Journal of Frailty & Aging最新文献

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.

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.

Older patients face increasing challenges in preserving mobility during hospitalization. This retrospective cohort study aimed to evaluate the effect of an Occupational Therapy (OT) program on mobility at discharge in older patients admitted to an Acute Geriatric Unit (AGU). All patients aged ≥65 years consecutively admitted to the AGU in an 18-month period were included in the study if scoring <4 or ≥ 8 at the Clinical Frailty Scale. Overall, 807 patients (median age 85 years, 50.2% females) were included: 665 (82%) received OT, while 142 who did not receive OT were used as controls. The Cumulated Ambulation Scale (CAS) was used to assess mobility at discharge. By multivariable logistic regression, OT was independently associated with higher odds of achieving higher CAS score at discharge. These findings emphasize the potential benefits of OT in acute geriatric settings, providing valuable insights for preserving mobility of frail older individuals during hospitalization.

Background: Recent studies have suggested the potential benefits of habitual coffee and green tea consumption on skeletal muscle health. However, it remains unclear whether these benefits are modified by genetic factors, particularly the alpha-actinin-3 (ACTN3) genotype, which is associated with the skeletal muscle phenotype. This study aimed to investigate the interaction between habitual coffee or green tea consumption and the ACTN3 genotype in association with skeletal muscle mass (SMM) and strength.

Methods: This cross-sectional study was conducted on 1,023 Japanese middle-aged and older adults (619 females, aged 45-74 years) living in the community. SMM was gauged using a bioelectrical impedance spectroscopy device, and handgrip strength (HGS) was used to measure muscle strength. The ACTN3 genotype (RR, RX, and XX) was determined from blood samples. Sex-specific linear regression models were used to analyze the interactions between coffee or green tea consumption and the ACTN3 genotype in association with SMM and HGS.

Results: In females, a significant interaction was observed between green tea consumption and the ACTN3 genotype in association with HGS (P interaction < 0.05). Furthermore, stratified analysis revealed a positive association between green tea consumption and HGS, specifically in females with the ACTN3 XX genotype (P trend < 0.05). In males, no significant interactions were observed between coffee or green tea consumption and the ACTN3 genotype in association with SMM or HGS (P interaction > 0.05).

Conclusion: Our findings suggest that the skeletal muscle strength benefits associated with habitual green tea consumption may be contingent upon sex and the ACTN3 genotype.

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.

Aims: Considering the impact of sarcopenia on mortality, and the difficulty to assessment of body composition, the hypothesis of the study is that calf circumference (CC) is closely related to mortality in older patients. The aim of the study was to analyze the potential role of CC to predict mortality in old individuals at 3, 6 and 12 months after discharge from hospital.

Methods: Patients aged >65 years were recruited for this retrospective study from September 2021 to March 2022. Their physical and body composition characteristics (including Body Mass Index-BMI and Mini Nutritional Assessment-MNA) were measured; data on mortality at 3 (T3), 6 (T6) and 12 (T12) months after discharge were recorded. Sarcopenia was diagnosed according to the 2019 European Consensus criteria.

Results: Participants were 192 older adults (92 women), with a mean age of 82.8±7.0 years. Sarcopenic people were 41. The mortality rate was higher in sarcopenic people only at T3 and T6. CC had comparable validity in predicting mortality to that of MNA and ASMMI (Appendicular Skeletal Muscle Mass), and was better than BMI and serum albumin at each time point. Youden's index showed that the best cut-off for CC for predicting mortality was 30.6 cm both at T3 (sensitivity: 74%; specificity: 75%) and T6 (sensitivity: 75%; specificity: 67%). At the Cox regression model for mortality, high values of CC (HR 0.73, CI95% 0.60-0.89/p<0.001) and ADL scores (HR 0.72, CI95% 0.54-0.96/p=0.04) were protective factors at T6 and T12 respectively; at T12 high comorbidity rate was a risk factor (HR 1.28, IC95% 1.02-1.62/p=0.04).

Conclusions: CC has a validity comparable to MNA and ASMMI in predicting mortality at 3, 6 and 12 months after hospital discharge. Moreover, it can be considered an independent predictor of medium-term mortality in the hospitalized older population. CC can be an effective method for the prognostic stratification of these patients, due to its simplicity and immediacy.

Objective: The intricate relationship between social determinants, e.g., social frailty, biomarkers and healthy aging remains largely unexplored, despite the potential for social frailty to impact both intrinsic capacity (IC) and functional ability in the aging process.

Design: Retrospective longitudinal cohort study.

Setting and participants: Participants aged 50+ years from the Social Environment and Biomarkers of Aging Study (SEBAS) in Taiwan, stratified into three age groups: 50-64, 65-74 and 75+.

Measurements: Social frailty was defined based on a score derived from four domains: exclusion from general resources, social resources, social activity, and fulfillment of basic social needs. The scores were categorized as score=0 (no social frailty), 1 (social pre-frailty), and 2+ (social frailty). Multivariable logistic regression and Cox proportional hazard models were employed to examine the dose-responsive relationship between social frailty, low IC, functional and psychological health, and mortality.

Results: Of 1015 study participants, 24.9% and 7.9% were classified as social pre-frailty and social frailty, respectively. No significant differences were observed in most biomarkers between those with social frailty and those without. A dose-responsive relationship was found between social frailty and increased risk of low IC (social pre-frailty: aOR 2.20 [95% CI 1.59-3.04]; social frailty: 5.73 [3.39-9.69]). Similar results were found for functional and psychological health. However, no significant association between social frailty and all-cause mortality was found at the 4-year follow-up (social pre-frailty: aHR 1.52 [95% CI 0.94-2.43]; social frailty: 1.59 [0.81-3.09]).

Conclusions: The significant association between social frailty and low IC, functional limitations, cognitive declines, and depressive symptoms underscores the pressing need for research on intervention strategies to enhance healthy aging in the lifespan course.