Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery

Gait Speed as a Measure of Frailty and Outcomes After Lung Resection

BACKGROUND

As a powerful, objective marker of frailty, 4-m gait speed (4MGS) can predict morbidity and mortality in various populations including cardiac surgery and oncology patients. Its role in thoracic surgery is understudied. This study aimed to evaluate associations between preoperative 4MGS and outcomes after pulmonary resection.

METHODS

A cohort study analyzed patients undergoing pulmonary resections at a high-volume surgical center from January 2021 to October 2023. Preoperative 4MGS was prospectively collected by medical assistants as part of routine vital sign assessments in clinic. Uni- and multivariable analyses were performed to evaluate the associations of preoperative 4MGS with postoperative length of stay, adverse events, and discharge disposition, controlling for lung function (FEV1), extent of resection, comorbidity, and other covariates.

RESULTS

Overall, 401 patients were included (median age, 69 years; interquartile range, 61-75 years): 123 (31%) lobectomy and 278 (69%) sublobar resection patients. After controlling for covariates, each decrease of 0.1 m/s in 4MGS was associated with average longer length of stay (beta, 0.12; 95% confidence interval [CI], 0.01-0.23) and increased odds of adverse events (odds ratio [OR], 1.10; 95% CI 1.00-1.25). These associations were largely maintained when analyses were repeated within the lobar and sublobar cohorts. Among the sublobar resections, decreases in 0.1 m/s of 4MGS was associated with increased odds of discharge to home requiring home services or to a rehabilitation facility (OR, 1.10; 95% CI 1.00-1.22).

CONCLUSIONS

Preoperative 4MGS is independently associated with important surgical outcomes after lung resection. The 4MGS marker can complement other preoperative measures used to risk-stratify patients undergoing lung resection.

Acute effects of tissue flossing on the thigh

OBJECTIVES

To compare variables of local temperature, hip joint range of motion, power tests, before and after Tissue Flossing (TF) in active men.

DESIGN

Experimental, controlled, cross-over and randomized.

SETTINGS

Field Experiment.

PARTICIPANTS

20 physically active men.

MAIN OUTCOME MEASURES

Thigh region temperature, range of motion and power were measured with a thermographic camera, digital goniometer and specific tests.

RESULTS

The use of TF showed improvements in the measurements of anterior plane TF versus sham temperature (p < 0.00001), posterior plane temperature (p < 0.00001), ROM (p = 0.002), power (p = 0.008).

CONCLUSION

The increase in temperature from muscle work plus TF facilitates metabolism in terms of a positive feedback loop. The increased temperature in the extremities leads to a significantly higher viscoelasticity of the fascia. Therefore, it generates less resistance of the fascia, with an increase in the amplitude of movement, the possibility of transmitting tension between segments, and better use of elastic energy.

Changes in fatigue after first-ever ischemic stroke and their associations with changes in physical fitness, body composition, and physical activity

OBJECTIVES

The objectives of the present study were 1) to describe changes in fatigue from 3 to 12 months post-stroke and compare different patterns of fatigue changes with respect to concurrent changes in physical fitness, body composition, and activity levels, and 2) to explore whether changes in fatigue are associated with changes in physical fitness, body composition, and physical activity levels in patients recovering from first-ever ischemic stroke.

MATERIALS AND METHODS

In this longitudinal observational study, we assessed 72 patients (mean age 62 years, 36 % females) at 3 and 12 months after first-ever ischemic stroke. Fatigue was measured with the 7-item Fatigue Severity Scale. Physical fitness, body composition and physical activity were assessed using cardiopulmonary exercise testing, physical function tests, Dual-energy X-ray Absorptiometry, and accelerometers.

RESULTS

Fatigue levels was stable between 3 and 12 months post-stroke in 44 (61 %) patients, decreased in 14 (19 %), and increased in another 14 (19 %). Patients with increased fatigue levels showed a greater decrease in cardiorespiratory fitness, as measured directly by peak oxygen uptake, compared to those with decreased fatigue. Robust regression analysis, adjusted for age and sex, indicated that each kilogram of lean body mass gained from 3 to 12 months post-stroke was significantly associated with a 0.3-point reduction in fatigue during the same timeframe (B= -0.32; 95 %CI [-0.51, -0.12]).

CONCLUSION

There was considerable individual variation in changes to fatigue, physical fitness, body composition, and physical activity levels between 3 and 12 months following a first-ever ischemic stroke. Increased fatigue was linked to a greater concurrent decline in cardiorespiratory fitness, while lean body mass was associated with decreases in fatigue.

Is serum 25-hydroxyvitamin D deficiency a risk factor for the incidence of slow gait speed in older individuals? Evidence from the English longitudinal study of ageing

AIMS

Cross-sectional studies demonstrate an association between low serum levels of vitamin D and slower gait speed in older individuals. However, longitudinal studies remain inconclusive. This study investigates whether vitamin D deficiency and insufficiency are risk factors for the incidence of slowness.

MATERIALS AND METHODS

A total of 2815 participants from the English Longitudinal Study of Ageing (ELSA), aged ≥60 years and with a baseline gait speed >0.8 m/s, were followed for six years. Baseline serum levels of vitamin D [25(OH)D] were categorized as "sufficiency" (>50 nmol/L), "insufficiency" (>30 and ≤50 nmol/L) or "deficiency" (≤30 nmol/L). Gait speed was reassessed at four and six years of follow-up to identify incident cases of slowness (walking speed ≤0.8 m/s). A Poisson regression model, adjusted for sociodemographic, behavioural and clinical characteristics at baseline, was conducted to determine the association between serum 25(OH)D levels and the risk of slowness.

RESULTS

The incidence densities of slowness per 1000 person-years were 67.4 (95% CI: 60.93-74.64) for sufficiency, 76.7 (95% CI: 68.30-86.22) for insufficiency and 90.7 (95% CI: 78.46-104.92) for deficiency. Serum 25(OH)D deficiency was associated with a 22% increase in the risk of slowness (IRR: 1.22; 95% CI: 1.01-1.49) compared with serum 25(OH)D sufficiency. No significant association was observed for serum 25(OH)D insufficiency.

CONCLUSIONS

Serum 25(OH)D deficiency is a risk factor for the incidence of slowness in older individuals, suggesting that maintaining sufficient 25(OH)D levels could be a strategic approach to minimise long-term mobility impairment.

Driving status, avoidance, and visual impairment among older adults in the United States

Background

Late-life visual impairment (VI) increases driving difficulty and affects driving outcomes, such as driving cessation and avoidance. Existing studies are limited by small sample sizes and a lack of objective VI measures in older drivers on a national scale.

Methods

Using nationally representative data from the 2022 National Health and Aging Trends Study, we examined associations between objectively measured VI, driving cessation, and avoidance among U.S. adults aged ≥65 (n=4,980). VI was defined using measures of binocular distance visual acuity and contrast sensitivity (CS). Driving cessation was defined as no longer driving in the prior month, and driving avoidance included avoiding driving at night, alone, and on highways.

Results

Weighted sample characteristics showed that 9.4% of older adults had distance VI (DVI) and 9.2% had CS impairment (CSI). Nearly half of older adults with VI avoided driving at night, about 1 in 7 avoided driving alone, and more than 1 in 4 avoided driving on highways. Compared to those without any VI, older adults with any type of VI were more likely to report driving cessation (OR=2.31, 95%CI=1.62-3.29) and to avoid driving at night(OR=1.63, 95%CI=1.15-2.32), on highways(OR=1.41, 95%CI=1.02-2.05), and alone(OR=1.76, 95%CI=1.07-2.89). DVI and CSI were each significantly associated with all outcomes, with stronger associations for more severe DVI. For each outcome, the joint association of combined DVI and CSI was stronger than for a single VI.

Discussion

Preventing VI and deploying interventions to restore vision are necessary to promote independence in late life by keeping older adults driving safely.

Targeting osteosarcopenia and multimorbidity for frailty prevention through identification and deep phenotyping methods in healthy ageing and high-burden disease cohorts (OPTIMA-C): a longitudinal observational cohort study protocol for neuromusculoskeletal muscle health

INTRODUCTION

Sarcopenia and frailty have been identified as negative predictors of health outcomes. Patients with stroke, traumatic brain injury (TBI), knee osteoarthritis (OA) and breast cancer commonly experience low physical activity levels in the chronic phase of recovery. This prospective study aims to explore the feasibility of multimodal screening and longitudinal tracking of various biomarkers from the acute to chronic phase of disease to determine the relationship with frailty outcomes.

METHODS AND ANALYSIS

A prospective longitudinal observational cohort study involving Asian populations is planned over 3 years. Enrolled participants with index conditions of acute stroke, TBI, knee OA and breast cancer will be recruited from rehabilitation hospitals and clinics and followed longitudinally. Reference thresholds from the Asian Working Group on Sarcopenia will be used. Variables include self-reported questionnaires, disease and comorbidity characteristics, anthropometric measurements, appetite questionnaires, muscle ultrasound (MUS), muscle/bone mass, blood biomarkers and markerless gait motion systems. In particular, physical performance (short physical performance battery and hand grip strength), sarcopenia (SARC-F questionnaire) and frailty assessment (FRAIL score, clinical frailty scale), four-region MUS, body composition analysis, dual X-ray absorptiometry, bone mineral densitometry, physical activity levels (International Physical Activity Questionnaire for the elderly [IPAQ-E], fitness trackers) and health-related quality of life assessment (EuroQoL-5D questionnaire five level [EQ5D-5L]) will be used. Blood biomarkers measuring metabolic health (eg, glycated haemoglobin, cholesterol, fasting glucose and 25-OH vitamin D) and inflammation (eg, Tumor Necrosis Factor-alpha [TNF-α] and Monocyte Chemoattractant Protein-1 [MCP-1]) will be measured at baseline. Data collection will take place at postrecruitment baseline (hospital admission), 1, 6 months, 12 months and 2 years postrecruitment (inpatient) and at postrecruitment baseline, 6 months, 12 months and 2 years postrecruitment (outpatient).

ETHICS AND DISSEMINATION

Ethical approval has been obtained from the National Healthcare Group Domain Specific Review Board (2023/00105). Findings will be disseminated through conference presentations and publication in scientific journals.

TRIAL REGISTERATION NUMBER

NCT06073106.

