Journal of Frailty & Aging最新文献

Background and objective: This study examined the relationship between body mass index (BMI) and sarcopenia with oral function decline in older patients as well as whether a combination of underweight BMI and sarcopenia was associated with decreased oral function in individuals with conservative restorative and prosthetic treatment for masticatory disorders.

Design, setting, and participants: This cross-sectional study included 290 older Japanese patients who regularly attended a general dental clinic. A detailed examination of oral function, sarcopenia, and BMI according to the Asian Working Group for Sarcopenia 2019 criteria was conducted for patients aged 65 years. This study used odds ratios as an epidemiological measure in the cross-sectional survey.

Results: Multinomial logistic regression analysis showed that the number of remaining teeth and tongue pressure was associated with both ideal and overweight BMI in individuals with sarcopenia when compared to healthy individuals. The underweight BMI plus sarcopenia group was associated with tongue and lip motor function [ka] sound test, swallowing function, and the presence of oral hypofunction.

Discussion: Our findings indicated that various aspects of oral function were impaired in community-dwelling older adult Japanese patients with sarcopenia and underweight BMI. Notably, among older adults with sarcopenia, both obese and thin patients exist, suggesting that distinct pathophysiological mechanisms influence oral function.

Conclusion: The above findings support the hypothesis that the coexistence of sarcopenia and underweight BMI is associated with poor oral function. Regular oral function assessments and weight measurements in general dental practice can aid the prompt identification of sarcopenia and reduced swallowing function and can facilitate early intervention. The presence of sarcopenia and impaired swallowing function should be considered in patients with underweight BMI, reduced [ka] sound, and low tongue pressure following a thorough oral function examination.

Background: Several indexes based on clinical and laboratory tests to identify frailty and to predict mortality have been produced. Only two studies, mixing clinical and laboratory parameters were made about a frailty index made of laboratory tests (FI-Lab) and mortality in older patients hospitalized for COVID-19. The aim of this study was to explore the accuracy and precision of an FI-Lab constructed with some common bio-humoral tests and mortality in a cohort of patients hospitalized for COVID-19.

Methods: The FI-Lab was constructed using 40 different bio-humoral tests during the first four days of hospitalization, with a score from 0 to 1. The association between FI-Lab and mortality was assessed using a multivariate Cox's regression analysis, reported as hazard ratios (HRs) and 95% confidence intervals (CIs). The accuracy of the FI-Lab was reported as area under the curve (AUC) and the precision with the C-Index.

Results: 376 patients (mean age: 65 years; 53.7% males) were initially included. During the follow-up period, 41 deceased. After adjusting for five different factors, an FI-Lab value >0.54, the median value of our cohort, was associated with a relative risk about five times greater than lower values. Modeling FI-LAB as a continous variable, each increase in 0.01 points was associated with an increased risk in mortality of 8.4% (HR=1.084; 95%CI: 1.039-2.044). The FI-Lab was highly accurate (AUC=0.91; 95%CI: 0.87-0.95) and precise (C-Index=0.81) in predicting death.

Conclusions: A simple index based on common laboratory tests can be used to predict mortality among older people hospitalized for COVID-19.

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.