Journal of Frailty & Aging最新文献

Background: Exercise is efficacious in older adults, including those with multi-morbidity. However, the optimum mode is not known and there are conflicting findings as regards the types of exercises to recommend. It is postulated that multi-component exercise interventions better meet the needs of older adults who experience multi-morbidity as they more holistically address the range of functional problems they may experience. To date, no review has explored and described in detail what multi-component exercise interventions have been tested in older adults with multi-morbidity.

Objectives: To explore the number and types of exercises included within multi-component exercise interventions that have been tested in older adults with multi-morbidity. Secondary objectives were to explore the rationale for selecting particular exercise components within the intervention design and to describe the characteristics of the exercise program.

Design: Systematic review and narrative synthesis.

Results: Database searches yielded 51,001 articles; following screening 138 unique interventions were retained for analysis. Across studies, 22 different multi-component combinations were identified, and there was marked variation in frequency, intensity and duration. Few studies describe characteristics that are in line with the preferences or needs of older adults with multi-morbidity. Exercise design decisions were most frequently judged to be based on practitioner intuition/local practice.

Conclusion: There is substantial heterogeneity within multi-component exercise interventions; which has significant implications for meta-analysis of effects. Interventions do not frequently appear to consider the abilities or needs of those with multi-morbidity, nor do they seem to be attuned to the participation barriers they experience.

Objectives: Flavonoids are of particular interest for their antioxidant property and anti-inflammatory, and a therapeutic potential for age-related diseases has been suggested. Frailty is becoming a global public health concern due to an increasingly aging population. We aimed to evaluate the association between dietary flavonoid intake and the likelihood of frailty in middle-aged and older adults.

Design: A US nationally representative cross-sectional study.

Setting: National Health and Nutrition Examination Surveys database.

Participants: Of the 8159 adults aged 50 years and older.

Measurements: This study used data from NHANES (2007-2010 and 2017-2018). Dietary flavonoid intake data were obtained from a 24-h recall interview. Frailty was measured using a 53-item frailty index (FI) and diagnosed as FI > 0.21. We used survey-weighted logistic regression models to assess the association between flavonoid intake and odds of having frailty. The dose-response association between flavonoid intake and frailty was estimated using a survey-weighted restricted cubic spline (RCS) model.

Results: Among the 8159 adults (63.42 ± 0.20 years), 2551 (31.3%) had frailty. The RCS depicted a U-shaped association between total flavonoid intake and frailty. Compared with those in the lowest quintile (≤14.55 mg/day), participants in the fourth total flavonoid intake quintile (84.13-313.51 mg/day) had the lowest likelihood of frailty with an OR (95% CI) of 0.65 (0.51-0.84). The likelihood of frailty decreased until 220 mg/day, with 2% (0.8%-4.1%) lower odds of frailty per 10 mg higher total flavonoid intake, which increased thereafter. Similarly, the U-shaped relation with frailty was observed for five flavonoid subclasses (flavan-3-ols, flavanones, flavones, flavonols, isoflavones), while a roughly negative linear relation was observed for the other flavonoid subclass (anthocyanidins).

Conclusion: U-shaped associations with frailty for dietary intake of total flavonoids and flavonoid subclasses (flavan-3-ols, flavanones, flavones, flavonols, and isoflavones) were observed in middle-aged and older US adults.

Objective: This study aims to investigate the correlation between leisure-time physical activity (LTPA) and cognitive function in older adults.

Methods: We conducted an analysis of 2,657 participants (aged ≥60 years) from the cross-sectional National Health and Nutrition Examination Survey (NHANES) spanning 2011-2014. Multiple logistic regression and linear regression analyses were employed to explore the associations between leisure-time physical activity and cognitive function.

Results: Significant correlations were observed between LTPA duration and frequency with Animal Fluency Test (AF) and Digit Symbol Substitution Test (DSST) scores. Engaging in leisure-time physical activity 1-4 times per week was associated with a 33%((OR) 0.67, (CI) 0.48-0.92) reduced risk of memory decline compared to non-active individuals. An inverted U-shaped relationship was observed between LTPA duration and AF/DSST and a U-shaped relationship between LTPA frequency and the risk of memory decline.

Conclusion: Encouraging older adults to participate in leisure activities 3-4 times per week may help protect cognitive function.

Background: Prevalence, correlates and outcomes of respiratory failure (RF) were never studied in large populations of older patients hospitalized in acute care medical settings. Little is known about the possible association between RF and delirium, and whether these two syndromes, alone or in combination, may affect short-term mortality.

Objectives: To investigate prevalence and features of RF, the association between delirium and RF, and their effect on short-term mortality.

Design: Prospective cross-sectional study with data collection on an index day and 30-day follow up.

Setting and participants: 1493 patients aged ≥ 65 years hospitalized in Italian acute medical wards from the 2017 Delirium Day database.