Association of Sleep Quality with Activity and Participation in Older Adults

OBJECTIVE

To explore the relation of self-reported sleep quality with the International Classification of Functioning domains of activity (e.g., physical functioning) and participation (e.g., disability).

DESIGN

Descriptive, secondary, cross-sectional data-analysis SETTING: General community PARTICIPANTS: Community-dwelling older adult, volunteers, n=249 INTERVENTIONS: not applicable MAIN OUTCOME MEASURES: . The Pittsburgh Sleep Quality Index (PSQI), self-reported measures of activity and participation by the Late-Life Function and Disability Instrument (LLFDI), the modified Gait Efficacy Scale for confidence in walking, and performance-based measures of physical functioning (gait speed, Six Minute Walk, Figure of 8 Walk and Short Physical Performance Battery, SPPB). Measures of function were regressed on sleep quality adjusted for age, sex, and comorbidities.

RESULTS

Older adults with good (PSQI≤5) compared to poor (>5) sleep quality reported better function and disability across almost all considered domains (p< 0.05). Effect sizes for self-reported and performance-based measures were comparable and in the small to moderate range.

CONCLUSIONS

Among older adults with mild to moderate functional limitations and disability, self-reported sleep quality related broadly to activity and participation. Experimental studies are needed to assess the effects of sleep interventions on activity and participation and understand if sleep quality may represent a novel treatment target in future intervention trials to improve function in older adults.

Comparing interpretable machine learning models for fall risk in middle-aged and older adults with and without pain

Pain is common in middle-aged and older adults, has also been identified as a fall risk factor, whereas the mechanism of falls in pain is unclear. This study included 13,074 middle-aged and older adults from the China health and retirement longitudinal study (wave 2011-2015) to separately develop four-year fall risk prediction models for older adults with and without pain, using five machine learning algorithms with 145 input variables as candidate features. Shapley Additive exPlanations (SHAP) was used for the prediction model explanations. Adjusted logistic regression (LR) models showed that pain (OR 1.40 [1.29, 1.53]) was associated with a higher fall risk. Among pain characteristics, lower limb pain had the highest risk (OR 1.71 [1.22, 2.18]), followed by severe pain (OR 1.53 [1.36, 1.73]) and multisite pain (OR 1.43 [1.28, 1.55]). Among the fall prediction models for pain and non-pain, the LR model performed best with AUC-ROC values of 0.732 and 0.692, respectively. Common important features included fall history and height. Unique features for the pain model were functional limitation, SPPB, WBC, chronic disease score, life satisfaction, platelets, cooking fuel, and pain quantity, while marital status, age, depressive symptoms, cognitive function, hearing, rainy days, tidiness, and sleep duration were exclusive to the non-pain model. Pain characteristics are associated with falls among middle-aged and older adults. Prediction model can help identify people at high risk of falls with pain. Important features of falls differ between pain and non-pain populations, and prevention strategies should target specific populations for fall risk prediction.

Geriatric assessment in older adults with acute myeloid leukemia: A Young International Society of Geriatric Oncology narrative review

The therapeutic landscape of acute myeloid leukemia (AML) in older adults has been transformed by the advent of targeted therapies, including venetoclax (a B-cell lymphoma-2 inhibitor), gilteritinib (a FMS-like tyrosine kinase 3 inhibitor), ivosidenib, and enasidenib (isocitrate dehydrogenase 1/2 inhibitors). These agents, in combination with hypomethylating agents, have significantly improved outcomes among patients aged 60 years and older, however, overall survival remains very poor. Hence, the management of AML in this population requires a nuanced approach to balance overall survival, treatment-related toxicities, quality of life, and the preservation of functional independence. In recent years, geriatric assessment (GA) has emerged as a critical strategy to identify vulnerabilities that may not be captured in routine oncology evaluations. This assessment helps guide tailored interventions to optimize the fitness of older adults, allowing for better risk stratification and thereby informing treatment plans. This review discusses available evidence for each domain within the GA, feasibility of GA in clinical trials, and gaps in knowledge and future directions to fill those gaps.

Exploring in-hospital mobility practices for geriatric patients: insights from a mixed-method study

BACKGROUND

It is well-established that mobility is very limited among older hospitalized patients and associated with several negative outcomes. Therefore, this mixed-methods study aimed to quantify 24-hour mobility levels in acutely admitted older adults and simultaneously explore clinical practice with regards to mobilization and mobility through an ethnographic field study.

METHODS

Over a 6-week period, hospital mobility was assessed in 44 geriatric patients by SENS motion® activity sensors that the patients wore continuously for 24 h a day during their hospitalization. An ethnographic field study was conducted alongside the cohort study. It included participant observation on the ward and situated conversations with staff, patients, and relatives 2-3 times a week for 4-5 h at different times of the day. The observations were noted in field notes. Activity data were aggregated into a per day measure based on the mean of all available days for a given patient. Also, the per day measures were stratified by walking dependency (walking with or without a walking aid). The field notes were analyzed through a thematic analysis.

RESULTS

During hospitalization, the patients spent most of their time (22.8 h/per day) in sedentary behavior and only 1.2 h/per day in uptime (walking and standing), including 43 min walking, and took less than 1200 steps daily. The field study revealed that most staff consider mobilization and mobility important tasks. However, mobilizing patients to a chair and performing functional level assessments are prioritized over patient mobility. Also, the patients' perceived mobility opportunities are limited by the physical environment (e.g., congested hallways) and lack of purposeful activities to engage in.

CONCLUSIONS

This study found low levels of mobility in geriatric inpatients during hospitalization. While mobility is considered important, mobilization to a chair and functional assessments are prioritized over patient mobility, which becomes dependent on the patient's own initiative. Therefore, environmental adjustment, enhanced interprofessional collaboration, and targeted strategies for integrating mobility into daily care practices are warranted to enhance in-hospital mobility. ClincalTrials.Gov identifier NCT06421246.

Effectiveness of a community-based rehabilitation programme following hip fracture: results from the Fracture in the Elderly Multidisciplinary Rehabilitation phase III (FEMuR III) randomised controlled trial

OBJECTIVE

To determine whether an enhanced community rehabilitation intervention (the Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR) intervention) was more effective than usual National Health Service care, following surgical repair of hip fracture, in terms of the recovery of activities of daily living (ADLs).

DESIGN

Definitive, pragmatic, multisite, parallel-group, two-armed, superiority randomised controlled trial with 1:1 allocation ratio.

SETTING

Participant recruitment in 13 hospitals across England and Wales, with the FEMuR intervention delivered in the community.

PARTICIPANTS

Patients aged over 60 years, with mental capacity, recovering from surgical treatment for hip fracture and living in their own home prior to fracture.

INTERVENTIONS

Usual rehabilitation care (control) was compared with usual rehabilitation care plus the FEMuR intervention, which comprised a patient-held workbook and goal-setting diary to improve self-efficacy, and six additional therapy sessions delivered in-person in the community, or remotely during COVID-19 restrictions (intervention), to increase the practice of exercise and ADL.

PRIMARY AND SECONDARY OUTCOME MEASURES

Primary outcome was the Nottingham Extended Activities of Daily Living (NEADL) scale at 12 months. Secondary outcomes included: Hospital Anxiety and Depression Scale, Falls Self-Efficacy-International scale, hip pain intensity, fear of falling, grip strength and Short Physical Performance Battery. Outcomes were collected by research assistants in participants' homes, whenever possible, but had to be collected remotely during COVID-19 restrictions.

RESULTS

In total, 205 participants were randomised (n=104 experimental; n=101 control). Trial processes were adversely affected by the COVID-19 pandemic. There were 20 deaths, 34 withdrawals and three lost to follow-up. At 52 weeks, there was no significant difference in NEADL score between the FEMuR intervention and control groups. Joint modelling analysis testing for difference in longitudinal outcome adjusted for missing values also found no significant difference with a mean difference of 0.1 (95% CI -1.1, 1.3). There were no significant between-group differences in secondary outcomes. Sensitivity analyses, examining the impact of COVID-19 restrictions, produced similar results. A median of 4.5 extra rehabilitation sessions were delivered to the FEMuR intervention group, with a median of two sessions delivered in-person. Instrumental variable regression did not find any effect of the amount of rehabilitation on the main outcome. There were 53 unrelated serious adverse events (SAEs) including 11 deaths in the control group: 41 SAEs including nine deaths in the FEMuR intervention group.

CONCLUSIONS

The FEMuR intervention was not more effective than usual rehabilitation care. The trial was severely impacted by COVID-19. Possible reasons for lack of effect included limited intervention fidelity (fewer sessions than planned and remote delivery), lack of usual levels of support from health professionals and families, and change in recovery beliefs and behaviours during the pandemic.

TRIAL REGISTRATION NUMBER

ISRCTN28376407.

Effects of Integrating Wearable Activity Trackers With a Home-Based Multicomponent Exercise Intervention on Fall-Related Parameters and Physical Function in Older Adults: Randomized Controlled Trial

Background

Older adults with a history of falling often encounter challenges in participating in group exercise programs. Recent technological advances, such as activity trackers, can potentially enhance home-based exercise programs by providing continuous physical activity monitoring and feedback.

Objective

The aim of the study is to explore whether integrating wearable activity trackers with a home-based exercise intervention is effective in reducing fear of falling and improving physical function in older adults.

Methods

This was a 12-week, parallel-group, randomized controlled trial involving 30 older adults (≥60 years) with a history of falling. Participants were randomly assigned in a 1:1 ratio to either a group combining an activity tracker with a home-based multicomponent exercise intervention, which included in-person exercise sessions, exercise videos, and objective feedback via phone calls (AT+EX group) or to a group using the activity tracker only for self-monitoring (AT-only group). The primary and secondary outcomes included fall-related parameters (fear of falling assessed by the Activities-Specific Balance Confidence [ABC] and the Falls Efficacy Scale-International [FES-I] scales), depression (Short Geriatric Depression Scale), cognition (Montreal Cognitive Assessment), physical function (grip strength, Short Physical Performance Battery, Timed Up and Go [TUG] test, and 2-Minute Step Test), and body composition. Changes in the average daily step count were monitored and analyzed.

