesity (OR:2.133, 95% CI: 0.963–4.725) compared to men. More specifically, 69.6% of the elders who did not exercise regularly had central obesity (men: 52.6% and women: 81.5%), while 38.2% of the exercised elders (men: 36.7% and women: 40%) had central obesity. Sedentary elders demonstrated an increased risk of obesity according to body fat (%BF) (OR: 1.259, 95% CI: 0.576–2.750), double the risk of obesity according to body mass (OR: 2.074, 95% CI: 0.765–5.622), and triple the risk of having central obesity (OR: 3.701, 95% CI: 1.612–8.494) compared to those who exercised. Conclusion Exercise appears to have a protective role against all modes of obesity and thus possibly against obesity-related co-morbidities in the elderly.
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Makizako H, Nakai Y, Tomioka K, Taniguchi Y, Sato N, Wada A, Kiyama R, Tsutsumimoto K, Ohishi M, Kiuchi Y, Kubozono T, Takenaka T. Effects of a Multicomponent Exercise Program in Physical Function and Muscle Mass in Sarcopenic/Pre-Sarcopenic Adults. J Clin Med 2020; 9:jcm9051386. [PMID: 32397192 PMCID: PMC7291119 DOI: 10.3390/jcm9051386] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/04/2020] [Accepted: 05/06/2020] [Indexed: 12/13/2022] Open
Abstract
This study aimed to assess the effects of a multicomponent exercise program on physical function and muscle mass in older adults with sarcopenia or pre-sarcopenia. Moreover, we aim to standardize the exercise program for easy incorporation in the daily life of community-dwelling older adults as a secondary outcome. A single-blind randomized controlled trial was conducted with individuals (≥60 years) who had sarcopenia or pre-sarcopenia (n = 72). Participants were randomly assigned to the exercise and control groups. The exercise program consisted of 12 weekly 60-min sessions that included resistance, balance, flexibility, and aerobic training. Outcome measures were physical function and muscle mass. Assessments were conducted before and immediately after the intervention. Among the 72 participants (mean age: 75.0 ± 6.9 years; 70.8% women), 67 (93.1%) completed the trial. Group-by-time interactions on the chair stand (p = 0.02) and timed “up and go” (p = 0.01) tests increased significantly in the exercise group. Although the exercise group showed a tendency to prevent loss of muscle mass, no significant interaction effects were observed for cross-sectional muscle area and muscle volume. The 12-week exercise program improved physical function in the intervention group. Although it is unclear whether the program is effective in increasing muscle mass, a multicomponent exercise program would be an effective treatment for physical function among older adults with sarcopenia.
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Affiliation(s)
- Hyuma Makizako
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima 890-8544, Japan; (Y.N.); (R.K.)
- Correspondence: ; Tel.: +81-99-275-5111; Fax: +81-99-275-6804
| | - Yuki Nakai
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima 890-8544, Japan; (Y.N.); (R.K.)
| | - Kazutoshi Tomioka
- Graduate School of Health Sciences, Kagoshima University, Kagoshima 890-8544, Japan; (K.T.); (Y.T.); (N.S.); (A.W.); (Y.K.)
- Tarumizu Municipal Medical Center Tarumizu Chuo Hospital, Kagoshima 891-2124, Japan;
| | - Yoshiaki Taniguchi
- Graduate School of Health Sciences, Kagoshima University, Kagoshima 890-8544, Japan; (K.T.); (Y.T.); (N.S.); (A.W.); (Y.K.)
- Department of Physical Therapy, Kagoshima Medical Professional College, Kagoshima 891-0133, Japan
| | - Nana Sato
- Graduate School of Health Sciences, Kagoshima University, Kagoshima 890-8544, Japan; (K.T.); (Y.T.); (N.S.); (A.W.); (Y.K.)
- Tarumizu Municipal Medical Center Tarumizu Chuo Hospital, Kagoshima 891-2124, Japan;
| | - Ayumi Wada
- Graduate School of Health Sciences, Kagoshima University, Kagoshima 890-8544, Japan; (K.T.); (Y.T.); (N.S.); (A.W.); (Y.K.)
- Tarumizu Municipal Medical Center Tarumizu Chuo Hospital, Kagoshima 891-2124, Japan;
| | - Ryoji Kiyama
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima 890-8544, Japan; (Y.N.); (R.K.)
| | - Kota Tsutsumimoto
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu 474-5811, Japan;
| | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan; (M.O.); (T.K.)
| | - Yuto Kiuchi
- Graduate School of Health Sciences, Kagoshima University, Kagoshima 890-8544, Japan; (K.T.); (Y.T.); (N.S.); (A.W.); (Y.K.)
| | - Takuro Kubozono
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan; (M.O.); (T.K.)
