European Geriatric Medicine最新文献

Introduction: Neuromuscular electrical stimulation (NMES) is a potentially effective intervention to improve outcomes after a fragility fracture, but its feasibility in this group has not been established.

Methods: A feasibility study was conducted in two phases: 1) in the hospital only, and 2) hospital, rehabilitation centres, and participants' homes. Patients with fragility fracture were randomised to receive NMES for 6 weeks/discharge either to the right or left leg, with the other leg serving as control. Patients who had no mobility issues had contraindications to NMES and were unable to give consent were excluded. NMES was applied to quadriceps and tibialis anterior muscles for 30 min, 3 days/week. Sessions were progressed to achieve 60 min, 5-7 days/week. Feasibility outcomes included participant characteristics, recruitment rate, tolerability, and number of NMES sessions. Clinical outcomes included muscle strength, and ADL at six months.

Results: Overall, 1052 patients were identified, of whom 113 (11%) were eligible, and 29 (3%) were recruited (median Clinical Frailty Score 3, median Barthel ADL score 93/100). The recruitment rate was 0.45/week in phase 1 and 0.9/week in phase 2. Fifty-three percent achieved the target of 24 NMES sessions. However, 5/29 withdrew due to intolerance of NMES. Leg muscle strength improved in both treated and untreated legs, with marginally greater improvement observed in the tibialis anterior of treated legs.

Conclusion: Although it would be feasible to evaluate the specific effect of NMES in fragility fracture patients in a multi-centre trial using home-based NMES, this would be possible only in a minority of mildly frail fragility fracture patients with little premorbid disability.

Purpose: A relationship between decreased plantar cutaneous sensation and impaired balance function has been reported in patients with peripheral neuropathy and diabetes. This cross-sectional study aimed to investigate the relationship between plantar sensation and postural balance, as well as the association between plantar sensation and sarcopenia-related motor function in community-dwelling older adults.

Methods: The participants included 1659 community-dwelling older adults with a mean age of 74 ± 5 years, of which 43% were male patients. Plantar cutaneous sensation thresholds were assessed using an automatic plantar sensation testing device. Postural balance was measured using one-leg standing (OLS) time. Grip strength, five-time sit-to-stand (STS) time, and normal gait speed were measured as components of muscle strength and physical function related to sarcopenia. The skeletal muscle mass index (SMI) and leg phase angle were obtained using bioelectrical impedance analysis.

Results: Age, sex, body mass index, and leg phase angle, but not SMI and grip strength, were independently associated with the plantar sensation threshold. Plantar sensation threshold was independently associated with the OLS time (P = 0.001) and STS time (P = 0.001) after adjusting for potential confounders. No significant association was found between plantar sensation threshold and normal gait speed (P = 0.741).

Conclusion: Plantar sensation was independently associated with postural balance and lower limb function in community-dwelling older adults. The assessment of plantar sensation could be useful for identifying factors contributing to poor postural balance and lower limb motor function.

Rationale and objective: Perceptions of sarcopenia have rarely been explored, yet understanding these will be key for successful translation of sarcopenia research findings into meaningful benefits for patients and the public. This scoping review aimed to explore how sarcopenia is perceived amongst patients, health and care professionals (HCP), and the public in different countries.

Methods: Seven electronic databases were searched from inception up to December 2023 with no geographical or language limitations. Studies were included if they were peer-reviewed research of any design where the focus related to perceptions of sarcopenia. Studies using alternative descriptors only, such as "skeletal muscle weakness/loss" were excluded. Study characteristics were charted, and thematic synthesis conducted.

Results: Following independent screening of 11,533 records, 20 articles were included in this review representing 19 countries. Five studies focused on patient perceptions, 11 investigated HCP, and four the public. Three key themes were identified: (1) Low awareness of sarcopenia-among all groups, its nature as a disease was contested. (2) The "know-do" gap in healthcare-even where knowledge among HCP existed, this had not translated into clinical practice, in part, due to perceptions of sarcopenia and its management. (3) Experiencing weakness-living with sarcopenia had physical and psychological sequalae.

Key conclusions: These findings reveal perceptions that may be contributing to the slow adoption of sarcopenia prevention, screening, diagnosis, and management. Addressing these areas has the potential to aid translation of sarcopenia research findings into improved clinical care and benefits for patients and the public.

Objective: The accuracy of determining gait independence using adductor pollicis muscle thickness (APMT) and skeletal muscle mass index (SMI) in community-dwelling older adults undergoing outpatient rehabilitation remains unclear. The purpose of this study was to compare the accuracy of determining gait independence using APMT and SMI in community-dwelling older adults undergoing outpatient rehabilitation.