Results

Overall, 28 (mean age 74.0, SD 6.4 years; n=23, 77% female) participants completed the 12-week follow-up period (28/30, 93%). In the activity tracker and exercise group (AT+EX group), significant improvements were observed in fear of falling (15.5 points of ABC: P=.002; -5.1 points of FES-I: P=.01). The activity tracker alone group (AT-only group) also showed a significant improvement in FES-I score (-5.5 points: P=.01). Physical function significantly improved in the AT+EX group (1.1 points of Short Physical Performance Battery: P=.004; -1.4 seconds of TUG; P=.008; and 26.7 steps of 2-Minute Step Test: P=.001), whereas the AT-only group showed significant improvement only in the TUG test (-1.3 seconds: P=.002). However, no significant between-group differences were observed in the ABC score, FES-I score, or physical function. Despite no significant increase in daily step counts, both groups maintained close to 10,000 steps per day throughout the 12 weeks.

Conclusions

Both groups showed improvements in the FES-I and TUG test scores without significant between-group differences. Wearable technology, with or without an exercise intervention, seems to be an effective tool in reducing the fear of falling and improving physical function in older adults susceptible to falls.

Longitudinal, Bidirectional Association between Gait Speed and Cognitive Function in Community-Dwelling Older Adults without Dementia

OBJECTIVES

The causal relationship between slow gait speed and poor cognition is uncertain due to potential reverse causality. This study aimed to examine the reciprocal relationship between gait speed and global as well as domain-specific cognitive functions in older adults.

DESIGN

Prospective cohort study (2013-2022) including 4 repeated measures.

SETTINGS AND PARTICIPANTS

Community-dwelling and adults without dementia aged ≥65 recruited at baseline.

METHODS

Biennial evaluations included assessments of 4-m usual walking speed, global cognition using the Taiwanese version of the Montreal Cognitive Assessment (MoCA), and cognitive domains (memory, executive function, verbal fluency, and attention) using a battery of neuropsychological tests. Cross-lagged models and linear mixed models were used to examine the bidirectional association between gait speed and cognitive functions with adjustment for potential confounders.

RESULTS

At baseline, 511 participants were enrolled, and 459 individuals with a mean age of 74.5 years were ultimately analyzed. A 1-SD decrease in gait speed was associated with a 0.07-0.09 SD decrease in subsequent global cognition [βˆWave 1→2: 0.07, standard error (SE): 0.03; βˆWave 2→3: 0.09, SE: 0.04; βˆWave 3→4: 0.09, SE: 0.04; all P < .05]. Similarly, a 1-SD decrease in global cognition was associated with a 0.18 to 0.19 SD decrease in subsequent gait speed (βˆWave 1→2: 0.18, SE: 0.05; βˆWave 2→3: 0.18, SE: 0.06; βˆWave 3→4: 0.19, SE: 0.07; all P < .001). In addition, slower gait speed was associated with poor memory, verbal fluency, and executive function, and vice versa. The results of linear mixed models were consistent with the findings obtained from cross-lagged models.

CONCLUSIONS AND IMPLICATIONS

This study found a reciprocal association between gait speed and global or domain-specific cognition. Regularly screening gait speed and cognitive function enables the early detection of declines in physical function and cognition.

Validation of the Patient-Determined Disease Steps in ambulatory older adults with multiple sclerosis

INTRODUCTION

Multiple sclerosis (MS) is increasingly prevalent among older adults, and this results in the cumulative effects of aging and MS on mobility disability. The Patient-Determined Disease Steps (PDDS) is a patient-reported outcome measure of mobility disability in adults with MS, but its validity has not been established in older adults. This study validated the PDDS in older adults with MS by examining correlations with conceptually-relevant objective and subjective measures, including neuroimaging markers.

METHODS

The sample included older adults with MS (N = 87, mean age = 64.67 ± 4.24yrs, percent female = 65.5). Primary outcome measures for validation included the Timed 25-foot Walk (T25FW), Short Physical Performance Battery (SPPB), University of Alabama at Birmingham Life-Space-Assessment scale (UAB-LSA), Nine-Hole Peg Test (9HPT), oral Symbol-Digit Modalities Test (Oral SDMT), and Fatigue Severity Scale (FSS). Structural measures of brain integrity, evaluated via 3T MRI, included grey matter volumes (thalamus, caudate, putamen, globus pallidus, hippocampus), and total white matter lesion load (WMLL). Spearman correlations were used for analyses based on non-normality of the data.

RESULTS

Higher PDDS scores were significantly correlated with slower walking speed (T25FW time: ρ= 0.664, p < .001), worse lower extremity functioning (SPPB: ρ= -0.540, p < .001), poor fine motor dexterity (9HPT time) bilaterally (dominant hand: ρ= 0.367, p < .001; non-dominant hand: ρ= 0.263, p= .014), worse fatigue (FSS: ρ= 0.383, p < .001), and lower community mobility (UAB-LSA: ρ= -0.586, p < .001). Higher PDDS scores were also associated with lower grey matter volume in the caudate (ρ= -0.218, p= .042), putamen (ρ= -0.226, p= .036), and hippocampus (ρ= -0.213, p= .047). There were no significant correlations with WMLL, Oral SDMT, or socio-demographic covariates.

CONCLUSION

The PDDS is a valid self-report measure of MS-related disability in ambulatory older adults with MS.

Cognitive benefits of hearing intervention vary by risk of cognitive decline: A secondary analysis of the ACHIEVE trial

INTRODUCTION

Results from the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) trial suggest hearing intervention may not reduce 3-year cognitive decline in all older adults with hearing loss but may be beneficial in certain groups. This secondary analysis investigated if participants with multiple risk factors for cognitive decline received greater benefits.

METHODS

We used a sample of dementia-free participants (N = 2692) from the Atherosclerosis Risk in Communities (ARIC) cohort to develop a predictive model for cognitive decline. The model was applied to baseline measures of ACHIEVE participants (N = 977) to estimate predicted risk. We tested an interaction between predicted risk and randomization to hearing intervention or health education control.

RESULTS

Among ACHIEVE participants in the top quartile of predicted risk, 3-year cognitive decline in the hearing intervention was 61.6% (95% confidence interval [CI]: 33.7%-94.1%) slower than the control.

DISCUSSION

The effect of hearing intervention on reducing 3-year cognitive decline was greatest among individuals with multiple baseline risk factors associated with faster cognitive decline.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03243422 HIGHLIGHTS: The Aging and Cognitive Health Evaluation in Elders (ACHIEVE) trial tested the effect of hearing intervention on cognitive decline. Participants were recruited from the Atherosclerosis Risk in Communities (ARIC) cohort or de novo from the local community. A 48% reduction in cognitive decline was observed in ARIC cohort participants. In this secondary analysis, there was an interaction between hearing intervention and predicted risk of cognitive decline. Among participants in the top quartile of predicted risk of cognitive decline, hearing intervention slowed cognitive decline by 62%.

Fit4Surgery app: Home-based prehabilitation app for older patients undergoing elective colorectal cancer surgery

BACKGROUND

Supervised multimodal prehabilitation prior to colorectal cancer (CRC) surgery is associated with reduced complications and enhanced recovery. However, it is labor intensive and expensive. In an aging population with increasing demand and costs on healthcare and staff shortages, home-based prehabilitation (HBP) with an app could be of interest. This study assessed the effectiveness of a Fit4Surgery app in CRC surgery.

METHOD

The app was effectuated in a prospective cohort study of 100 CRC patients ≥60 years from October 2021-December 2022. The primary outcome was preservation or improvement of the 6-minute walking test (6MWT) six weeks postoperative, compared to baseline. Secondary outcomes were 90-day complication and mortality rate, 90-day readmission, length of stay, 6MWT and Short Performance Physical Battery (SPPB) at different timepoints and total costs.

RESULTS

Three patients needed urgent surgery, remaining 97 patients (mean age 72) using the app for at least three weeks. The 6MWT was preserved in 74.7 % with a 12.1 m higher mean six weeks postoperative, compared to baseline (p = 0.194). A significant higher 6MWT was observed after prehabilitation and one year postoperative, compared to baseline (p=<0.001). The SPPB was significant higher at all timepoints. Overall 90-day complication rate was 25.8 %, readmission rate 6.3 % and mortality occurred in 2.1 %. Total costs were €518.50 per patient.

CONCLUSION

This is the first study of multimodal HBP by an app for CRC surgery patients with high compliance. Results show promising results regarding functional capacity and a low occurrence of complications, in line with multimodal supervised prehabilitation. This by reducing costs by half.

Predictors of the Disability in Activities of Daily Living in Nursing Home Residents: A Descriptive Study

BACKGROUND

Disability in activities of daily living (ADL) is a common problem among nursing home residents. The purpose of this research was to evaluate the geriatric syndromes that contribute to disability in nursing home residents.

METHOD

The cross-sectional study included 124 older adults from two nursing homes. ADL disability was assessed with the Barthel Index. The sociodemographic characteristics and geriatric syndromes, including malnutrition, sarcopenia risk, frailty, immobility, urinary incontinence, cognitive impairment, and balance dysfunction were evaluated.

RESULTS

The 124 residents had a mean age of 80.12 ± 9.20 years and included 55.67% males. Age, malnutrition, sarcopenia risk, frailty, immobility, urinary incontinence, cognitive impairment, and balance dysfunction were all significantly correlated with the Barthel Index. However, only malnutrition, immobility, and urinary incontinence were found to account for 84.9% of the variance in disability of nursing home residents in regression analysis. These geriatric syndromes are the best predictors of ADL disability in all models (p < .05).

CONCLUSION

This study found that malnutrition, immobility, and urinary incontinence considerably contributed to the disability profile of nursing home residents. Health professionals need to develop multi-dimensional care and prevention strategies, especially for geriatric syndromes such as malnutrition, immobility, and urinary incontinence.

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

INTRODUCTION

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

METHODS AND ANALYSIS

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

ETHICS AND DISSEMINATION

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

TRIAL REGISTRATION NUMBER

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

Arteriolosclerosis in CNS Tissues Outside the Cerebrum and Late-Life Motor Impairment

BACKGROUND

The pathological basis underlying motor impairment in older adults is partially accounted for by Alzheimer disease and related dementias pathologies. We tested the hypothesis that arteriolosclerosis, a pathological correlate of small vessel disease, outside the cerebrum is related to motor impairment in older adults above and beyond Alzheimer disease and related dementias pathologies.