| | - Toshihiro Takenaka
- Tarumizu Municipal Medical Center Tarumizu Chuo Hospital, Kagoshima 891-2124, Japan;
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Older Adults with Physical Frailty and Sarcopenia Show Increased Levels of Circulating Small Extracellular Vesicles with a Specific Mitochondrial Signature. Cells 2020; 9:cells9040973. [PMID: 32326435 PMCID: PMC7227017 DOI: 10.3390/cells9040973] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 04/10/2020] [Accepted: 04/13/2020] [Indexed: 01/23/2023] Open
Abstract
Mitochondrial dysfunction and systemic inflammation are major factors in the development of sarcopenia, but the molecular determinants linking the two mechanisms are only partially understood. The study of extracellular vesicle (EV) trafficking may provide insights into this relationship. Circulating small EVs (sEVs) from serum of 11 older adults with physical frailty and sarcopenia (PF&S) and 10 controls were purified and characterized. Protein levels of three tetraspanins (CD9, CD63, and CD81) and selected mitochondrial markers, including adenosine triphosphate 5A (ATP5A), mitochondrial cytochrome C oxidase subunit I (MTCOI), nicotinamide adenine dinucleotide reduced form (NADH):ubiquinone oxidoreductase subunit B8 (NDUFB8), NADH:ubiquinone oxidoreductase subunit S3 (NDUFS3), succinate dehydrogenase complex iron sulfur subunit B (SDHB), and ubiquinol-cytochrome C reductase core protein 2 (UQCRC2) were quantified by Western immunoblotting. Participants with PF&S showed higher levels of circulating sEVs relative to controls. Protein levels of CD9 and CD63 were lower in the sEV fraction of PF&S older adults, while CD81 was unvaried between groups. In addition, circulating sEVs from PF&S participants had lower amounts of ATP5A, NDUFS3, and SDHB. No signal was detected for MTCOI, NDUFB8, or UQCRC2 in either participant group. Our findings indicate that, in spite of increased sEV secretion, lower amounts of mitochondrial components are discarded through EV in older adults with PF&S. In-depth analysis of EV trafficking might open new venues for biomarker discovery and treatment development for PF&S.
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25
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Effects of dance intervention on frailty among older adults. Arch Gerontol Geriatr 2020; 88:104001. [PMID: 32113011 DOI: 10.1016/j.archger.2019.104001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 12/15/2019] [Accepted: 12/16/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The aims of this study were to examine the effects of dance intervention on frailty in pre-frail and frail older persons. DESIGN This is a quasi-experimental, two-group trial. SETTING Older adults living nursing home. PARTICIPANTS Participants aged ≥ 60 years with low physical activity (mean age was 81.8 years; 71 % were female) (N = 66). METHODS Participants allocated to the dance group attended 40 min dance sessions in a nursing home, three times a week for 12-weeks. Participants allocated to the control group maintained their normal daily activities. Assessments were conducted at baseline, 6 weeks, and 12 weeks by researchers blinded to the allocation. Frailty was measured based on Fried criteria. Estimates of frailty between groups over time were calculated using the generalized estimating equations (GEE) and mixed effects models. RESULTS The prevalence of frailty decreased over time in the dance group compared to the control group (P = 0.002). The mean frailty scores decreased 0.69 at 6 weeks and 1.06 at 12 weeks. Compared to the control group, the prevalence of slowness (p = 0.002), weakness (p = 0.005), and low physical activity (p < 0.001) significantly decreased in the dance group. CONCLUSIONS Dance intervention may reduce the presence and severity of frailty in older adults. Slowness and low physical activity improve following 12 weeks of dance intervention.
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Liu J, Du X, Li M, Jia Z, Lu S, Chang S, Tang R, Bai R, Dong J, Lip GYH, Ma C. Frailty and Anticoagulant Therapy in Patients Aged 65 Years or Older with Atrial Fibrillation. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2020. [DOI: 10.15212/cvia.2019.0562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Elderly adults with atrial fibrillation (AF) are at increased risk of frailty and thromboembolic complications. However, studies on the prevalence of frailty in AF patients and data on the relationship between frailty and the use of anticoagulants are limited.Methods:
We conducted a cross-sectional study involving 500 participants. Patients aged 65 years or older were consecutively selected from the Chinese Atrial Fibrillation Registry study. The patient’s frailty status was assessed with use of the Canadian Study of Health and Aging Clinical Frailty
Scale. We assessed the prevalence of and factors associated with frailty, and how frailty affects anticoagulant therapy.Results: In 500 elderly adults with AF (age 75.2±6.7 years; 51.6% female), 201 patients (40.2%) were frail. The prevalence of frailty was higher in females
(P=0.002) and increased with age and CHA2DS2-VASc score (P for trend less than 0.001 for both). The factors associated with frailty were a history of heart failure (odds ratio [OR] 2.40, 95% confidence interval [CI] 1.39‐4.14), female sex (OR 2.09, 95% CI 1.27‐3.43),
and advanced age (OR 1.13, 95% CI 1.09‐1.17). Frail patients were significantly less likely to have ever been prescribed anticoagulants compared with nonfrail patients (81.7 vs. 54.9%, P<0.001).Conclusions: Frailty is prevalent in elderly adults with AF, especially in
females, those of advanced age, and those with heart failure. Frailty status has a significant impact on prescription of anticoagulants for high-risk AF patients.
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Affiliation(s)
- Jiapeng Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Mengmeng Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Zhaoxu Jia
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Shangxin Lu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Sanshuai Chang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Ribo Tang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Rong Bai
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Jianzeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
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Jankowska EA, Vitale C, Uchmanowicz I, Tkaczyszyn M, Drozd M, Ponikowski P. Drug therapy in elderly heart failure patients. Eur Heart J Suppl 2019; 21:L8-L11. [PMID: 31885505 PMCID: PMC6926409 DOI: 10.1093/eurheartj/suz237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Although heart failure (HF) is considered as a cardiogeriatric syndrome, elderly and very elderly patients are under-represented in the vast majority of clinical trials investigating novel drugs and therapies in this population. The homoeostatic systems of elderly subjects are very fragile, and the management of HF accompanied by numerous comorbidities requires a holistic approach towards the patient, with special emphasis not only on psychosomatic problems but also on the individual (including social) needs of each particular patient, along with the support for the family and/or caregivers. In this article, we summarize current evidence regarding pharmacotherapy of elderly patients with HF and summarize the clinical problems occurring in this population.
