Annals of Geriatric Medicine and Research最新文献

Background: Despite updated sarcopenia guidelines, inconsistent protocols still cause clinical confusion and may compromise diagnostic and outcome accuracy. This Delphi study aimed to establish expert consensus to support the standardization of muscle strength and physical performance assessments for sarcopenia.

Methods: A two-round modified Delphi study was conducted with 26 experts in geriatrics and sarcopenia. Participants completed two rounds of anonymous questionnaires evaluating 39 items across seven domains using a nine-point Likert scale or choice-based questions. Consensus was defined as ≥75% agreement.

Results: In total, 27 of 38 statements (71.1%) reached consensus across two rounds Experts supported further standardization of assessments in alignment with the Asian and Korean Working Group on Sarcopenia (AWGS and KWGS) guidelines. For handgrip strength, consensus was achieved on using both mechanical and hydraulic dynamometers, hydraulic protocols, value selection, measurement time, and positioning, but not on mechanical protocols, repetitions, recovery intervals, repetitions, or unified cutoff values. For calf circumference, consensus was reached on measurement position, method, and value selection, but not on guideline application. In gait speed assessment, agreement was reached on speed, repetitions, assistive device use, and equipment type, but not on value selection, distance, acceleration/deceleration phases, or device interchangeability. For the 400-m walk test, the KWGS guideline and speed were endorsed. Chair stand test (CST) and Timed up-and-go (TUG) test reached consensus on armrest use, value selection, and repetitions, but not on seat height, (CST), or speed (TUG).

Conclusion: This study highlights areas of agreement and ongoing uncertainty, supporting future standardization efforts sarcopenia assessment methods.

Background: Older adults frequently utilize healthcare services across diverse medical settings to maintain continuity of care. However, data from the hospital records of older adults is often not linked to their health status in community settings, preventing a full understanding of their healthcare needs.

Methods: This study aimed to compare the multidimensional health status (i.e., self-rated health, depression, physical function/activity, mobility, nutrition, lifestyle factors, blood laboratory, and diseases) of older adults between community and hospital cohorts. The goal was to identify the potential health problems of older adults and establish a preventive care system. Secondary analysis was conducted using data obtained from the Korean Urban Rural Elderly study for the community cohort and outpatient patients from a single tertiary hospital for the hospital cohort.

Results: Using age- and sex-matched propensity score matching, 550 older adults were selected equally from the two cohorts. Logistic regression was performed to predict the health status of the two groups. The health status of the community and hospital cohorts differed in several health domains. The hospital cohort group had more risk of depression, impairment in instrumental activities of daily living, and malnutrition. The hospital cohort group had lower alcohol intake and albumin, and higher glucose levels. The hospital group also had a higher prevalence of stroke and depression.

Conclusion: The findings of this study highlight the need to provide multidimensional healthcare services that consider the deterioration of multiple health conditions in older adults.

Background: Home-visit care should prioritize patient safety and promote positive safety awareness to maintain caregivers' commitment to providing safe care. This descriptive study aims to examine the relationship between home-visit caregivers' knowledge, attitudes, awareness of patient safety, and safety-related activities.

Methods: The participants were 210 adult home-visit caregivers, aged 20 years or older, with more than six months of experience working at six long-term care centers in Daejeon Metropolitan City. Data were collected using a structured self-report questionnaire to measure participants' general characteristics and their patient safety knowledge, attitudes, awareness, and activities, and analyzed using SPSS/WIN version 28.0.

Results: This study demonstrated that patient safety activities were significantly positively correlated with patient safety knowledge (r=0.63, p˂0.001), patient safety attitude (r=0.49, p ˂0.001), and patient safety awareness (r=0.69, p˂0.001). The factors affecting patient safety activities were patient safety awareness and patient safety knowledge, with an explanatory power of 55%.

Conclusion: To practice patient safety activities and maintain a desirable attitude, an educational strategy that promotes cognitive change, such as a systematic and continuous practice-oriented campaign, is needed. Furthermore, efforts to improve the working environment to extend the tenure of experienced caregivers are required.