METHODS

The data were from decedents of a community-based clinical-autopsy study. Arteriolosclerosis was assessed in the cerebrum (as 1 of 10 Alzheimer disease and related dementias pathologies), midbrain, cerebellum, pons, and 4 levels of the spinal cord. Parkinsonism was assessed using the Unified Parkinson Disease Rating Scale. Other motor performances included timed-peg placement and finger tapping, grip and pinch strength, walking 8 ft and turning 360° twice, and sensor-derived metrics assessing tandem walk. Multivariate linear regression models were used to examine the association of arteriolosclerosis across varied motor performances.

RESULTS

The participants (n=403) were on average 91.4 (6.1) years old at death, and 73.2% (n=295) were women. The frequency of moderate/severe arteriolosclerosis varied outside the cerebrum, ranging from 15.5% (40/258) in the pons to 49.6% (200/403) in the spinal cord. The correlation of the severity of arteriolosclerosis between these regions ranged from unrelated to modestly related. Spinal arteriolosclerosis was associated with impaired motor function (P=0.006), in particular more severe parkinsonism (estimate, 0.170; SE, 0.071; P=0.018) and less hand dexterity (estimate, -0.022; SE, 0.009; P=0.014). Arteriolosclerosis of the cerebellum was associated with impaired tandem walk (P=0.012), in particular more variability in the acceleration signal in the mediolateral direction (estimate, 0.023; SE, 0.011; P=0.040). Arteriolosclerosis in the pons or midbrain was not associated with motor performances.

CONCLUSIONS

Arteriolosclerosis severity varies in the central nervous system tissues outside of the cerebrum and is differentially associated with varied motor performances, suggesting that the adverse motor consequences of small vessel disease in older adults may be underestimated by studies focusing only on the brain.

Sarcopenia and it's influencing factors among adults with asthma, chronic obstructive pulmonary disease, and tuberculosis in Penang, Malaysia

BACKGROUND

Chronic respiratory diseases like asthma, chronic obstructive pulmonary disease (COPD), and tuberculosis (TB) are increasing globally, leading to systemic symptoms like skeletal muscle dysfunction. Ageing and physical inactivity exacerbate sarcopenia, reducing functional capacity, disability, and quality of life. However, limited research exists on the prevalence of sarcopenia among chronic respiratory diseases in low-middle-income countries like Malaysia. Hence, this study aims to investigate the prevalence of sarcopenia and its associated risk factors among adults with asthma, COPD, and TB in Penang, Malaysia.

METHODS

A cross-sectional study was conducted from June 2023 to March 2024. This study included 469 patients (mean age: 52.62 ± 16.61 years) diagnosed with asthma (n = 180), COPD (n = 186), or TB (n = 103) receiving treatment in chest clinics of two governmental hospitals in Penang. The SARC-F and SARC-CalF questionnaires were used to assess the participants' risk of sarcopenia. Sarcopenia was identified using the 2019 criteria of the Asian Working Group for Sarcopenia (AWGS). The risk factors for sarcopenia in asthma, COPD, and TB patients were investigated using multivariable logistic regression.

RESULTS

The prevalence of sarcopenia was 18.9% (95% CI 13.5-25.4) in patients with asthma, 33.9% (95% CI 27.1-41.2) in those with TB, and 35.9% (95% CI 26.7-46.0) in those with COPD, according to AWGS 2019 criteria. The SARC-CalF screening tool showed that 27.3% of participants had a positive risk of having sarcopenia. The independent risk factors associated with sarcopenia in asthma patients were age, physical activity and body mass index (BMI). For TB patients, significant risk factors included Chinese and other ethnicities, foreigners, lower daily protein intake, and BMI. In COPD patients, independent risk factors included age, moderate physical activity, BMI and history of heart failure.

CONCLUSION

This study highlighted a significant burden of sarcopenia among patients with asthma, COPD and TB. Non-clinical interventions such as lifestyle modification and nutritional support to the patients are crucial to maintain muscle strength and delay the onset of sarcopenia, particularly in people with chronic respiratory diseases.

Healthcare needs, care use and health status outcomes in adults with Bardet-Biedl syndrome: a cross-sectional study in Norway

OBJECTIVES

This study aimed to determine healthcare needs and care use (provision of healthcare) in adults with Bardet-Biedl syndrome (BBS) and the associations between care use and physical functioning, health status outcomes and distress.

DESIGN

Cross-sectional study.

SETTING

Outpatient hospital visits.

PARTICIPANTS

30 adults with BBS were included (50% women, aged 20-69 years) and assessed with the Needs and Provision Complexity Scale, Short Physical Performance Battery, EuroQoL five dimensions with five severity levels (EQ-5D-5L) and Hospital Anxiety and Depression Scale.

RESULTS

The majority (80%) received disability benefits, 93% were overweight or obese and all had retinal dystrophy. Unmet needs (needs-gets) were found within the domains of rehabilitation (83%), social and family support (63%), healthcare (50%), personal care (47%) and the environment (40%). Significant correlations were observed between care use (gets) and worse physical performance (τ=-0.34, p<0.05), more problems with self-care (τ=0.47, p<0.01) and more problems with usual activities (τ=0.41, p=0.01). Compared with those in the general population, adults with BBS reported significantly more problems (EQ-5D-5L) with mobility, self-care, and usual activities (all p<0.001).

CONCLUSIONS

Most adults with BBS have unmet physical, social and medical needs, with the majority having unmet rehabilitation needs that require special attention. Physical mobility and usual activities were correlated with the provision of healthcare. The complexity of BBS requires a multidisciplinary approach that focuses not only on the medical follow-up of the condition but also on healthcare needs for functional mobility and social care.

TRIAL REGISTRATION NUMBER

This study was registered at ClinicalTrials.gov, NCT05400278.

Clinical Tools to Diagnose Frailty in Women With Geriatric Urinary Incontinence

IMPORTANCE

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

OBJECTIVE

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

STUDY DESIGN

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

RESULTS

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

CONCLUSION

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

Effects of physical exercise on physical and mental health in older adults with gait disorders: A systematic review

The benefits of physical exercise are well-known, but there is limited research on its effects on the physical and mental health of elderly individuals with gait disorders. This review aims to evaluate the impact of physical exercise on these outcomes. A literature search was conducted, retrieving studies published from inception to November 2024 in databases such as PubMed, Scopus, Web of Science, ProQuest, and SPORTDiscus. Fifteen randomized controlled trials (RCTs) were included in the review. The results indicate that physical exercise improves both physical health (gait, balance, mobility, reduce fall rate) and mental health (Qality of life [QoL] cognitive function, anxiety levels, and Activities-Specific Balance Confidence [ABC]) in older adults with gait disorders. Of the 15 studies, 10 reported positive effects on both physical and mental outcomes, while the remaining five studies showed either no effect or a lack of positive results. The interventions evaluated included Tai Chi (TC), Tango, aerobic training (AT), resistance training (RT), combined training (CT), virtual reality (VR), resistance training plus standard pharmacological treatment (RTG + pharmacological treatment), high-speed treadmill training, brisk walking, and multimodal exercise program (MEP). Notably, there are six items of TC intervention. Most interventions lasted for 12 weeks with sessions conducted twice a week, each lasting between 30 and 60 minutes. Additionally, limited studies (one per indicator) assessed strength, functional gait assessment (FGA), and center of pressure (COP), indicating a need for more research in these areas. This review concludes that physical exercise is effective in improving physical and mental health outcomes in older adults with gait disorders, with TC emerging as the most commonly used and beneficial intervention.

White matter integrity and motor function: a link between cerebral myelination and longitudinal changes in gait speed in aging

Gait speed is a robust health biomarker in older adults, correlating with the risk of physical and cognitive impairments, including dementia. Myelination plays a crucial role in neurotransmission and consequently affects various functions, yet the connection between myelination and motor functions such as gait speed is not well understood. Understanding this link could offer insights into diagnosing and treating neurodegenerative diseases that impair mobility. This study analyzed 437 longitudinal observations from 138 cognitively unimpaired adults, aged 22 to 94 years, to investigate the relationship between myelin content and changes in gait speed over an average of 6.42 years. Myelin content was quantified using a novel multicomponent magnetic resonance relaxometry method, and both usual and rapid gait speeds (UGS, RGS) were measured following standard protocols. Adjusting for covariates, we found a significant fixed effect of myelin content on UGS and RGS. Longitudinally, lower myelin content was linked to a greater decline in UGS, particularly in brain regions associated with motor planning. These results suggest that changes in UGS may serve as a reliable marker of neurodegeneration, particularly in cognitively unimpaired adults. Interestingly, the relationship between myelin content and changes in RGS was only observed in a limited number of brain regions, although the reason for such local susceptibility remains unknown. These findings enhance our understanding of the critical role of myelination in gait performance in unimpaired adults and provide evidence of the interconnection between myelin content and motor function impairment.

Resistance-Based Muscle Therapy, Frailty, and Muscle Biopsy Findings in Kidney Transplant Candidates: A Clinical Trial

Rationale & Objective

Frailty is associated with increased morbidity and mortality in kidney transplant recipients. We hypothesized that frailty may be attributable to diminished muscle function associated with muscle morphologic changes. This trial in kidney transplant candidates tested the reversibility of frailty by specifically targeting the affected major muscle groups.

Study Design

Randomized clinical trial.

Setting & Participants

Kidney transplant candidates.

Exposure

Supervised, resistance-based muscle therapy program delivered for 1 hour, 2 times per week for 1 year.

Outcomes

Baseline, 6-month, and 12-month Short Physical Performance Battery, gait speed, grip strength, sit-to-stand in 30 s, 36-item Short Form Survey, Patient-Reported Outcomes Measurement Information System-29, and muscle biopsy light and electron microscopy and immunohistochemistry.

Analytic Approach

Paired 2-tailed t test, 1-way repeated measures analysis of variance.