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Affiliation(s)
- Ewa A Jankowska
- Department of Heart Diseases, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland.,Centre for Heart Diseases, University Hospital, Borowska 213, 50-556 Wroclaw, Poland
| | - Cristiana Vitale
- Department of Medical Sciences, IRCCS San Raffaele Pisana, Centre for Clinical and Basic Research, Via della Pisana 235, 00163 Rome, Italy
| | - Izabella Uchmanowicz
- Department of Clinical Nursing, Wroclaw Medical University, K. Bartla 5, 51-618 Wroclaw, Poland
| | - Michał Tkaczyszyn
- Department of Heart Diseases, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland.,Centre for Heart Diseases, University Hospital, Borowska 213, 50-556 Wroclaw, Poland
| | - Marcin Drozd
- Department of Heart Diseases, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland.,Centre for Heart Diseases, University Hospital, Borowska 213, 50-556 Wroclaw, Poland
| | - Piotr Ponikowski
- Department of Heart Diseases, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland.,Centre for Heart Diseases, University Hospital, Borowska 213, 50-556 Wroclaw, Poland
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Abstract
Sarcopaenia is defined as reduced skeletal muscle mass associated with either a decline in muscle strength or low physical performance. It has been shown to affect 17.5% of people worldwide, with a prevalence of 20% or higher in patients with heart failure (HF). Sarcopaenia has severe impact on mortality, physical capacity, and quality of life. Even though several mechanisms, such as autonomic imbalance, reduced muscle blood flow, increased inflammation, hormonal alterations, increased apoptosis, and autophagy have been proposed to fuel the pathogenesis of sarcopaenia, additional studies assessing the interaction of these conditions need to be conducted to elucidate how the presence of sarcopaenia can exacerbate the progression of HF and vice-versa. Resistance training combined with nutritional protein intake seems to be effective in the treatment of sarcopaenia, although current pharmacotherapies have not been extensively studied with this endpoint in mind. In conclusion, sarcopaenia is interwoven with HF and leads to worse exercise capacity in these patients. The mechanisms associated with this bilateral relationship between sarcopaenia and HF are still to be elucidated, leading to effective treatment, not only for the heart, but also for the skeletal muscle.
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Affiliation(s)
- Guilherme Wesley Peixoto da Fonseca
- Cardiovascular Rehabilitation and Exercise Physiology Unit, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 44 - Cerqueira Cesar, 05403-900 São Paulo, Brazil.,Department of Cardiology and Pneumology, University Medicine Göttingen (UMG), Robert-Koch-Straße 40, 37075 Göttingen, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University Medicine Göttingen (UMG), Robert-Koch-Straße 40, 37075 Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Robert-Koch-Straße 40, 37075 Göttingen, Germany
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Seferović PM. Introduction to the special issue entitled 'Heart failure management of the elderly patient: focus on frailty, sarcopenia, cachexia, and dementia'. Eur Heart J Suppl 2019; 21:L1-L3. [PMID: 31885503 PMCID: PMC6926411 DOI: 10.1093/eurheartj/suz234] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This is a special issue focused on heart failure management of the elderly patient with a focus on frailty, sarcopaenia, cachexia, and dementia, all common problems in the contemporary older heart failure (HF) patient. The Heart Failure Association (HFA) of the European Society of Cardiology (ESC) has brought together experts to discuss these topical and clinically difficult areas. There are papers on ageing, demographics, and heart failure, drug treatment of the older patient, the frail heart failure patient and how to recognize frailty and screen for it without the risk segmenting these patients in a form of discrimination of them as less worthy of treatment through ‘frailtyism’. This is also discussion of the common problems affecting skeletal muscle, both sarcopaenia and cachexia, as well as dementia and cognitive decline and the crucial issue of planning health care for the older patient with HF most effectively by the use of care plans.
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Affiliation(s)
- Petar M Seferović
- Faculty of Medicine, University of Belgrade, 8 Dr Subotića, 11000 Belgrade, Serbia.,Serbian Academy of Sciences and Arts, Belgrade, Serbia
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30
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Coats AJS. Heart failure management of the elderly patient: focus on frailty, sarcopaenia, cachexia, and dementia: conclusions. Eur Heart J Suppl 2019; 21:L36-L38. [PMID: 31885512 PMCID: PMC6926414 DOI: 10.1093/eurheartj/suz236] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2019] [Indexed: 12/30/2022]
Abstract
With the ageing of populations heart failure is becoming more common and more complex. It is affecting ever older patients and the number of prevalent comorbidities is rising. Even as we continue to gain success in large-scale clinical trials with more effective therapies so our patients are becoming more complex. One of the biggest challenges is the effect of age. Frailty, comorbidity, sarcopaenia, cachexia, polypharmacy, and cognitive decline are all challenging our patients as never before and these challenges will be difficult for cash strapped health care systems to manage. For these reasons, the Heart Failure Association brought together a panel of experts to debate and review this complex area, championing the need for us to establish better ways of caring for the patients of the future.
