SERDI

Sedentary lifestyle leads to worse health outcomes with aging, including frailty. Older adults can benefit from regular physical activity, but exercise promotion in the clinical setting is challenging. The objective of this clinical demonstration project was to implement a Geriatric Walking Clinic for older adults and determine whether this clinical program can lead to improvements in characteristics of frailty. This was a clinical demonstration project/quality improvement project. Outpatient geriatrics clinic at the South Texas Veterans Health Care System (STVHCS). Older Veterans, aged ≥60 years. A 6-week structured walking program, delivered by a registered nurse and geriatrician. Patients received a pedometer and a comprehensive safety evaluation at an initial face-to-face visit. They were subsequently followed with weekly phone calls and participated in a final face-to-face follow-up visit at 6 weeks. Grip strength (handheld dynamometer), gait speed (10-ft walk), Timed Up and Go (TUG), and body mass index (BMI) were assessed at baseline and follow-up. Frailty status for gait speed was assessed using Fried criteria. One hundred eighty five patients completed the program (mean age: 68.4 ±7 years, 88% male). Improvements from baseline to follow-up were observed in average steps/day, gait speed, TUG, and BMI. Improvement in gait speed (1.13 ±0.20 vs. 1.24 ± 0.23 meter/second, p<0.0001) resulted in reduced odds of meeting frailty criteria for slow gait at follow-up compared to the baseline examination (odds ratio = 0.31, 95% confidence interval: 0.13–0.72, p = 0.01). Our findings demonstrate that a short duration, low-intensity walking intervention improves gait speed and TUG. This new clinical model may be useful for the promotion of physical activity, and for the prevention or amelioration of frailty characteristics in older adults.

The age-related loss of skeletal muscle (sarcopenia) is a major health concern as it is associated with physical disability, metabolic impairments, and increased mortality. The coexistence of sarcopenia with obesity, termed ‘sarcopenic obesity’, contributes to skeletal muscle insulin resistance and the development of type 2 diabetes, a disease prevalent with advancing age. Despite this knowledge, the mechanisms contributing to sarcopenic obesity remain poorly understood, preventing the development of targeted therapeutics. This article will discuss the clinical and physiological consequences of sarcopenic obesity and propose myostatin as a potential candidate contributing to this condition. A special emphasis will be placed on examining the role of myostatin signaling in impairing both skeletal muscle growth and insulin signaling. In addition, the role of myostatin in regulating muscle-to fat cross talk, further exacerbating metabolic dysfunction in the elderly, will be highlighted. Lastly, we discuss how this knowledge has implications for the design of myostatin-inhibitor clinical trials.

This systematic literature review documents the link between frailty or sarcopenia, conceptualized as dimensions of physical health, and the use of long-term care services by older individuals. Long-term care services include formal and informal care provided at home as well as in institutions. A systematic review was performed according to PRISMA requirements using the following databases: PubMed-Medline, Embase, CINAHL, Web of Science, and Academic Search Premier. We included all quantitative studies published in English between January 2000 and December 2018 focusing on individuals aged 50 or more, using a relevant measurement of sarcopenia or physical frailty and a long-term care related outcome. A quality assessment was carried out using the questionnaire established by the Good Practice Task Force Report of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Five subsets of long-term care outcome were considered: 1/ nursing home placement (NHP), 2/ nursing home short stay (NHSS), 3/ formal personal care (FPC), 4/ formal home help (FHH), 5/ informal care (IC). Out of 1943 studies, 17 were finally included in the review. With some studies covering several LTC outcomes, frailty and / or sarcopenia were associated with increased LTC use in 17 out of 26 cases (NHP: 5/6, NHSS: 3/4, FPC: 5/7, FHH: 1/4, IC: 3/5) The association was not consistent in 5 cases (NHP: 1/6, NHSS: 1/4, FPC: 2/7, FHH: 0/4, IC: 1/5) and the association was either not significant or the results inconclusive in the remaining 9 cases. Overall, while results on sarcopenia are scarce, evidence support a positive association between frailty and LTC use. The evidence is stronger for the association of physical frailty with nursing home placement / short stay as well as on FPC. There is less (more heterogeneous) evidence regarding the correlation between physical frailty and FHH or IC use. Results need to be confirmed by more advanced statistical methods or design based on longitudinal data.