Background: The aim of this study was to examine the effects of different levels of physical activity on functional capacity, muscle strength, and the contractile properties of single muscle fibers in older adults.

Methods: Twenty-ones older adults (71.1±3.7 years) were divided into the high physical activity (HPA, n=10) and low physical activity (LPA, n=11) groups. Physical activity was assessed using a short form of the International Physical Activity Questionnaire (IPAQ). Physical function and muscle strength tests were performed. The fiber cross-sectional area (CSA), maximal force (Po), maximal force normalized to CSA (specific force, SF), maximal shortening velocity (Vo), and myosin heavy chain isoform expression were determined in single muscle fibers.

Results: IPAQ walking and total scores were higher in the HPA than in the LPA. The differences in body composition of the LPA and HPA were not significant. The 4-m walking velocity and isometric and isokinetic knee extensor strength were higher in the HPA than in the LPA. There was a significant difference between the two groups in Vo, but not fiber CSA, peak force, and SF. In addition, the Vo was significantly higher in the HPA than in the LPA for type I but not type II fibers. The correlation between total physical activity level and Vo was positive.

Conclusion: In older adults, higher levels of physical activity may have a greater impact on muscle function than on body composition. Moreover, increased physical activity is associated with higher Vo at the muscle cell level. Thus, we propose that enhancing overall physical activity levels should be considered an effective strategy for improving muscle function in older adults.

Background: Appetite loss in older adults raises the risk of malnutrition and frailty. The recent emphasis on psychological and social support for appetite loss reveals the importance of robust social networks. Depression is linked to a decline in appetite and social networks. Social networks may influence appetite directly and indirectly through depression. This exploratory cross-sectional study categorizes social networks into family and friend networks to elucidate their direct and indirect effects.

Methods: The study analyzed 193 community-dwelling older adults (women 78.2%; mean age 77.1±5.3 years) who participated in health-checkup events in two cities in Japan. Appetite was assessed using the Japanese version of the Simplified Nutritional Appetite Questionnaire, and family and friend networks were assessed using the Lubben Social Network Scale-6. Depression was assessed using the Geriatric Depression Scale-15. Based on previous research, we constructed a causal model examining the impacts of family and friend social networks and depression on appetite and calculated the direct and indirect effects through structural equation modeling.

Results: The family network had a direct effect on appetite (path coefficient=0.18) and an indirect effect via depression (path coefficient=0.0608). Conversely, the friend network was not directly associated with appetite but had an indirect effect through depression (path coefficient=0.095). The model exhibited a good fit. The mechanism of influence on appetite varied between the networks.

Conclusion: To prevent appetite loss, social networks with family and friends should be assessed separately, and tailored support should be provided for each.

Background: Changes in cognitive function are associated with increased depression and decreased quality of life (QOL). This study aimed to determine the relationship between the characteristics of geriatric patients and anesthetic management with changes in postoperative cognitive function and QOL of geriatric patients undergoing elective surgery.

Methods: This prospective observational analytic multicenter study included patients aged ≥60 years who underwent elective surgery in hospitals in Indonesia. We used the whole sampling method and performed follow-up 30 days after surgery. Data were analyzed using bivariate chi-square and multivariate regression tests with a confidence interval of 95% and α=5%.

Results: Among the 933 geriatric patients included in this study 55.0%, females most (59.8%) received general anesthesia. Factors including age (p<0.001, B=-0.374, odds ratio [OR]=0.688), body mass index (BMI) (p<0.05, B=0.129, OR=1.138), and physical status based on American Society of Anesthesiologists (ASA) classification (p<0.001, B=-0.458, OR=0.633) were significantly associated with postoperative cognitive function. BMI (p<0.001, B=-0.218, OR=1.244), absence of comorbidities (p<0.05, B=-0.312, OR=0.732), regional anesthesia (p<0.05, B=0.606, OR=1.883), and changes in cognitive function (p<0.05, B=0.288, OR=1.334) were significantly correlated with changes in postoperative QOL.