Results

Twenty-nine participants (mean age, 55 years; female, 55%; African American, 65%) were analyzed: 23 intervention and 6 control. Exercise intervention participants had significant improvements in Short Physical Performance Battery, baseline 5.2 (95% CI, 3.6-6.7) versus 6 months, 6.9 (95% CI, 5.2-8.5; P < 0.001) and 12 months, 7.2 (95% CI, 5.6-8.8; P < 0.001); baseline hand grip, 14.3 kg (95% CI, 10.3-18.4) versus 6 months, 16.9 kg (95% CI, 13.1-20.8; P < 0.05) and 12 months, 17.4 kg (95% CI, 13.9-21.0; P < 0.05); and baseline sit-to-stand in 30 s, 8.0 (95% CI, 3.8-12.2) versus 6 months, 12.7 (95% CI, 8.2-17.1; P < 0.001) and 12 months, 16.2 (95% CI, 10.7-21.7; P < 0.001). The exercise group 12-month muscle fiber diameter increased by 18.6 μm (95% CI, 8.4-28.5; P = 0.003). Expression of immunohistology markers of muscle atrophy decreased significantly. The mean difference in immunohistology score of mitochondrial oxidative function improved for cytochrome c oxidase complex IV, 1.00 (95% CI, 0.71-1.29; P < 0.001) and ATP5I increased by 0.74 (95% CI, 0.49-0.99; P < 0.001). Increased mitochondrial count did not achieve statistical significance (P = 0.096). Controls showed no improvement in either physical performance or histology.

Limitations

Significant under-enrollment in the control group required a paired t test analysis of experimental participants.

Conclusions

One year of muscle rehabilitation therapy resulted in significant improvements in physical performance metrics accompanied by significant improvements in muscle morphology.

Internet-Based Psycho-Physical Exercise Intervention Program in Mild-to-Moderate Depression: The Study Protocol of the SONRIE Randomized Controlled Trial

The COVID-19 pandemic has intensified depression due to isolation and reduced physical activity, highlighting the need for accessible remote treatments. The SONRIE study evaluates the effectiveness of a 12-week online intervention combining physical exercise and internet-based cognitive-behavioral therapy on depressive symptoms in adults with mild-to-moderate depression. This randomized controlled trial involved 80 adults aged 25-65 years diagnosed with depression according to the ICD-10 criteria. Participants were randomized to an experimental group receiving the combined online intervention or to a control group receiving standard care. The primary outcome was the change in depression severity, assessed by the Beck Depression Inventory, with outcomes measured at baseline, immediately post-intervention, and after an 8-week follow-up phase. Statistical analyses include analysis of covariance to compare group changes over time, with effect sizes quantifying the intervention's impact. The SONRIE study demonstrates a promising online approach for treating depression, with potential implications for clinical practice and public health strategies.

Influence of two strength training modalities (hypertrophy vs. contrast training) on muscular strength, bone health parameters and quality of life in a group of older adults with low skeletal muscle mass index

The main aim of the current study was to compare the effects of two strength training modalities (hypertrophy vs. contrast training) on bone health parameters, physical performance and quality of life in a group of subjects aged 60 and above with low skeletal muscle mass index (SMI). 45 older adults voluntarily participated in this study, but only 41 (22 women and 19 men) completed it. The participants were assigned to 3 different groups: control group (CG; n = 15), contrast training group (CTG; n = 13) and hypertrophy training group (HTG; n = 13). The duration of the training protocol was six months. The experimental groups performed two sessions of strength training per week; the duration of each session was forty-five minutes. Several measurements (which included anthropometrics, body composition, bone parameters, maximal strength parameters, physical performance parameters, fracture risk and quality of life) were performed in the three groups before and after the six-month training period. The different measurements of the protocol were carried out under the same conditions with identical materials and investigators for all the participants and for each approach. The current study has demonstrated that the two training modalities show common benefits such as improving maximal strength, physical performance and quality of life parameters but have no significant effects on bone mineral density (BMD) and bone mineral content (BMC). The influence of training was marked more for improving maximal strength and reducing fracture risk for the contrast training group (who performs movements at high speed) compared to the hypertrophy training group (who performs movements at spontaneous speed). In conclusion, this study shows that both resistance training programs are effective in improving maximal strength, physical performance and quality of life in older adults with low SMI. However, this 6-month intervention was not sufficient to significantly increase BMC nor BMD values in this population.

Association between changes in physical functions and risk of stroke: a prospective cohort study

BACKGROUND

The association between changes in physical functions and stroke incidence remains uncertain.

METHODS

A total of 7978 participants without stroke from the China Health and Retirement Longitudinal Study (CHARLS) were recruited in 2011-2012 and followed up until 2020. We assessed annual changes in physical functions from 2011 to 2015, including absolute grip strength, relative grip strength, walking speed, chair-rising time and standing balance. The Cox proportional hazards model was applied to assess the longitudinal associations between annual changes in physical functions and stroke. Restricted cubic spline analyses were used to explore the dose-response relationships.

RESULTS

During 71 714 person-years of follow-up, 549 incident stroke cases were reported. For each 1-kg absolute grip strength increment, 0.1-unit relative grip strength increment, or 1-point standing balance test score increment, the hazard of stroke was reduced by 12% [hazard ratio (HR): 0.88; 95% confidence interval (CI): 0.84-0.93], 53% (HR: 0.47; 95% CI: 0.34-0.64), 55% (HR: 0.45; 95% CI: 0.30-0.67), respectively. We found a negative linear dose-response association of the annual change in absolute and relative grip strength with incident stroke, as well as a nonlinear association between the annual change in standing balance and incident stroke. However, neither the annual change in walking speed nor chair-rising time was related to the incident stroke.

CONCLUSIONS

A greater improvement in absolute grip strength, relative grip strength or standing balance was suggested to be associated with a lower risk of stroke amongst middle-aged and older people. These objectively measured physical function changes are imperative for high-risk population classification and stroke prevention.

Low gait speed is better than frailty and sarcopenia at identifying the risk of disability in older adults

OBJECTIVE

To compare frailty, sarcopenia and their respective components to determine which is more effective in identifying the risk of disability in basic and instrumental activities of daily living (BADL and IADL, respectively).

METHODS

A longitudinal study involving 3,637 individuals without disabilities concerning BADL and 3,696 individuals without disabilities regarding IADL at baseline. Frailty was defined using the phenotype. Sarcopenia was determined according to the criteria proposed by the EWGSOP2: low strength (grip strength <27 kg for men and <16 kg for women), low skeletal muscle mass index (<9.36 kg/m2 for men and <6.73 kg/m2 for women) and low physical performance (gait speed ≤0.8 m/s). In addition to the complete constructs, each component was assessed. Poisson mixed models were utilised, with the outcome identified as incident cases of disability over 8 years, adjusted for covariates. Results: Pre-frailty was associated with a 17% and 18% annual increase in the risk of disability for BADL and IADL, respectively. These figures were 27% and 28% for individuals classified as frail. Sarcopenia was not associated with an increased risk of disability. Amongst the components of frailty and sarcopenia, low physical performance, assessed by gait speed ≤0.8 m/s, was the most effective for identifying the risk of disability (12% per year for BADL and 14% per year for IADL).

CONCLUSION

In clinical practice, low physical performance (gait speed ≤0.8 m/s) may be the preferred tool for screening the risk of functional decline in older adults.

Health outcomes of sarcopenia: a consensus report by the outcome working group of the Global Leadership Initiative in Sarcopenia (GLIS)

The Global Leadership Initiative in Sarcopenia (GLIS) aims to standardize the definition and diagnostic criteria for sarcopenia into one unifying, common classification. Among other actions to achieve this objective, the GLIS has organized three different working groups (WGs), with the WG on outcomes of sarcopenia focusing on reporting its health outcomes to be measured in clinical practice once a diagnosis has been established. This includes sarcopenia definitions that better predict health outcomes, the preferred tools for measuring these outcomes, and the cutoffs defining normal and abnormal values. The present article synthesizes discussions and conclusions from this WG, composed of 13 key opinion leaders from different continents worldwide. Results rely on systematic reviews, meta-analyses, and relevant cohort studies in the field. With a high level of evidence, sarcopenia is significantly associated with a reduced quality of life, a higher risk of falls and fractures and a higher risk of mortality. Sarcopenia has been moderately associated with a higher risk of reduced instrumental activities of daily living (IADL). However, the GLIS WG found only inconclusive level of evidence to support associations between sarcopenia and higher risks of hospitalization, nursing home admission, mobility impairments, and reduced basic activities of daily living (ADL). This limitation underscores the scarcity of longitudinal studies, highlighting a barrier to understanding its progression and implications over time.

Visual impairment predicts greater declines in physical performance over time: the Health, Aging and Body Composition Study

BACKGROUND

Poor vision has been associated with physical dysfunction and falls in older adults, but it is not known whether particular types of visual impairment (VI) may predict greater rates of decline in mobility over time in older adults.

METHODS

Multi-center longitudinal cohort study of 2219 older adults (mean age = 75.5 years; 52.4% female; 37.4% black) who completed self-reported (visual function questions (VFQ)) or performance-based (visual acuity (VA); log contrast sensitivity (LCS); stereoacuity (SA)) vision testing at year 3 and the short physical performance battery (SPPB) at year 4. Analyses were performed including all 2219 participants (Cohort A) and 1795 of these participants with SPPB ≥ 9 (Cohort B) at year 4. Separate linear mixed models were constructed to evaluate the relationship of each vision measure with rate of change in performance on the SPPB and its components (gait speed, balance time, and chair pace) over 8 years.

RESULTS

In cohort A, compared to the predicted decline at the mean vision level, a significantly faster rate of decline in SPPB was experienced by those with a 1 standard deviation worse year 3 logMAR VA (-0.044; 95% CI -0.065, -0.024), LCS (-0.062; 95% CI -0.082, -0.041), and VFQ (-0.045; 95% CI -0.065, -0.025) and those with a SA > 85 arcsec (-0.095; 95% CI -0.139, -0.052) versus those with SA ≤ 85 (all p < 0.001 for difference in slopes). Cohort B showed similar but stronger findings for SPPB, and demonstrated that worse logMAR VA, LCS and VFQ were significantly associated with a faster decline in gait speed, while worse logMAR VA, LCS, and SA were significantly associated with greater decline in balance times. Only poor SA > 85 arcsec was significantly associated with declines in chair pace.

CONCLUSIONS

All VI measures predicted faster declines in SPPB. Older adults with VI may benefit from targeted intervention to prevent declines in mobility.

Effect of a Multicomponent Exercise Program with Virtual Reality (MEP-VR) versus standard approaches on functional and cognitive domains in hospitalised geriatric patients: Study protocol for a randomized controlled trial

BACKGROUND

Conventional care models for older adults often disregard negative effects of hospitalization and neglect potential benefits of technology. This trial aims to investigate effects of Multicomponent Exercise Program with Virtual Reality (MEP-VR) on functional and cognitive outcomes in hospitalized older adults, compared to MEP-only or usual care approaches.