Methods: This study included 98 older adults (mean age: 85.2 years). Participants received outpatient rehabilitation one to three times a week. The main outcomes were gait independence (functional independence measure gait score: 6 or 7), skeletal muscle mass index (SMI), and APMT. Receiver operating characteristic (ROC) curves of APMT and SMI for gait independence were created, and cut-off values were calculated using the Youden index. Additionally, the area under the curve (AUC) s of the APMT model and the SMI model were compared using the Delong test.

Results: Among the 98 participants (male; 19, female; 79), 53 (54.1%) were in the gait independent group. The cut-off value of APMT calculated from the ROC curve was 13 mm; the sensitivity and specificity were 67.9% and 86.7%, respectively; and the AUC was 0.800. The cut-off value of SMI calculated from the ROC curve was 4.6 kg/m²; the sensitivity and specificity were 90.6% and 26.7%, respectively; and the AUC was 0.582. The AUC for the APMT model was significantly higher than the SMI model (P < 0.001).

Conclusions: The results of this study show that the cut-off value of APMT for determining the gait independence was 13 mm. In addition, APMT had a higher accuracy of determining gait independence than SMI. This indicates that measuring APMT is more useful for predicting gait independence than SMI in community-dwelling older adults undergoing outpatient rehabilitation.

Purpose: As the global population of older adults rises, the United Nations Decade of Healthy Ageing (2021-2030) advocates for disease prevention, management, and enhancing overall wellbeing in older adults. We reviewed the MEDLINE literature under the MeSH term "music therapy" (MT), for its role in promoting healthy ageing.

Methods: A systematic search of the MEDLINE biomedical database (Ovid) was conducted using "MT" and "Ageing" as keywords, retrieving relevant full-text studies in English. Preference was given to more recent studies with higher levels of evidence. The studies were categorised according to the biopsychosocial framework into physical, cognitive and social domains, and further subcategorised based on their relevance to disease prevention and management.

Results: The initial search identified 1147 articles, of which 75 met inclusion criteria. Studies encompassed both MT and music interventions delivered by non-music therapists. Overall, studies showed benefits in the promotion of physical health, including enhancing exercise capacity and improving fitness among older adults. Results were promising in managing conditions such as Parkinson's disease and frailty. In the area of brain health, studies showed cognitive benefits, particularly in attention and processing speed among older adults. Socially, there was evidence of enhanced quality of life, reduced anxiety and depression, and improved social engagement, including in people living with dementia, underscoring the role of music in fostering emotional connections and mitigating caregiver stress.

Conclusion: MT and interventions can enhance biopsychosocial health outcomes in older adults. Research should prioritise isolating MT's specific effects, standardising definitions and methodologies, and exploring therapeutic mechanisms.

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

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

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

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

Purpose: To explore if patients' preferences regarding formalities and inpatient accommodation during their inpatient hospital experience have changed since 1999.

Methods: A ten-item survey was administered to an inpatient sample in an urban teaching hospital and compared with results from a similar survey in 1999.

Results: The majority (98.1%; n = 211) of patients in 2023 preferred to be addressed by their first name (73.8%; n = 152 in 1999; p < 0.001). Patient's preference for doctors using their full title fell (72.3% in 1999 versus 36.7% in 2023; p < 0.001). Inpatients in 2023 tended to have no preference regarding their doctor's gender (91.6% versus 80.1% in 1999; p = 0.001) and age (87.0% versus 40.8% in 1999; p < 0.001). Half (52.7%) of inpatients aged above 65 years preferred multi-occupancy wards when compared with those aged below 65 years (32.0%; p = 0.02).

Conclusion: Inpatients prefer less formal interactions within the doctor-patient relationship. Multi-occupancy ward accommodation is favored among those above 65 years.

Purpose: Sarcopenia is a progressive and generalized skeletal muscle disorder, involving the accelerated loss of skeletal muscle mass and function, associated with an increased probability of adverse outcomes including falls. The circadian timing system may be involved in molecular pathways leading to sarcopenia in older adults. We aimed to provide an updated and systematic map of the available evidence on the role of the circadian timing system in sarcopenia, specifically related to the aging process.

Methods: We developed a scoping review protocol following the PRISMA-ScR guidelines. Searches were conducted on PubMed, Scopus, Web of Science, RESULTS: We identified 373 papers from three online databases, screened 97 for full-text analysis. and selected 37 papers for inclusion. These papers included 17 primary research studies on human persons, focusing on cortisol and melatonin secretion, rest-activity rhythms, chrono-exercise, and chrono-dietary regimens, 9 primary research studies on animal models (mice, rats, fruit flies) focusing on direct expression measurement or mutations of core clock genes, and 11 narrative reviews.

Conclusion: While several reports supported the role of the circadian timing system in sarcopenia, specifically related to the aging process, the available evidence is fragmented and limited. The field is thus open to preclinical and clinical research that addresses the wide knowledge gaps in the available evidence, taking advantage of what has already been published to optimize and refine experimental and clinical protocols.