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Affiliation(s)
- Andrew J Stewart Coats
- Department of Medical Sciences, Centre for Clinical and Basic Research, IRCCS San Raffaele Pisana, Via di Val Cannuta 247, 00166 Roma, Italy
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Yu R, Tong C, Ho F, Woo J. Effects of a Multicomponent Frailty Prevention Program in Prefrail Community-Dwelling Older Persons: A Randomized Controlled Trial. J Am Med Dir Assoc 2019; 21:294.e1-294.e10. [PMID: 31706917 DOI: 10.1016/j.jamda.2019.08.024] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 08/15/2019] [Accepted: 08/30/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To examine the effects of a multicomponent frailty prevention program in community-dwelling older persons with prefrailty. DESIGN A randomized controlled trial. SETTING A community elderly center in Hong Kong. PARTICIPANTS Persons aged ≥50 years who scored 1-2 on a simple frailty questionnaire (FRAIL) METHODS: Participants (n = 127) were randomly assigned to a 12-week multicomponent frailty prevention program (exercise, cognitive training, board game activities) or to a wait-list control group. The primary outcomes were FRAIL scores, frailty status, and a combined frailty measure including subjective (FRAIL total score) and objective (grip strength, muscle endurance, balance, gait speed) measures. The secondary outcomes were verbal fluency assessed by dual-task gait speed, attention and memory assessed by digit span task, executive function assessed by the Frontal Assessment Battery, self-rated health, and life satisfaction. Assessments were conducted at baseline and at week 12. RESULTS The mean age of the participants was 62.2 years, and 88.2% were women. At week 12, the FRAIL score had decreased in the intervention group (-1.3, P < .001) but had increased in the control group (0.3, P < .01) (between-group differences P < .001). In addition, 83.3% and 1.6% of the intervention and control groups, respectively, had reversed from prefrailty to robust phenotype (between-group differences P < .001). Participants in the intervention group also had a greater reduction in the combined frailty score and greater improvements in muscle endurance, balance, verbal fluency, attention and memory, executive function, and self-rated health than those in the control group (all P < .05). There were no significant differences between the groups with respect to grip strength, gait speed, and life satisfaction. CONCLUSIONS AND IMPLICATIONS The multicomponent frailty prevention program reduced frailty and improved physical and cognitive functions, and self-rated health in community-dwelling older persons with prefrailty. Findings can provide insights into the consideration of incorporating frailty prevention programs into the routine practice of community elderly services.
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Affiliation(s)
- Ruby Yu
- Jockey Club Institute of Ageing, Chinese University of Hong Kong, Hong Kong SAR, China; Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Cecilia Tong
- Jockey Club Institute of Ageing, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Florence Ho
- Jockey Club Cadenza Hub, Hong Kong SAR, China
| | - Jean Woo
- Jockey Club Institute of Ageing, Chinese University of Hong Kong, Hong Kong SAR, China; Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
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Sanborn V, Azcarate-Peril MA, Gunstad J. The effects of medication adherence on study outcomes in randomized clinical trials: A role for cognitive dysfunction? APPLIED NEUROPSYCHOLOGY-ADULT 2019; 28:641-646. [PMID: 31650861 DOI: 10.1080/23279095.2019.1680987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Medication nonadherence is common and has been associated with poor health outcomes. Older adults are especially likely to be non-adherent to their medications, as they often have more medications to manage and are at greater risk for cognitive dysfunction. Though less frequently examined, the association between cognitive dysfunction and nonadherence also likely extends to clinical trials research. The current study used archival data to examine the potential impact of cognitive dysfunction on adherence to a nutritional supplement as part of a 90-day randomized clinical trial in neurologically healthy middle-aged and older adults. Results showed overall cognitive performance was predictive of adherence to capsule intake when controlling for polypharmacy [F(1,157) = 6.53, p < .01]. These results suggest that cognitive dysfunction may impact findings from RCTs through its adverse impact on adherence to study protocol, possibly leading to greater treatment variance, artificially reduced treatment effects, lower study power, and distorted study outcomes and conclusions. A better understanding of methodological and statistical approaches to account for these unwanted effects are needed.
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Affiliation(s)
- V Sanborn
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - M A Azcarate-Peril
- Department of Medicine, Division of Gastroenterology and Hepatology, and UNC Microbiome Core, Center for Gastrointestinal Biology and Disease, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - J Gunstad
- Department of Psychological Sciences, Kent State University, Kent, OH, USA.,Brain Health Research Institute, Kent State University, Kent, OH, USA
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Lee SY, Tung HH, Peng LN, Chen LK, Hsu CI, Huang YL. Resilience among older cardiovascular disease patients with probable sarcopenia. Arch Gerontol Geriatr 2019; 86:103939. [PMID: 31525556 DOI: 10.1016/j.archger.2019.103939] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 08/18/2019] [Accepted: 08/18/2019] [Indexed: 12/25/2022]
Abstract
AIM AND OBJECTIVES The purpose of this study was to investigate the factors associated with resilience among probable sarcopenia older adults with cardiovascular disease. INTRODUCTION Resilience has been reported to be positively correlated with the mental health and physical functioning of older adults. Previous research has found that the development of resilience constitutes a form of compensation for loss of physical health. It is important for older adults, especially those with other underlying conditions, such as cardiovascular disease and sarcopenia, to have the ability to overcome adversity during the aging process. Thus, resilience becomes a critical characteristic in achieving a better life. METHODS A cross-sectional study design was used. A demographic questionnaire and the Chinese version of the Resilience Scale (CRS) were used to collect data. Multiple logistic regression was used to evaluate the predictors of low resilience. RESULTS A total of 267 participants were recruited, including 126 females and 141 males. Of the participants, 56% of their scores indicated low resilience. Income, education level, exercise time, primary caregiver, and having hypertension were the predictors of resilience. CONCLUSION The population with sarcopenia is increasing worldwide. Understanding resilience levels among older adults with probable sarcopenia is essential for promoting their mental health. Clinicians can use the results of this study to identify populations at high risk for low resilience and design specific interventions to promote better health outcomes.