METHODS

This three-arm, parallel-group, randomized controlled trial will include 255 participants aged 75 or older, with a Barthel Index score of at least 60, able to walk and cooperate, have an estimated hospital stay of at least four days, and provide informed consent. Patients with severe dementia, terminal illness, or clinical instability will be excluded. Participants will be randomly assigned to a control group or one of two intervention groups. The intervention groups will receive either MEP-VR or MEP-only program, consisting of supervised aerobic exercise, resistance training, and balance training, with or without a virtual reality component. The intervention will occur over four consecutive days, each session lasting 30-40min. The primary outcome measure will be functional changes at discharge. Cognition, mood, quality of life, and immersive virtual reality (IVR) usability will also be assessed.

DISCUSSION

Technological advances are rapidly increasing with population aging, creating potential benefits for integrating technology into older adult care. This study will evaluate the implementation of IVR combined with MEP. If our hypothesis proves accurate, it will pave the way for modifying the hospitalization system, helping to reduce the critical healthcare burden resulting from hospital-acquired disability in the older population.

TRIAL REGISTRATION

This study was approved by the Navarra Clinical Research Ethics Committee on June 14th, 2021 (PI_2021_90). The trial was retrospectively registered at ClinicalTrials.gov, registration number NCT06469554.

Intraindividual variability differentiated older adults with physical frailty and the role of education in the maintenance of cognitive intraindividual variability

OBJECTIVES

Physical frailty is associated with increased risk of cognitive impairment. However, its impact on sustained cognitive processing as evaluated by intraindividual variability (IIV), and factors beneficial to IIV in physically frail older adults remain unexplored. This study aimed to quantify differences in IIV between older adults with and without physical frailty, and examine whether education facilitated maintenance of IIV.

METHODS

This cross-sectional study included 121 community-dwelling older adults 65-90 years with/without physical frailty (PF and non-PF; n = 41 and n = 80 respectively). Physical frailty was determined via Short Physical Performance Battery. Dispersion across the seven components of the Montreal Cognitive Assessment (MoCA) was computed to ascertain IIV. Multivariate analysis of covariance was used to determine group differences in total score and IIV. Four moderation models were constructed to test the effects of education on age-total score and age-IIV relationships in PF and non-PF.

RESULTS

Compared with non-PF, PF showed greater IIV (p = .022; partial η² =  0.044). Among PF, education moderated age-total score (R-sq =  0.084, F =  5.840, p <  0.021) and age-IIV (R-sq =  0.101, F =  7.454, p =  0.010) relationships. IIV increased with age for those with five years (β =  0.313, p =  0.006) or no formal education (β =  0.610, p =  0.001). Greater than seven years of education (β =  0.217, p =  0.050) may be required to maintain IIV at older age.

CONCLUSION

IIV may be a sensitive method to differentiate physically frail older adults. Additionally, perceived cognitive benefits of education may be dependent on physical functioning.

Uncovering hidden insights in the chair rise performance of older adults using Dynamic Time Warping and K-means clustering

The five time chair rise test (5CRT) is commonly used in geriatric medicine and research to assess functional capacity and lower extremity strength to detect early age-related changes in older adults. Traditional stopwatch-based analyses may mask temporal variations in 5CRT transitions due to averaging. Temporal variations and dynamic characteristics are better assessed by motion variability analysis. This work employs k-means clustering using Dynamic Time Warping (DTW) as a metric for 5CRT to examine compensation mechanisms of older adults. The observational study included 172 healthy, community-dwelling adults aged 70+, yielding 860 chair rises recorded on a force plate and clustered using k-means. Descriptive statistics summarized performance distribution across clusters. Optimal clustering revealed two movement patterns, differing significantly (p [Formula: see text]) in 5CRT duration and forces during the stabilization phase. These patterns did not correlate directly with shorter or longer 5CRT durations, indicating overlap and highlighting the limitations of traditional stopwatch methods. This study demonstrates the potential of DTW and k-means clustering in geriatric medicine and research, enabling analysis of 5CRT performance independent of temporal variations, identifying potential health issues undetectable by conventional methods. The k-means model can be further trained to automate analysis, enhancing insights from 5CRT.

Prescribing patterns in people living with dementia in the community: A cross-sectional study

OBJECTIVES

To identify the prevalence of and factors associated with medication use in people living with dementia in the community.

METHODS

A cross-sectional study using baseline data from a randomised controlled trial known as the Interdisciplinary Home-bAsed Reablement Program (I-HARP) between 2018 and 2021 in Sydney, Australia. Participants included people with mild-moderate dementia and their carers. Medication use was classified according to the Anatomical Therapeutic Chemical codes, while potentially inappropriate medications (PIMs) were defined using 2019 Beer's Criteria and 2024 Australian list. Logistic regression models were used to identify factors associated with use of medication classes.

RESULTS

A total of 130 people with dementia and their carers were included. Of the people with dementia, 35% were using antidementia medication, 48% psychotropics, 76% PIMs and 65% polypharmacy (≥5 medications). Polypharmacy was associated with the use of psychotropics (adjusted OR [aOR]: 5.09, 95% confidence interval [CI]: 1.94-13.39) and PIMs (aOR: 17.38, 95% CI: 5.12-59.02). Higher education level was associated with lower odds of psychotropic use (aOR: .33, 95% CI: .15-.76), and age over 80 years was associated with lower odds of antidementia medication use (aOR: .29; 95% CI: .12-.72).

CONCLUSIONS

The use of PIMs, psychotropics and polypharmacy were common in this sample of people with dementia living in the community. Associations were seen between participant characteristics and medication use. Future research should focus on reviewing PIMs and polypharmacy in people with dementia living in the community to assess the impact on health outcomes.

Development and validation of an earphone-based system to measure short physical performance battery in older adults

The short physical performance battery (SPPB) is a widely used clinical assessment tool to evaluate physical function in older adults. However, the manual measurement of the SPPB presents difficulties in terms of standardization and accessibility. To address these limitations, an earphone-shaped SPPB assessment device, named B-Lab, was developed. To validate the device, 45 healthy participants aged 60 years and older were recruited, and the SPPB results obtained through the B-Lab were compared with those from the manual method. Results showed high agreement between the two methods, with an intraclass correlation coefficient of 0.87 and 0.68 for the first and second trials, respectively. The reliability of the B-Lab was also comparable to that of the manual method. Overall, the B-Lab showed potential as an alternative for assessing SPPB scores. It enables patients to assess their physical function without hospital visits, and is expected to contribute to the development of a more effective healthcare environment.

Association Between Oral Hypofunction and Maximum Gait Speed in Older Adults: A Cross-Sectional Study

BACKGROUND

Previous studies have reported an association between oral hypofunction and normal gait speed as a marker for physical function; however, the association between maximum gait speed as a more sensitive marker for physical function and poor oral function has not been investigated.

OBJECTIVES

To elucidate associations of oral hypofunction, comprising seven elements, with both normal and maximum gait speeds in an older population.

METHODS

Participants were recruited in 2018 from a hospital-based health checkup in Kyoto Prefecture. Seven oral function tests (oral hygiene, oral dryness, occlusal force or number of teeth, tongue-lip motor function, tongue pressure, masticatory function and swallowing function) were performed. Oral hypofunction was defined as an abnormality in at least three of these items. Gait speed was measured as normal and maximum gait speeds. The relationship between oral hypofunction and maximum gait speed was analysed using logistic regression.

RESULTS

This study included 198 participants (130 men and 68 women; mean age: 75.0 years). Among them, 152 (76.7%) had oral hypofunction. After adjustment for age, sex and body mass index, oral hypofunction was significantly associated with a low maximum gait speed (odds ratio: 2.75, 95% confidence interval: 1.41-5.37).

CONCLUSION

Oral hypofunction is associated with maximum gait speed in older people. The prevention of oral hypofunction may help maintain walking speed and promote an increase in healthy life expectancy.

Characteristics and outcomes for hip fracture patients in an integrated orthogeriatric care model: a descriptive study of four discharge pathways with one-year follow-up

BACKGROUND

Orthogeriatric hospital care is recommended for hip fra cture patients, but differentiated hospital care has not been evaluated. The aim of this study was to describe physical performance and health-related quality of life for hip fracture patients 1-year after surgery in four treatment pathways. We also report changes in functional outcomes from baseline to 1-year follow-up together with readmission and mortality rates for each pathway.

METHODS

We included 177 hip fracture patients aged 65 years or older from a single center in Norway. Participants were discharged home, to specialised rehabilitation, regular rehabilitation or nursing home based on orthogeriatric assessment of pre- and postfracture function, mobility level and Ac tivities of Daily Living. Outcome variables included Short Physical Performance Battery, EuroQol-5-dimension-5-level, Barthel-index, Lawton & Brody Instrumental Activities of Daily Living, Lawton & Brody Self-Maintenance Scale, readmission and mortality rates during follow-up.

RESULTS

Participants discharged home and to specialised rehabilitation were younger and healthier than participants discharged to regular rehabilitation and nursing home. All groups had a clinically important improvement in Short Physical Performance Battery score (mean 4.8 points, 95% confidence interval (CI) 4.2, 5.5) from post-surgery to 1-year follow-up and a clinically important decline in EuroQol-5-dimension-5-level (mean -0.12 points, CI -0.16, -0.07) from baseline to 1-year follow-up. The decline in Barthel-index from baseline to 1-year follow-up was greater in the regular rehabilitation group (mean -2.3 points, CI -4.2, -0.2) than in the home group (mean -0.6 points, CI -1.4, 0.2) and specialised rehabilitation group (mean -0.4 points, CI -2.4, 1.6). Participants in the regular rehabilitation group were more frequently readmitted (standardised Pearson residual 4.1) and mortality rates were higher in the nursing home group (standardised Pearson residual 7.8) during the first year.

CONCLUSIONS

Orthogeriatric treatment pathways for hip fracture patients entailed differentiation based on factors such as age, mobility, comorbidity and physical function. Participants in all pathways improved in physical performance-scores, yet experienced decline in quality of life-scores during follow-up. Overall readmission and mortality rates were not influenced, but varied between pathways. Further research is needed to investigate the need for differentiated hospital treatment and its potential effects on rehabilitation after discharge.