Dân số toàn cầu đang già hóa nhanh chóng, với sự gia tăng đáng kể nhất ở các nước đang phát triển như Malaysia. Người cao tuổi có nguy cơ cao hơn về đa bệnh lý, suy yếu và ngã. Nghiên cứu này nhằm xác định mối quan hệ giữa tham gia xã hội, sự suy yếu và ngã ở Malaysia. Đây là một nghiên cứu cắt ngang nhằm khảo sát các cá nhân từ 55 tuổi trở lên được lựa chọn từ danh sách cử tri của ba khu vực bầu cử ở thung lũng Klang thông qua lấy mẫu ngẫu nhiên phân tầng. Những người tham gia được mời tham gia vào một bảng hỏi và đánh giá thể chất như một phần của nghiên cứu Dài Hạn Người Cao Tuổi Malaysia (MELoR). Những người ngã là những cá nhân đã ngã trong năm trước đó. Sự suy yếu được định nghĩa là đáp ứng ≥3 tiêu chí: chỉ số khối cơ thể thấp, giảm nhận thức, hoạt động thể chất thấp, sức mạnh nắm tay yếu và tốc độ đi bộ chậm. Tham gia xã hội được xác định từ tình trạng việc làm, mạng xã hội, và hoạt động cộng đồng. Phân tích hồi quy logistic nhị thức đa biến được thực hiện để xác định các liên kết giữa các chỉ số tham gia xã hội với ngã và suy yếu. Tuổi trung bình của 1383 người tham gia là 68,5 tuổi, với 57,1% là nữ giới. Trong số đó, 22,9% là những người ngã và 9,3% là người suy yếu. Sự cô lập xã hội (OR= 2,119; 95% CI=1,351–3,324), và không tham gia vào hoạt động cộng đồng (OR=2,548; 95% CI=1,107–5,865) liên quan tới sự suy yếu tăng lên. Tần suất ngã cũng tăng theo sự cô lập xã hội (OR=1,327; 95% CI=1,004–1,754). Các nghiên cứu trước đây cho thấy tham gia xã hội có liên quan tới sự suy yếu và nguy cơ ngã, và sự cô lập xã hội là một yếu tố tiên đoán nguy cơ ngã. Trong nghiên cứu này, sự suy yếu liên quan tới cả ba chỉ số tham gia xã hội và lịch sử ngã có liên quan tới sự cô lập xã hội.

We conducted a post-hoc analysis of a pre/post, single-arm, nonrandomized, multicomponent weight loss intervention in older adults. Fifty-three older adults aged ≥65 with a body mass index ≥ 30 kg/m2 were recruited to participate in a six-month, remote monitoring and video-conferencing delivered, prescriptive intervention consisting of individual and group-led registered dietitian nutrition and physical therapy sessions. We assessed weight, height, and body composition using a SECA 514 bioelectrical impedance analyzer. Mean age was 72.9±3.9 years (70% female) and all had ≥2 chronic conditions. Of those with complete data (n=30), we observed a 4.6±3.5kg loss in weight, 6.1±14.3kg (1.9%) loss in fat mass, and 0.78±1.69L loss in visceral fat (all p<0.05). Fat-free mass (−3.4kg±6.8, p=0.19), appendicular lean mass (−0.25±1.83, p=0.22), and grip strength (+3.46±7.89, p=0.56) did not significantly change. These variables were preserved after stratifying by 5% weight loss. Our intervention led to significant body and visceral fat loss while maintaining fat-free and appendicular lean muscle mass.

Frailty is associated with multiple adverse health outcomes, including mortality. Several methods have been used to characterize frailty, each based on different frailty scales. These include scales based on phenotype, multidomain, and deficit accumulations. Several systematic reviews have examined the association between frailty and mortality; however, it is unclear whether these different frailty scales similarly predict mortality. This umbrella review aims to examine the association between frailty assessed by different frailty scales and all-cause mortality among community-dwelling older adults. A protocol was registered at PROSPERO, and it was conducted following the PRISMA statement. MEDLINE, Embase, PubMed, Cochrane Database of Systematic Reviews, Joanna Briggs Institute (JBI) EBP database, and Web of Science database was searched. Methodological quality was assessed using the JBI critical appraisal checklist and online AMSTAR-2 critical appraisal checklist. For eligible studies, essential information was extracted and synthesized qualitatively. Five systematic reviews were included, with a total of 434,115 participants. Three systematic reviews focused on single frailty scales; one evaluated Fried’s physical frailty phenotype and its modifications; another focused on the deficit accumulation frailty index. The third evaluated the FRAIL (Fatigue, Resistance, Ambulation, Illness, and Loss of weight) scale. The two other systematic reviews determined the association between frailty and mortality using different frailty scales. All of the systematic reviews found that frailty was significantly associated with all-cause mortality. This umbrella review demonstrates that frailty is a significant predictor of all-cause mortality, irrespective of the specific frailty scale.