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Affiliation(s)
- Szu-Ying Lee
- Department of Nursing, Mackay Medical College, No.46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., New Taipei City, 252, Taiwan, ROC.
| | - Heng-Hsin Tung
- School of Nursing, National Yang-Ming University, No.155, Sec.2, Linong Street, Taipei, 112, Taiwan, ROC; Tungs' Taichung MetroHarbor Hospital, No.155, Sec.2, Linong Street, Taipei, 112, Taiwan, ROC.
| | - Li-Ning Peng
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei City, 11217, Taiwan, ROC.
| | - Liang-Kung Chen
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei City, 11217, Taiwan, ROC.
| | - Ching-I Hsu
- Nursing Department, Heart Center of Chen-Hsin Hospital, 45 Cheng-Hsin St, PeiTou, Taipei, 112, Taiwan, ROC.
| | - Yen-Ling Huang
- Nursing Department, Heart Center of Chen-Hsin Hospital, 45 Cheng-Hsin St, PeiTou, Taipei, 112, Taiwan, ROC.
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Yuki A, Otsuka R, Tange C, Nishita Y, Tomida M, Ando F, Shimokata H, Arai H. Daily Physical Activity Predicts Frailty Development Among Community-Dwelling Older Japanese Adults. J Am Med Dir Assoc 2019; 20:1032-1036. [DOI: 10.1016/j.jamda.2019.01.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 01/01/2019] [Accepted: 01/03/2019] [Indexed: 01/09/2023]
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Abstract
PURPOSE OF REVIEW Frailty is a multidimensional condition common in older adults, where reduced resiliency leads to adverse outcomes. It has strong links with malnutrition and sarcopenia, mostly through muscle health. This review explores the links between nutrition and frailty from different perspectives. RECENT FINDINGS Studies linking malnutrition and frailty show that most malnourished persons are frail, and malnutrition risk is increased in frail people. Energy and protein intake and some micronutrients are linked to frailty. Research on the role of microbiota and specific amino acids is increasing. Recent literature on the prevention of frailty with nutrition confirms that an appropriate intake of proteins, vitamin D and other nutrients is needed, but this information is still not in the public domain. Interventions to reverse frailty and sarcopenia should include exercise and nutrition interventions, usually with a multidomain approach including other elements. SUMMARY Public health recommendations to eat an optimal diet with the right amount of energy and proteins should be moved to the public domain. Whenever frailty is present, nutrition has a role in reverting it and avoiding adverse outcomes, but high-quality research is still needed in this area.
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Affiliation(s)
| | - Jean Woo
- Department of Medicine & Therapeutics, Faculty of Medicine, The Chinese University of Hongkong, Hong Kong, China
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Update on Interventions to Prevent or Reduce Frailty in Community-Dwelling Older Adults: a Scoping Review and Community Translation. CURRENT GERIATRICS REPORTS 2019. [DOI: 10.1007/s13670-019-0277-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Lana LD, Crossetti MDGO. Outcome of interventions in elderly persons classified according to the Fried frailty phenotype: an integrative review. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2019. [DOI: 10.1590/1981-22562019022.190008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Objective: To analyze the interventions carried out with elderly persons classified according to the Fried frailty phenotype criteria and the outcomes obtained. Method: The PubMed, Embase, Scopus, CINAHL, PEDro, SciELO, BVS and Web of Science portals were used, and a manual search was applied to identify the interventions implemented in elderly persons aged over 60 years, which were able to modify the scores of the frailty phenotype criteria and other outcomes. Results: The final sample totaled 14 randomized clinical trials published between 2001 and 2018. The combined interventions of exercise, orientation and nutritional supplementation with or without cognitive training presented better outcomes for the frailty criteria and other clinical outcomes in pre-frail and frail elderly persons living in the community and in long-term care facilities. Conclusion: The implementation of combined interventions sustains frailty as a reversible and multifactorial syndrome.
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Suzuki T, Palus S, Springer J. Skeletal muscle wasting in chronic heart failure. ESC Heart Fail 2018; 5:1099-1107. [PMID: 30548178 PMCID: PMC6300810 DOI: 10.1002/ehf2.12387] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 11/07/2018] [Indexed: 02/06/2023] Open
Abstract
Patients suffering from chronic heart failure (CHF) show an increased prevalence (~20% in elderly CHF patients) of loss of muscle mass and muscle function (i.e. sarcopenia) compared with healthy elderly people. Sarcopenia, which can also occur in obese patients, is considered a strong predictor of frailty, disability, and mortality in older persons and is present in 5–13% of elderly persons aged 60–70 years and up to 50% of all octogenarians. In a CHF study, sarcopenia was associated with lower strength, reduced peak oxygen consumption (peak VO2, 1173 ± 433 vs. 1622 ± 456 mL/min), and lower exercise time (7.7 ± 3.8 vs. 10.22 ± 3.0 min, both P < 0.001). Unfortunately, there are only very limited therapy options. Currently, the main intervention remains resistance exercise. Specialized nutritional support may aid the effects of resistance training. Testosterone has significant positive effects on muscle mass and function, and low endogenous testosterone has been described as an independent risk factor in CHF in a study with 618 men (hazard ratio 0.929, P = 0.042). However, the use of testosterone is controversial because of possible side effects. Selective androgen receptor modulators have been developed to overcome these side effects but are not yet available on the market. Further investigational drugs include growth hormone, insulin‐like growth factor 1, and several compounds that target the myostatin pathway. The continuing development of new treatment strategies and compounds for sarcopenia, muscle wasting regardless of CHF, and cardiac cachexia makes this a stimulating research area.