Sarcopenia, Depressive Symptoms, and Fall Risk: Insights from a National Cohort Study in the Chinese Population

Background

Previous investigations have indicated that both sarcopenia and depressive symptoms are linked to a heightened risk of falls. However, the potential synergistic effect of these conditions on fall risk remains unclear. This study aims to assess the combined influence of sarcopenia and depressive symptoms on the occurrence of falls in the Chinese population.

Methods

The analysis included 8,405 participants from the China Health and Retirement Longitudinal Study (CHARLS), conducted from 2011 to 2015. Sarcopenia was confirmed using the 2019 Asian Working Group for Sarcopenia (AWGS) algorithm consisting of muscle strength, appendicular skeletal muscle mass (ASM), and physical performance. ASM was calculated using the formula: 0.193 × weight (kg) + 0.107 × height (cm) - 4.157 × sex - 0.037 × age (years) - 2.631. The Center for Epidemiological Research Depression Scale was utilized to assess depressive symptoms, with a cut-off score of 12 points. Depressive sarcopenia is defined as the coexistence of sarcopenia and depression. Multiple logistic regression analyses were conducted to explore the associations among sarcopenia, depressive symptoms, and fall occurrences.

Results

During the four-year follow-up, 1,275 participants reported experiencing falls. A significant synergistic effect was identified between sarcopenia and depressive symptoms regarding fall risk. Compare to robust individuals, those with sarcopenia alone or depression alone had increased falls risks, but those with both conditions exhibited the highest fall risk, with adjusted odds ratios (OR) of 1.21 (95% CI 1.03, 1.42; P = 0.0174), 1.53 (95% CI 1.24, 1.88; P < 0.001), and 1.78 (95% CI 1.48, 2.15; P < 0.001), respectively.

Conclusion

The findings highlight a synergistic effect between sarcopenia and depressive symptoms on fall risk. This study highlights the importance of early detection and intervention for both conditions, especially in older and middle-aged individuals, to mitigate fall risk.

Gender differences in the French Caribbean nursing homes

In French Caribbean nursing homes, male represent half of the older adult population. We hypothesized that this distribution could be attributed to a higher prevalence of psychotic disorders among men or to sociocultural factors. This cross-sectional study aimed to assess gender differences in clinical characteristics of older adults residing in these facilities (n = 332). Compared to females, males were younger (78.4 ± 9.6 years versus 84.1 ± 9.8; p < 0.001), more frequently childless (51.9% vs. 36.7%; p = 0.007) and more often single (62.5% vs. 53.4%; p = 0.012). The prevalence of major cognitive impairment (Mini Mental State Examination score ≤ 18) was similar (M/F: 73.6% vs. 76.2%). Delusions (40.8%) and hallucinations (32.5%) were common in both groups; however, males were more likely to receive antipsychotic treatment (42.9% vs. 29%; p = 0.009). Females exhibited a higher prevalence of depression (24.5% vs. 12.9%; p = 0.007) and anxiety (51.2% vs. 38.2%; p = 0.026). Familial isolation and the presence of psychotic disorders may contribute to the skewed sex ratio in nursing homes. Healthcare services should prioritize the management of psychotic disorders when planning future long-term care facilities in the Caribbean.

Use of a Technology-Based Fall Prevention Program With Visual Feedback in the Setting of Early Geriatric Rehabilitation: Controlled and Nonrandomized Study

Background

The Otago program (OP) is evidence-based and focuses on fall prevention in older people. The feasibility and usability of a short-term digital program modeled after the principles of the OP in the setting of early geriatric rehabilitation (EGR) are unclear.

Objective

This study investigated the feasibility and usability of an additional technology-based fall prevention program (FPP) in the setting of EGR.

Methods

We performed a feasibility study in the setting of EGR. A sample of 30 patients (mobility at least by walker; mini-mental status test score >17) was recruited between March and June 2024 and compared with a retrospective cohort (n=30, former EGR patients). All patients in the intervention group (IG) received a supervised, OP-modified FPP thrice/week for 20 minutes using a technology-based platform called "Pixformance." The device is a digital trainer and enables real-time corrections. The primary end point was the feasibility (given when 80% of the IG participated in 6 trainings within 2 weeks). Secondary outcomes were usability (patients' and facilitators' perspective; ≥75%), risk of falls (Berg Balance Scale), mobility (Timed Up and Go Test), functional independence (Functional Independence Measure), and activities of daily living (Barthel Index). Several further exploratory end points were analyzed including anxiety and depression (Four-Item Patient Health Questionnaire; PH-Q4). Data were accessed at entry to EGR and after 2 weeks prior to discharge. To analyze the pre-posttest results, the dependent Student t test and the Wilcoxon test were applied. A mixed ANOVA with repeated measurements was used for statistical analyses of time-, group-, and interaction-related changes.

Results

A cohort of 60 patients (mean 80.2, SD 6.1 y; 58% females, 35/60) was analyzed. The main indication for EGR was stroke (9/60, 15%). Patients were recruited into a prospective IG (n=30) and a retrospective control group (n=30). Of the 30 patients in the prospective IG, 11 patients (37%) completed 6 training sessions within 2 weeks. Reasons why participants did not complete 6 training sessions were diagnostic appointments (33%), pain/discomfort (33%), or fatigue (17%). EGR patients rated FPP usability at 84% and facilitators at 65% out of 100%. Pre-posttest analysis of the standard assessments showed a significant interaction in Berg Balance Scale (<.01). In both groups, a significant improvement over time was found in the Timed Up and Go Test (<.01), Barthel Index (<.01), and Functional Independence Measure (<.01). Likewise, in the IG, the PH-Q4 score (.02) improved.

Conclusions

While the technology-based FPP in the EGR setting was generally well-accepted by patients, with high usability ratings, its feasibility was limited. Only 37% of participants completed the required additional training sessions. Further studies should test the technology-based FPP as an integrated part of the EGR complex therapy concept. Our findings suggest potential benefits of incorporating technology-based FPPs in EGR, but further refinement is needed to enhance participation and feasibility.

Understanding Cognition, Oxytocin, and Pain in Elders (UCOPE): protocol for a double-blinded cross-over trial in chronic knee osteoarthritis pain

BACKGROUND

Osteoarthritis (OA) is the leading cause of disability among older adults with the knee being the most affected joint. Specifically, there is an urgent need to develop better analgesics for individuals with OA-related pain, since currently used analgesics frequently fail to provide adequate relief or must be discontinued owing to adverse effects. A promising treatment is the neuropeptide oxytocin (OT), which has been shown to play a role in endogenous analgesia with human and animal studies demonstrating anti-nociceptive effects. The primary aims of the study are to examine preliminary analgesic effects of a chronic OT intervention in community-dwelling older individuals with chronic knee osteoarthritis pain.

METHODS

In this article, we describe the rationale and design of the Understanding Cognition, Oxytocin, and Pain in Elders (UCOPE) study, a double-blinded intervention in which 80 participants over 45 years of age with knee osteoarthritis pain will be recruited to participate in a cross-over trial of 4 weeks of intranasal oxytocin or placebo administration. Primary study outcomes include preliminary changes in pain intensity and interference as well as multi-modal assessment batteries including circulating biomarkers and neuroimaging measures. Self-reported and quantitative outcomes will be assessed at baseline, post-intervention periods, and up to a 6-month follow-up period.

DISCUSSION

This study will establish preliminary effectiveness of a novel intervention in middle to older aged adults with knee osteoarthritis pain. Achievement of these aims will provide a rich platform for future intervention research targeting improvements in pain and disability among geriatric populations and will serve as a foundation for a fully powered trial to examine treatment efficacy and potential mechanisms of the proposed intervention.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03878589. Registered on March 18th, 2019.

Body composition and aging: cross-sectional results from the INSPIRE study in people 20 to 93 years old

Aging is characterized by several major changes, including altered body composition, which is associated with numerous negative clinical consequences such as sarcopenia, osteoporosis, and frailty. The study is to evaluate body composition parameters depending on age and sex in a population ranging from the young adult to the very old, and to identify break points in the association between body composition and age. In this cross-sectional study, we included the enrolment population of the French INSPIRE-T prospective cohort, accounting for 915 subjects (62% female). Age ranged from 20 to 93 years, median age (years) was 63 (IQR 27). Body composition (lean mass, fat mass, and bone mineral content) was assessed with dual-X-ray absorptiometry (DXA). Different break points in the relationship between age and body composition variables in males and females were identified using a segmented regression analysis adjusted on physical activity, nutritional status, educational level, and comorbidities. Lean mass decreased from the age of 55 years for males (CI 95% 44-66) and 31 years for females (CI 95% 23-39). For fat mass, we observed a trend towards an increase with age for males. For females, we observed an increase with age up to age 75 (CI 95% 62-86), followed by a decreasing trend. In this study, we described the relationship between body composition and age as a function of sex, establishing a foundation for further studies on predictive biomarkers of age-related body composition alteration.

Investigation of the validity and reliability of the short physical performance battery in patients undergoing total knee arthroplasty

BACKGROUND

Practical, applicable, valid, and reliable tools are needed to assess physical performance in patients with Total Knee Arthroplasty (TKA) in a variety of settings, including routine clinical assessment, research studies, and community-based programs.

OBJECTIVE

The aim of this study is to evaluate the validity and reliability of the Short Physical Performance Battery (SPPB) among patients with TKA.

METHODS

We included 45 patients who underwent TKA surgery (mean age 68.89 ± 9.26). The SPPB, Timed up and go (TUG) test and, Hospital for Special Surgery (HSS) Knee Score were administered to the patients. SPPB was performed twice on the same day with 1 h rest.

RESULTS

The ICC(2,1) coefficient, MDC95 and SEM values were 0.97, 1.02 and 0.37 respectively. The Pearson correlation coefficient of the SPPB with the TUG and HSS was -.78, and 0.74 respectively.

CONCLUSION

SPPB has excellent reliability, and strong validity in assessing physical performance in patients with TKA. SPPB can identify even minimal detectable difference in physical performance and can be reliably used to monitor patient outcomes in the postoperative period for a comprehensive assessment of TKA in many physical performance domains, including balance, walking speed, and lower extremity strength.

CLINICAL TRIAL NUMBER

NCT06201637.

Intensified dietetic care during and up to three months after hospital admission in older patients at risk of malnutrition, a randomised controlled trial

BACKGROUND

Inadequate protein intake is associated with poor physical functioning and suboptimal recovery in hospitalised older adults. Despite standard dietetic care, dietary protein intakes falls well below the recommended levels. To address this problem, we developed an intensified trans-sectorial dietetic intervention that targets hospitalised older adults. This study aims to evaluate its impact on physical functioning and dietary protein intake during and post hospitalisation.