Stride-to-stride fluctuations, or gait variability, can be captured easily using body worn inertial sensors. Previously, sensor-measured gait variability has been found to be associated with fall risk and central nervous changes. However, further research is needed to clarify the clinical relevance of this method. In this study, we look at how gait variability is associated with muscle strength, measured two years earlier. This is study of longitudinal associations. Participants were community-dwelling volunteers between 70–81 years. Participants were tested while walking with a single sensor at their lower back, and they walked back and forth over a distance of 6.5 meters under four conditions: at preferred speed, at fast speed, with an added cognitive task, and while walking across an uneven surface. Gait variability in the anteroposterior (AP), mediolateral (ML) and vertical (V) directions was identified. A muscle strength score was composed by transforming hand grip strength, isometric knee extension strength and the 30 second chair rise-test to z-scores and adding them. 56 individuals were analysed (mean age at baseline 75.8 (SD 3.43), 60 percent women). In a backwards regression method using age, gender and baseline walking speed as covariates, muscle strength predicted gait variability after two years for AP variability during preferred speed (Beta=.314, p=.025) and uneven surface walking (Beta=.326, p=.018). Further, muscle strength was associated with ML variability during preferred speed (Beta=.364, p=.048) and fast speed (Beta=.419, p=.042), and V variability during preferred speed (Beta=.402, p=.002), fast speed (Beta=.394, p=.004) and uneven surface walking (Beta=.369, p=.004). Sensor-measured gait variability tended to be associated with muscle strength measured two years earlier. This finding could emphasize the relevance of this relatively novel measure of gait in older adults for both research and clinical practice.

Currently, only one study has used dual-energy X-ray absorptiometry (DXA)-derived percent body fat (BF%) as the criterion measure to develop ultrasound prediction equations to estimate BF% in adults between the ages of 50 and 80 years. The aim of this study was to examine the relationship between BF% estimated from subcutaneous fat thickness using a previously published Japanese-based prediction equation and DXA-derived BF% in Caucasian middle-aged and older adults. A secondary aim was to develop a new prediction equation for Caucasian adults if the previously published equation did not predict BF% well in Caucasians. Cross-sectional study. One-hundred and two Caucasian adults aged 50–76 years (59 men and 43 women) had ultrasound fat thickness and DXA values measured. A new BF% prediction model was developed using ordinary least squares multiple linear regression. There was a strong correlation between ultrasound predicted and DXA-derived BF% (r = 0.882, p<0.001). Bland-Altman analysis did not indicate a bias in the prediction of BF% for Caucasian adults (r = −0.092, p>0.05). However, the predicted BF% was significantly higher compared to DXA-derived BF% (approximately 4%). A newly developed nonlinear prediction model used to estimate BF% was significant [F(17,84) = 33.44, p<0.001] with an R2 of 0.871 and an adjusted R2 of 0.845. When examining the stability of the model, bootstrapping (n=1000) resulted in an optimism value of 0.1135 so that the corrected R2 was 0.758. After removing an outlier, the model was significant [F(17,83) = 34.82, p<0.001] and it’s R2 was 0.877 and adjusted R2 was 0.852. The developed equation was stable with a high degree of variance compared to results from previous studies. The results of this study also suggest that ethnicity should be considered when choosing which prediction equations should be used to estimate BF%.

Protein intake is suggested as an important dietary factor in the prevention of frailty, however, the influence of lifelong intake remains unclear. The present study investigated the relationship between daily protein intake and patterns of protein intake over 21 years and the risk of pre-frailty/frailty. Prospective cohort study. The population-based Tromsø Study in Tromsø municipality, Norway. In total, 1,906 women and 1,820 men aged ≥45 years in 1994 who participated in both Tromsø4 (1994–95) and Tromsø7 (2015–16). Frailty status in Tromsø7 was measured according to Fried’s phenotype, classifying participants as “robust” (frailty components present: 0), “pre-frail” (1–2) or “frail” (≥3). Daily intake of protein was estimated from self-reported habitual dietary intake using food frequency questionnaires and assessed as grams per kilogram bodyweight (g/kg BW) and per megajoule energy intake (g/MJ). The protein–frailty association was assessed via longitudinal and cross-sectional multivariable logistic regression analyses. The prevalence of pre-frailty and frailty in this study was 27% and 1.0%, respectively. Longitudinal analysis showed that the odds of pre-frailty/frailty decreased by 57% (odds ratio (OR) = 0.43, 95% confidence interval (CI) = 0.31;0.58, p<0.001) with the increase in intake of one additional gram of dietary protein per kg BW. The results obtained from cross-sectional analysis were similar. Tracking analysis showed that, compared to a stable high intake of protein in g/kg BW over time, other patterns of protein intake increased the risk of pre-frailty/frailty. No associations were found between intake of protein in g/MJ and pre-frailty/frailty. Intake of protein in g/kg BW both in mid-life and later in life was inversely associated with pre-frailty/frailty in older adults. This emphasizes the importance of an adequate protein intake to facilitate healthy ageing in Norwegian older adults.