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Affiliation(s)
- Tsuyoshi Suzuki
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany
| | - Sandra Palus
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany
| | - Jochen Springer
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany
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Delaying and reversing frailty: a systematic review of primary care interventions. Br J Gen Pract 2018; 69:e61-e69. [PMID: 30510094 DOI: 10.3399/bjgp18x700241] [Citation(s) in RCA: 190] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 07/18/2018] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Recommendations for routine frailty screening in general practice are increasing as frailty prevalence grows. In England, frailty identification became a contractual requirement in 2017. However, there is little guidance on the most effective and practical interventions once frailty has been identified. AIM To assess the comparative effectiveness and ease of implementation of frailty interventions in primary care. DESIGN AND SETTING A systematic review of frailty interventions in primary care. METHOD Scientific databases were searched from inception to May 2017 for randomised controlled trials or cohort studies with control groups on primary care frailty interventions. Screening methods, interventions, and outcomes were analysed in included studies. Effectiveness was scored in terms of change of frailty status or frailty indicators and ease of implementation in terms of human resources, marginal costs, and time requirements. RESULTS A total of 925 studies satisfied search criteria and 46 were included. There were 15 690 participants (median study size was 160 participants). Studies reflected a broad heterogeneity. There were 17 different frailty screening methods. Of the frailty interventions, 23 involved physical activity and other interventions involved health education, nutrition supplementation, home visits, hormone supplementation, and counselling. A significant improvement of frailty status was demonstrated in 71% (n = 10) of studies and of frailty indicators in 69% (n=22) of studies where measured. Interventions with both muscle strength training and protein supplementation were consistently placed highest for effectiveness and ease of implementation. CONCLUSION A combination of muscle strength training and protein supplementation was the most effective intervention to delay or reverse frailty and the easiest to implement in primary care. A map of interventions was created that can be used to inform choices for managing frailty.
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von Haehling S. Muscle wasting and sarcopenia in heart failure: a brief overview of the current literature. ESC Heart Fail 2018; 5:1074-1082. [PMID: 30570227 PMCID: PMC6300806 DOI: 10.1002/ehf2.12388] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Indexed: 12/15/2022] Open
Affiliation(s)
- Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
- Deutsches Zentrum für Herz-und Kreislaufforschung, Standort Göttingen, Göttingen, Germany
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Dinatolo E, Sciatti E, Anker MS, Lombardi C, Dasseni N, Metra M. Updates in heart failure: what last year brought to us. ESC Heart Fail 2018; 5:989-1007. [PMID: 30570225 PMCID: PMC6300825 DOI: 10.1002/ehf2.12385] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Indexed: 12/21/2022] Open
Affiliation(s)
- Elisabetta Dinatolo
- Department of Medical and Surgical Specialties, Radiological Sciences and Public HealthUniversity of BresciaBresciaItaly
| | - Edoardo Sciatti
- Department of Medical and Surgical Specialties, Radiological Sciences and Public HealthUniversity of BresciaBresciaItaly
| | - Markus S. Anker
- Division of Cardiology and Metabolism, Department of Cardiology, Berlin‐Brandenburg Center for Regenerative Therapies (BCRT), DZHK (German Centre for Cardiovascular Research), partner site BerlinCharité—Universitätsmedizin BerlinBerlinGermany
| | - Carlo Lombardi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public HealthUniversity of BresciaBresciaItaly
| | - Nicolò Dasseni
- Department of Medical and Surgical Specialties, Radiological Sciences and Public HealthUniversity of BresciaBresciaItaly
| | - Marco Metra
- Department of Medical and Surgical Specialties, Radiological Sciences and Public HealthUniversity of BresciaBresciaItaly
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42
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Rodrigues RAP, Fhon JRS, Pontes MDLDF, Silva AO, Haas VJ, Santos JLF. Frailty syndrome among elderly and associated factors: comparison of two cities. Rev Lat Am Enfermagem 2018; 26:e3100. [PMID: 30517585 PMCID: PMC6280173 DOI: 10.1590/1518-8345.2897.3100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 10/08/2018] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE to compare the frailty syndrome among elderly people living at home in two Brazilian cities and to identify factors related to sociodemographic and health-related variables. METHOD population-based cross-sectional study with 480 elderly individuals from the cities of Ribeirão Preto/SP and João Pessoa/PB, with application of the Mini Mental State Examination instruments and the Edmonton Frailty, Geriatric Depression and Lawton and Brody scales. Descriptive analysis, Chi-square test, Fisher's test, Student's t-test, Spermann's correlation and Logistic regression were used. In all analyzes, the level of significance was set at p≤0.05. RESULTS in relation to frailty, it was verified that living in Ribeirão Preto, presenting advanced age, low schooling, multiple chronic diseases, reduced cognitive status and functional capacity, besides depressive symptoms, are factors associated with the frailty syndrome, in both cities. CONCLUSION we identified that the frailty syndrome in the elderly of both cities has a relation with the place where the elderly person lives, age, schooling, number of diseases, reduction of cognitive status, functional capacity and presence of symptoms depressive.