METHODS

This multicentre individually randomised controlled trial was conducted in five hospitals from January 2021 until December 2022. Hospitalised older adults, aged ≥55 years and at risk of malnutrition were randomised to receive regular care (CON) or intensive dietetic intervention (INT). The intervention consisted of personalized, intensive care, including trans-sectorial guidance by trained dietitians, increased consultations, and supportive materials focused on protein intake. Additionally, the intervention emphasized engagement in dietary behaviour and physical activity during hospitalisation and continued for three months post-discharge. The primary outcome was change in physical functioning measured by the Short Physical Performance Battery (SPPB) from admission to three months post-discharge, analysed with linear mixed models for repeated measures. Secondary outcomes included protein intake, body composition, muscle strength, physical activity, activities of daily living, fear of falling, pain, fatigue, appetite and quality of life.

RESULTS

A total of 76 hospitalised older adults were included in the study of which 38 were in CON and 38 received INT. The overall drop-out was 30 % (CON 26 %; INT 34 %). The participants had a median age 73 y (Inter Quartile Range: 62-78 y) with 50 % females. Overall, Physical functioning improved from 6 points (IQR: 1-9 points) at baseline to 9 points (IQR: 7-11) at three months post-discharge (p < 0.0001). Likewise, protein intake increased from 0.8 g/kg bodyweight (IQR: 0.6-1.0) to 1.0 g/kg bodyweight (IQR: 0.8-1.2) (p < 0.0001). There were no significant differences between intervention and control group. All secondary outcomes improved over time, except for fear of falling, leg extension strength, and body composition, with no significant differences between intervention and control group.

CONCLUSIONS

Hospitalised older patients improved their physical functioning and protein intake after three months post-discharge, although the majority not to recommended levels. No effects of the intensive dietetic treatment could be detected due to low intervention adherence and a small sample size. Future research should be conducted with an intervention consisting of a strong combination of nutritional support and exercise with a successful implementation and a flexible study design catered to the needs of the older patient.

TRIAL REGISTRATION

Landelijk Trial Register (NL8041; NL72069.029.19) www.onderzoekmetmensen.nl; registered 2019-09-23; covering all WHO Trial Registration Data Set items.

Innovative equipment for lower limb muscle strength measurement: Design and application in sarcopenia screening

BACKGROUND

Grip Strength has been established as a practical and efficient method for screening and diagnosing sarcopenia. It is recognized that with advancing age, there is a more significant decline in lower limb muscle mass compared to the upper limb. However, due to the inherent complexity of assessing lower limb muscle strength compared to measuring Grip Strength, these assessments have not been universally adopted for sarcopenia screening.

METHODS

We measured the Forefoot Strength, Heel Strength, Knee Extension Strength, and Hip Extension Strength in 98 participants using portable equipment designed for lower limb muscle strength assessment. We compared the efficacy of using lower limb muscle strength cutoff values with grip strength for the screening of sarcopenia.

FINDINGS

The optimal cutoff values for screening sarcopenia in males using Knee Extension Strength and Hip Extension Strength were 140.1 N and 121.7 N, respectively, while for females they were 91.6 N and 90.4 N, respectively. In binary logistic regression models adjusted for age and body weight, Knee Extension Strength and Hip Extension Strength were found to be associated with sarcopenia in both males and females. Moreover, the efficacy of sarcopenia screening using Knee Extension Strength or Hip Extension Strength cutoff values was superior to that of grip strength alone, and the combination of Knee Extension Strength and Hip Extension Strength cutoff values yielded the best results for sarcopenia screening.

INTERPRETATION

Measurements of Knee Extension Strength and Hip Extension Strength may potentially serve as a promising method for sarcopenia screening.

Association between fish intake and incidence of sarcopenia in community-dwelling older adults after a 6-year follow-up: the Korean frailty and aging cohort study

Previous studies have suggested beneficial effects of n-3 polyunsaturated fatty acids on sarcopenia. However, the associations of dietary fish intake with the prevalence of sarcopenia are inconsistent, and those with the incidence of sarcopenia has not been studied. This study investigated the hypothesis that seafood and fish consumption is inversely associated with the subsequent incidence of sarcopenia. Using data from the Korean Frailty and Aging Cohort Study, 503 non-sarcopenic community-dwelling Korean adults aged 70-84 years were followed-up for 6 years. Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2019 consensus. Dietary intake was assessed using two non-consecutive 24-h dietary recalls at baseline. The incidence of sarcopenia was 37.8% after the 6-year follow-up. The intake of oily fish was inversely associated with the incidence of sarcopenia (OR 0.99; 95% CI 0.98-1.00; p for trend = 0.046) and that of low gait speed (OR 0.98; 95% CI 0.97-1.00; p for trend = 0.016) after the 6-year follow-up, adjusting for confounding factors. Consumption of total seafood, fish, non-oily fish, or shellfish was not significantly associated with the incidence of sarcopenia or its parameters, such as muscle mass, handgrip strength, usual gait speed, 5-times sit-to-stand test, or the Short Physical Performance Battery. The findings demonstrate that the consumption of oily fish could be beneficial in preventing sarcopenia, particularly by improving usual gait speed in Korean community-dwelling older adults, suggesting oily fish as a strategy to reduce sarcopenia risk.

Adverse childhood experiences, sleep quality/duration and later-life lower extremity function among older adults in China: evidence from CHARLS

OBJECTIVE

This study aimed to explore the relationship between adverse childhood experiences (ACEs), sleep, and lower extremity function in older adults using a nationally representative cohort.

METHODS

This study included 4,439 participants aged 60 years or older (mean age: 67.2 ± 5.7 years) from the China Health and Retirement Longitudinal Study (CHARLS) 2015 national survey and the 2014 Life History Survey. ACEs, sleep duration, and sleep quality were assessed through self-report, and lower extremity function was measured using the Short physical performance battery (SPPB). The relationships between ACEs, sleep, and lower extremity function were analyzed using multivariate linear regression model and restricted cubic splines.

RESULTS

After adjusting for covariates, older adults with four or more ACEs exhibited worse lower extremity function compared to those with no ACEs (β: -0.175). 6-8 h of sleep was associated with improved lower extremity function (β: 0.119), while good sleep quality was also associated with higher lower extremity function scores (β: 0.177). Age-related differences revealed that the association between four or more ACEs and reduced lower extremity function (β: -0.431) was significant only in individuals aged 70 years and older. In the 60-69 years age group, the sleep duration of 6-8 h was significantly related to better lower extremity function (β: 0.150), however, in those aged 70 years and older, more than 8 h of sleep was associated with poorer function (β: -0.378). Furthermore, good sleep quality was associated with better lower extremity function in individuals aged 70 years and older (β: 0.246).

CONCLUSION

ACEs, particularly household mental illness and parental disability, are associated with poorer lower extremity function in older adults. Normal sleep duration and good sleep quality are linked to better lower extremity function and may mitigate the negative effects of ACEs. However, these associations vary by age.

Randomized Controlled Trial: Preliminary Investigation of the Impact of High-Intensity Treadmill Gait Training on Recovery Among Persons with Traumatic Brain Injury

Exercise to treat traumatic brain injury (TBI) is a novel approach that has only become recognized in the past decade. High-intensity gait training (HIGT) has been studied in subjects following stroke; however, little research investigates similar protocols on patients with TBI. The study evaluated HIGT as an intervention for enhancing patient recovery after TBI. Adult subjects (18-65 years) who suffered TBI were randomly allocated to an intervention (HIGT) or control (low-intensity physical therapy) group given three days/week for 1 h over four weeks. Assessments included the 10-m walk test, 6-min walk test, Berg Balance Scale, five-times sit-to-stand (5TSTS), timed up and go (TUG), cognitive TUG, and Montreal Cognitive Assessment (MoCA) at day one, two weeks, four weeks, and a four-week follow-up. In addition to a trend toward improved gait speed (p < 0.1) and significantly improved endurance (p < 0.05) in the HIGT group (n = 5), both the control (n = 4) and HIGT groups demonstrated trends toward improved mobility (5TSTS, p < 0.1; TUG, p < 0.1) and significantly improved cognition (cognitive TUG, p < 0.01; MoCA, p < 0.05) over the four-week time period and at the one-month follow-up. HIGT showed longer-lasting rehabilitative effects on gait distance, endurance, mobility, and cognitive function at the four-week follow-up. This study suggests that HIGT may support functional recovery, and future work will involve increasing sample size.

Circulating biomarkers associated with walking performance in elderly subjects: exploring miRNAs, metabolic and inflammatory biomarkers

Aging phenotype is characterized by musculoskeletal impairment that leads to diminished mobility and physical function. This study investigated whether circulating miRNAs and metabolic and inflammatory biomarkers may reflect the walking performance of the elderly. Elderly hospitalized for an acute condition and recruited from the ReportAge Biobank were grouped, based on their walking performance, in active subjects (n = 23, age: 83.0 ± 4.3), able to walk ≥ 1 km and who performed more than 1 h activity, and inactive subjects (n = 23, age: 85.0 ± 6.0), able to walk < 100 m and who performed < 1 h activity in the 3 days prior hospitalization. Plasma levels of 754 miRNAs were evaluated using OpenArray® platform, and miRNAs whose level was ± 2.5 fold (p < 0.05) were validated by qPCR. Target prediction for validated miRNAs was performed on MirWalk 3.0, Gene Ontology and pathway enrichment on Panther 19.0. Cytokines and metabolites associated with bone, muscle, and inflammation were evaluated from plasma samples using Luminex and ELISA. Among the 7 miRNAs found differentially expressed in active compared to inactive elderly after the initial screening, 4 miRNAs were validated: hsa-let7g-5p, hsa-miR-27a-3p, hsa-miR-361-5p, hsa-miR-574-3p, all upregulated in the active group. Gene Ontology and pathway enrichment analysis revealed the identified miRNAs potentially involved in muscle and bone metabolism during aging. Among cytokines, gp130 and IL-10 significantly differed between the two groups. This study suggests the potential association of specific circulating biomarkers with walking performance in elderly and their potential involvement in the molecular mechanism underlying age-associated musculoskeletal impairment.