Methods: RF was identified according to the detection of peripheral oxygen saturation ≤ 91% on the index day, or to ongoing oxygen therapy or non-invasive ventilation on the index day or the day before. A modified National Early Warning Score (NEWS), obtained removing the "Oxygen Saturations" and "Any Supplemental Oxygen" items, measured non-hypoxemic severity of acute illness.

Results: 300 patients (20.1%) had RF. Mortality was 16.6% in the RF group and 8.2% in the non-RF group (p<0.001). Delirium prevalence was 31.3% in RF (94 patients, 72 of whom with hypoactive or mixed delirium) and 22% in non-RF patients (p<0.001). Age, frailty, modified NEWS, steroids use, presence of urinary catheters or other major devices, but not delirium, were independent RF correlates. RF alone (OR [odds ratio]: 1.83; 95% CI [confidence interval]: 1.02-3.29) predicted 30-day mortality after adjustment for confounders, including modified NEWS. Without adjustment for modified NEWS, the combination of delirium and RF also significantly predicted 30-day mortality (OR: 2.26; 95% CI 1.08-4.72).

Conclusions: In hospitalized older medical patients, RF was a prevalent syndrome which was frequently complicated by delirium. RF was featured by older age, frailty and severe illness, and independently predicted short-term mortality.

Background: The gut microbiome is recognized as a pivotal factor in the pathophysiology of sarcopenia-a condition marked by the accelerated loss of muscle strength, mass and function with ageing. Despite this well-known gut-muscle axis, the potential links between other microbial ecosystems and sarcopenia remain largely unexplored. The oral microbiome has been linked to various age-related health conditions such as rheumatoid arthritis and colorectal cancer. However, its potential association with sarcopenia is unknown. The Saliva and Muscle (SaMu) study seeks to address this knowledge gap.

Methods: The SaMu study comprises three sequential phases. In phase 1, a cross-sectional analysis will be conducted on a cohort of 200 individuals aged 70 years or older to examine the relationship between salivary microbiome and sarcopenia status. Participants will be recruited in the three main places of living: general community, assisted living facilities and nursing homes. The salivary microbiome composition will be evaluated utilizing shotgun metagenomics sequencing, while sarcopenia status will be determined through muscle mass (determined by whole-body bioelectrical impedance analysis and calf circumference), muscle strength (grip strength and the 5-times-sit-to-stand test) and physical performance (usual walking speed). In addition to investigating the microbiome composition, the study aims to elucidate microbiome functions by exploring potential omic associations with sarcopenia. To achieve this, salivary proteomics, metabolomics and quorum sensing peptidomics will be performed. Covariates that will be measured include clinical variables (sociodemographic factors, health status, health-related behaviours, oral health and quality of life) as well as blood variables (immune profiling, hormones, kidney and liver function, electrolytes and haematocrit). In phase 2, an in-depth mechanistic analysis will be performed on an envisaged subcohort of 50 participants. This analysis will explore pathways in muscle tissue using histology, genomics and transcriptomics, focusing on (maximal) 25 healthy older adults and (maximal) 25 with severe sarcopenia. Phase 3 involves a two-year clinical follow-up of the initial participants from the cross-sectional analysis, along with a resampling of blood and saliva. Additionally, secondary outcomes like falls, hospitalization and mortality will be examined.

Discussion: Using a salivary multi-omics approach, SaMu primarily aims to clarify the associations between the oral microbiome and sarcopenia. SaMu is expected to contribute to the discovery of predictive biomarkers of sarcopenia as well as to the identification of potential novel targets to prevent/tackle sarcopenia. This study-protocol is submitted for registration at the ISRCTN registry.

Background: Sarcopenia negatively impacts quality of life. It is unclear whether different measures of muscle size, strength, physical performance, and fitness have similar associations with quality of life.

Objective: To describe associations of sarcopenia metrics with quality of life outcomes.

Participants: Community-dwelling adults aged 70+ years participating in the SOMMA (Study of Muscle, Mobility and Aging) study, (N=875 ((women: 519, men:356)), age, years 76.3±5.0).

Design and settings: Two academic medical centers.

Measurements: Measures included muscle size (MRI- muscle volume. D3Cr muscle mass); strength and power (grip strength, leg extension power and strength, stair climb); walking and physical performance (4m and 400m walk, SPPB (Short Physical Performance Battery), chair stand); fitness (VO2 peak); health related quality of life (EQ-5D); and anthropometrics (weight, height, and body mass index). Results were stratified by sex. Correlations, scatterplots and linear regression models described the association between various measures of sarcopenia and fitness with overall quality of life score (EQ5D VAS) as a continuous variable. We also quantified differences between sarcopenia and fitness measures by overall QOL (Quality of Life) as a categorical variable (low, medium, high) and by QOL subcomponents (pain and discomfort, problems with usual activities, mobility, anxiety and depression, and problems with self-care) using distributionally appropriate methods.