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Affiliation(s)
- Rosalina Aparecida Partezani Rodrigues
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto,
Centro Colaborador da OPAS/OMS para o Desenvolvimento da Pesquisa em Enfermagem,
Ribeirão Preto, SP, Brasil
| | - Jack Roberto Silva Fhon
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto,
Centro Colaborador da OPAS/OMS para o Desenvolvimento da Pesquisa em Enfermagem,
Ribeirão Preto, SP, Brasil
| | | | - Antonia Oliveira Silva
- Universidade Federal da Paraíba, Instituto Paraibano de
Envelhecimento, João Pessoa, PB, Brasil
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von Haehling S, Anker MS, Ebner N, Anker SD. Time to jump on the bandwagon: the Journal of Cachexia, Sarcopenia and Muscle in 2018. J Cachexia Sarcopenia Muscle 2018; 9:793-801. [PMID: 30311438 PMCID: PMC6204581 DOI: 10.1002/jcsm.12356] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical School, Göttingen, Germany
| | - Markus S Anker
- Division of Cardiology and Metabolism, Department of Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site: Department of Cardiology Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Nicole Ebner
- Department of Cardiology and Pneumology, University of Göttingen Medical School, Göttingen, Germany
| | - Stefan D Anker
- Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site: Department of Cardiology Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Cardiology (CVK), Charité-Universitätsmedizin Berlin, Berlin, Germany
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Schrag A, Khan K, Hotham S, Merritt R, Rascol O, Graham L. Experience of care for Parkinson's disease in European countries: a survey by the European Parkinson's Disease Association. Eur J Neurol 2018; 25:1410-e120. [DOI: 10.1111/ene.13738] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 06/21/2018] [Indexed: 12/01/2022]
Affiliation(s)
- A. Schrag
- Department of Clinical Neurosciences; Institute of Neurology; University College London; London UK
| | - K. Khan
- Department of Clinical Neurosciences; Institute of Neurology; University College London; London UK
| | - S. Hotham
- Centre for Health Services Studies; University of Kent; Canterbury UK
| | - R. Merritt
- Centre for Health Services Studies; University of Kent; Canterbury UK
- University of Surrey; Guildford UK
| | - O. Rascol
- Départements de Pharmacologie Clinique et de Neurosciences; Centre Hospitalo-Universitaire de Toulouse and INSERM; Centre d'Investigation Clinique CIC1436; Centre Expert Parkinson, NeuroToul COEN Centre of Excellence in Neurodegeneration; Université de Toulouse; Toulouse France
| | - L. Graham
- European Parkinson's Disease Association; Sevenoaks UK
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Anker SD, von Haehling S, Coats AJS. More variety with the Journal of Cachexia, Sarcopenia and Muscle: JCSM Clinical Reports and JCSM Rapid Communications have both gone live. J Cachexia Sarcopenia Muscle 2018; 9:217-219. [PMID: 29608044 PMCID: PMC5879971 DOI: 10.1002/jcsm.12298] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 02/20/2018] [Indexed: 12/19/2022] Open
Affiliation(s)
- Stefan D Anker
- Division of Cardiology and Metabolism, Department of Cardiology (CVK); Berlin-Brandenburg Center for Regenerative Therapies (BCRT); Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK) partner site Berlin; Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
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Lee SY, Tung HH, Liu CY, Chen LK. Physical Activity and Sarcopenia in the Geriatric Population: A Systematic Review. J Am Med Dir Assoc 2018; 19:378-383. [PMID: 29580886 DOI: 10.1016/j.jamda.2018.02.003] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 02/10/2018] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Sarcopenia is an aging-related health problem in the geriatric population. Sarcopenia reduces muscle mass, muscle strength, and physical performance. Although physical activity is protective against sarcopenia for older adults, there are limited studies in this area. The purpose of this study was to integrate and analyze research on physical activity and sarcopenia in the geriatric population. METHODS Studies that assess sarcopenia were searched across electronic databases that included Medline, PubMed, CINAHL, and Cochrane Database of Systematic Reviews. Studies that implemented physical activity-related intervention or research were included. A critical appraisal skills program was used for quality assessment of the selected articles. Study selection and data extraction were counted by 2 independent reviewers. RESULTS Of the 149 references identified through the database search, 10 studies were included in this systematic review. Seven studies were randomized controlled trials, and 3 were cross-sectional or longitudinal. The results of 8 studies indicated significant improvement in muscle mass, muscle strength, and physical performance through exercise intervention, as determined by long-term observation. CONCLUSIONS Physical activity is an effective protective strategy for sarcopenia. Most studies of older adults exercise intervention indicated that the participants achieved positive results, but maintenance of muscle strength appeared to depend on continuous implementation of certain types of physical activities. A limitation of these 10 reviewed studies was that there was no consistency in the measurement of sarcopenia. Therefore, sarcopenia measurement needs further investigation.