Conclusion: Age, BMI, and ASA physical status were significantly associated with postoperative cognitive function in geriatric patients, whereas BMI, comorbidities, regional anesthesia, and changes in postoperative cognitive function were associated with QOL. These preoperative factors can predict postoperative cognitive function and QOL and may be useful during preoperative planning.

Background: Older adults undergoing surgery frequently have multiple comorbidities and reduced physical and cognitive reserves. This study aims to assess the effect of physical and cognitive frailty on long-term mortality in older patients undergoing elective non-cardiac surgery in a tertiary center.

Methods: Patients aged ≥65 years old admitted to surgical wards at the University of Malaya Medical Centre were recruited. Physical frailty and cognitive status were assessed using the Fried Frailty Index (FFI) and the Montreal Cognitive Assessment, respectively. Patients were stratified into six groups based on their frailty and cognitive status: Group 1, normal cognition and non-frail (reference group); Group 2, normal cognition and frail; Group 3, mild cognitive impairment (MCI) and non-frail; Group 4, MCI and frail; Group 5, dementia and non-frail; and Group 6, dementia and frail.

Results: A total of 406 patients with a mean FFI score of 1.1±1.2 were recruited. Predictors of mortality include male sex (hazard ratio [HR]=1.96; 95% confidence interval [CI], 1.14-3.37; p=0.015), presence of active malignancy (HR=3.86; 95% CI, 2.14-6.95; p<0.001), and high FFI scores (1.8±1.2 vs. 1.0±1.1; p=0.013). Compared to Group 1, long-term mortality risk was significantly increased in Group 4 (HR=3.17; 95% CI, 1.36-7.38) and Group 6 (HR=3.91; 95% CI, 1.62-9.43) patients.

Conclusion: The combination of physical frailty and cognitive impairment was associated with long-term mortality risk among older patients who underwent elective non-cardiac surgery. This highlights the importance of assessing physical frailty and cognitive function of all older surgical patients to guide targeted intervention, especially for those with impairments which may be potentially reversible.

Background: In May 2023, Japan reclassified coronavirus disease 2019 (COVID-19) under the Infectious Disease Control Law. However, there have been insufficient examinations on how the change in classification has impacted citizens' lives. This study examined the impact of revisions to the Infectious Disease Control Law in Japan on the social frailty and social life of older adults in the community.

Methods: From mid-March to mid-April 2023, a self-administered survey targeting community-dwelling older adults aged 65 years and over was conducted by mail, before the revision of the Infectious Disease Control Law. From mid-February to mid-March 2024, after the revision of the law, a second survey was conducted among those who had responded to the first one. Ultimately, data from 240 cases were collected. The survey included social information such as mask-wearing when going out, status of long-term care insurance, presence of polypharmacy, sleep status, long outings, presence of COVID-19 infection, presence of post-COVID-19 syndrome (if infected), social frailty, and the Kihon Checklist, alongside basic demographic information.

Results: After the revision of the Infectious Disease Control Law, there was an increase in the number of individuals receiving benefits from long-term care insurance and those identified as socially frail. However, no significant differences were observed in the other surveyed items.

Conclusion: The increase in socially frail individuals and those with long-term care insurance suggests that, despite the revision of the Infectious Disease Control Law, the connections within the local community that had once weakened due to the COVID-19 pandemic have not been fully restored.

Background: Understanding the relationship between muscle mass, muscle strength, and bone density in older adults is crucial for addressing age-related conditions like osteoporosis and sarcopenia. This review aims to evaluate the relationship between muscle mass and muscle strength with bone density in older adults.

Methods: This systematic review, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, involved a comprehensive search across seven databases from 2014 to April 2024. Included were observational studies in English and Indonesian on adults aged 60 and older. The Appraisal Tool for Cross-Sectional Studies (AXIS) tool assessed the risk of bias, and the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) framework evaluated the evidence quality. Study selection was independently reviewed, and consensus was reached through discussion.

Results: Ten studies were included. For muscle mass and bone density, five studies showed a significant association, while four did not. For muscle strength and bone density, four of seven studies reported a significant association. However, the evidence quality was low due to inconsistency.

Conclusion: The relationship between muscle mass, muscle strength, and bone density in older adults shows variability and inconsistent evidence.