Results: Walking tests and physical performance were most consistently (but modestly) associated with overall quality of life (r~0.2, p<.001) and its subcomponents. For both men and women, several sarcopenia and fitness measures were more strongly associated with pain and usual activity than other QOL components.

Conclusions: Poor performance, lower fitness and lower strength are related to worse quality of life, particularly pain, in older adults. Future studies should quantify these relationships longitudinally.

Background: Experimental evidence suggests that polyphenols, a large group of phytochemicals found in fruits and vegetables, may preserve muscle mass and strength by increasing the expression of anabolic factors and enhancing mitochondrial function.

Objectives: This systematic review and meta-analysis aims to summarize the evidence about the effect of polyphenol supplementation on muscle mass, muscle strength, and physical performance in individuals with sarcopenia.

Methods: A systematic search was conducted using three databases (PubMed/Medline, Scopus, and Web of Science) from the date of inception to April 2024. Interventional studies examining the effect of polyphenol supplementation on muscle measures and physical performance in middle-aged and older subjects with sarcopenia were included.

Results: Of the 344 articles screened, 7 articles were included in the systematic review. Five of the 7 included studies were meta-analyzed, involving a total of 227 patients with sarcopenia. The results showed a statistically significant effect of polyphenols on muscle mass (SMD = 1.50; 95% CI: 0.26, 2.75; Z = 2.36; P = 0.02), no effect on muscle strength (SMD = 0.03; 95% CI: -0.24, 0.30; Z = 0.20; P = 0.84), and a near-significant trend on physical performance (SMD = 0.52; 95% CI: -0.03, 1.07; P = 0.06).

Conclusions: Based on the available data, this study provides pooled evidence that treatment with polyphenols may have a beneficial effect on muscle mass in sarcopenic subjects. However, further studies with larger sample sizes are required to substantiate this effect and draw more accurate conclusions.

Objectives: This study aimed to provide evidence regarding the clinical significance of assessing intrinsic capacity (IC).

Design: Longitudinal study.

Setting: Frailty clinic.

Participants: 351 disability-free outpatients aged ≥65 years.

Measurements: Adverse health outcomes were a composite of adverse health outcomes, including mortality, emergency hospitalization, nursing home placement, and new certification or exacerbation for long-term care. We created a composite score based on five IC domains using assessment scales from the WHO ICOPE handbook, with the weights for each domain determined through confirmatory factor analysis.

Results: The composite score of IC was inversely associated with adverse health outcomes within 1-year; the multivariable-adjusted odds ratio (95% confidence interval) was 0.20 (0.09-0.41) for the highest versus lowest tertile, and 0.63 (0.48-0.83) for each 1-point increment in IC score, respectively. Similar associations were observed for specific adverse health outcome, but not for mortality.

Conclusion: IC was inversely associated with subsequent adverse health outcomes in older outpatients, suggesting its prognostic value in routine geriatric practices. Considering the limited sample size, our findings need to be further confirmed.

Current interventions targeting sarcopenia are diverse, incorporating a blend of nutritional, exercise, and pharmacological strategies. Although muscle mass, muscle strength, or functional performance typically serve as the primary endpoints, regulatory agencies have recently emphasized integrating Patient-Reported Outcome Measures (PROMs) as primary or secondary outcomes in interventional studies. This shift acknowledges the importance of PROMs and Patient-Reported Experience Measures (PREMs) in assessing intervention effectiveness and aligns with patient-centered healthcare models. The aims of this systematic review are 1) to identify all sarcopenia-designed interventional studies that used PROMs/PREMs as the primary or secondary outcome, 2) to identify the different PROMs/PREMs used within those studies, and 3) to summarize the effects of sarcopenia-designed interventions on PROMs/PREMs of sarcopenic participants. For that, a systematic search of databases (Medline, EMBASE, Review- Cochrane Central of Register of Controlled Trials, and PsychINFO (Via Ovid)) was conducted in September 2023. The review followed the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement, and the protocol was registered on Open Science Framework (https://osf.io/zxgwm/). The systematic review identified 17 RCTs as sarcopenia-designed interventional studies reporting PROMs. PROMs covered the assessment of various aspects, including quality of life, depressive symptoms, loneliness/social isolation, daytime sleepiness, insomnia impact, and sleep quality/disturbance. Only one sarcopenia-specific PROM, namely the SarQoL, was reported. The effect of sarcopenia-designed interventions on PROMs showed considerable heterogeneity, underscoring the need for standardization in sarcopenia research by developing a Core Outcome Set (COS). COS in sarcopenia studies would ensure consistent and comparable findings, ultimately enhancing the reliability and effectiveness of interventions.