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Affiliation(s)
- Szu-Ying Lee
- School of Nursing, National Yang Ming University, Taipei City, Taiwan (ROC)
| | - Heng-Hsin Tung
- School of Nursing, National Yang Ming University, Taipei City, Taiwan (ROC); Tungs' Taichung MetroHarbor Hospital, Taipei, Taiwan (ROC).
| | - Chieh-Yu Liu
- Department of Speech Language Pathology and Audiology, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan (ROC)
| | - Liang-Kung Chen
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan (ROC)
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47
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Morley JE. Editorial: Defining Undernutrition (Malnutrition) in Older Persons. J Nutr Health Aging 2018; 22:308-310. [PMID: 29484342 DOI: 10.1007/s12603-017-0991-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- J E Morley
- John E. Morley, MB,BCh, Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 S. Grand Blvd., M238, St. Louis, MO 63104,
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Yeh JJ, Wei YF, Lin CL, Hsu WH. Effect of the asthma-chronic obstructive pulmonary disease syndrome on the stroke, Parkinson's disease, and dementia: a national cohort study. Oncotarget 2017; 9:12418-12431. [PMID: 29552322 PMCID: PMC5844758 DOI: 10.18632/oncotarget.23811] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 11/10/2017] [Indexed: 12/13/2022] Open
Abstract
Background To evaluate the association of asthma–chronic obstructive pulmonary disease syndrome (ACOS) with neurodegenerative diseases (stroke, Parkinson's disease and dementia) and the role of the steroids in the neurodegenerative diseases among the ACOS cohort. Materials and Methods Comparison of the ACOS cohort (N = 10,260) with the non-ACOS cohort (n = 20,513) based on the patients aged ≧40 years in the National Health Insurance Research Database from January 1, 2000 to December 31, 2010. These patients follow up to diagnosis of neurodegenerative diseases or the December 31, 2011; using multivariable Cox proportional hazards models. Results After adjustment for potential confounders, the [adjusted hazard ratio (aHR), 95% confidence interval (CI)] in the ACOS cohort were [1.39, 1.28–1.50] [1.56, 1.34–1.81] and [1.43, 1.29–1.59] for stroke, Parkinson's disease, dementia; respectively. The [aHR, 95% CI] for ACOS cohort with (inhaler corticosteroids ≧0.13 gram/ oral steroids ≧0.08gram) were with less risk (all aHR<1, p values <0.05) for these 3 neurodegenerative diseases except Parkinson's disease with inhaler corticosteroids >0.43 gram. The risk of stroke and dementia were the lower in patients with < 250 μg/d of a fluticasone equivalent inhaler corticosteroids (aHR = 0.53, 95% CI = 0.35–0.79; aHR = 0.53, 95% CI = 0.31–0.90, respectively). Conclusions The ACOS cohort had a higher risk of the neurodegenerative diseases. The lower dose of the inhaler corticosteroids with cumulative dose ≧0.13 gram have the less risk of stroke and dementia.
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Affiliation(s)
- Jun-Jun Yeh
- Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan.,Chia Nan University of Pharmacy and Science, Tainan, Taiwan.,Meiho University, Pingtung, Taiwan.,Pingtung Christian Hospital, Pingtung, Taiwan
| | - Yu-Feng Wei
- Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Wu-Huei Hsu
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
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Abstract
Introduction Cachexia is a common complication of many and varied chronic disease processes, yet it has received very little attention as an area of clinical research effort until recently. We sought to survey the contemporary literature on published research into cachexia to define where it is being published and the proportion of output classified into the main types of research output. Methods I searched the PubMed listings under the topic research term "cachexia" and related terms for articles published in the calendar years of 2015 and 2016, regardless of language. Searches were conducted and relevant papers extracted by two observers, and disagreements were resolved by consensus. Results There were 954 publications, 370 of which were review articles or commentaries, 254 clinical observations or non-randomised trials, 246 original basic science reports and only 26 were randomised controlled trials. These articles were published in 478 separate journals but with 36% of them being published in a core set of 23 journals. The H-index of these papers was 25 and there were 147 papers with 10 or more citations. Of the top 100 cited papers, 25% were published in five journals. Of the top cited papers, 48% were review articles, 18% were original basic science, and 7% were randomised clinical trials. Discussion This analysis shows a steady but modest increase in publications concerning cachexia with a strong pipeline of basic science research but still a relative lack of randomised clinical trials, with none exceeding 1000 patients. Research in cachexia is still in its infancy, but the solid basic science effort offers hope that translation into randomised controlled clinical trials may eventually lead to effective therapies for this troubling and complex clinical disease process.
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Abstract
PURPOSE OF REVIEW Physical inactivity in older adults is associated with declining functional capacity, sarcopenia, metabolic changes, and cognitive changes. Current Physical Activity Guidelines recommend 150 min of moderate-intensity exercise along with strengthening and balance exercises. Despite the guidelines there is little evidence of a population-based change in physical activity. RECENT FINDINGS There is a growing body of research investigating the use of high-intensity interval training in older adult to improve health-related outcomes. Research indicates that high-intensity interval training confers greater benefit than moderate-intensity exercise and is acceptable and safe for older adults and those with various noncommunicable diseases. SUMMARY A major challenge to health systems is the growing number of people surviving into older age, many of whom have more than one noncommunicable disease. Physical inactivity is a modifiable risk factor for the development of noncommunicable diseases. Increasing participation in physical activity interventions, particularly those at a high intensity, appears to be a safe and feasible approach to reducing the demand on healthcare systems into the future.
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