Journal of frailty, sarcopenia and falls最新文献

Objectives: Acutely ill hospitalized geriatric patients with sarcopenia have a poor clinical outcome. The European Working Group on Sarcopenia in Older People-2 (EWGSOP-2) recommends measuring handgrip strength (HGS) or the 5-times-repeated-Chair-Stand-Test (5t-CST) to assess muscle strength. The modified-thirty-seconds-Chair-Stand-Test (m-30s-CST) is expected to be more feasible than the 5t-CST and probably a better proxy for physical function compared to HGS. The aim of the study is to test the feasibility and reliability of the m-30s-CST in these patients.

Methods: 92 patients (aged 84±6 y, mean GFI score of 6.1± 2.9, 53.5% female) participated. The m-30s-CST was performed at 3 different occasions. Feasibility was measured at admission and test-retest reliability at the day before and of discharge. Additionally Short Physical Performance Battery (SPPB), ADL-Barthel-Index (ADL-BI) and HGS were assessed.

Results: The m-30s-CST is a significant more feasible test compared to the 5t-CST (n=92; 76.1% versus 20.1%; P<0.001), with a intraclass correlation coefficient (ICC) of 0.954 (n=59; CI-95%:0.921-0.973; P<0.001). The m-30s-CST has compared to HGS a significant better correlation with the ADL-BI and with the SPPB.

Conclusion: The m-30s-CST is a feasible and reliable method to assess muscle strength and is compared to HGS a better proxy for physical performance in geriatric patients.

Falls efficacy is an important psychological construct in falls prevention and management. It refers to an individual's perceived physical ability to prevent and manage falls. Despite its significance, falls efficacy remains under-researched. This article highlights three findings to encourage clinical practitioners to integrate falls efficacy assessments into practice for hospitalised and community-dwelling seniors. Hospitalised seniors face reduced mobility and deconditioning, significantly lowering falls efficacy. Conversely, community-dwelling seniors exhibit higher falls efficacy due to greater functioning levels and independence, though some may lack the physical capacity to mitigate falls. Differentiating between domains of falls efficacy is crucial, as confidence expressed by individuals in their specific physical abilities may vary. Seniors displaying discordance between their confidence and actual falls risk may be more vulnerable to falls. Our analysis reveals that 45% of hospitalised seniors and 19% of community-dwelling seniors exhibited such discordance. Incorporating falls efficacy assessments into clinical practice can help identify at-risk individuals, enable personalised interventions, and facilitate safer transitions post-discharge. Understanding the interplay between psychological and physical dimensions of falls risk is essential for improving older adults' quality of life and independence.

Objectives: The use of forearm circumference (FC) in the estimation equation to predict appendicular lean mass (ALM) in older adults who require care remains unclear.

Methods: This cross-sectional study targeted 132 participants aged ≥65 years requiring care. The ALM was measured with bioelectrical impedance analysis (BIA). Handgrip strength (HS) was measured with a digital hand dynamometer. FC was measured at the site of maximum swelling using a tape measure. Multiple regression analysis was conducted to develop an equation for estimating BIA-measured ALM using FC. Moreover, we investigated a systematic error by Bland-Altman analysis between BIA-measured ALM and ALM calculated by the estimation equation.

Results: We developed the four estimation equations. The values of r, adjusted R², and SEE in the representative model (FC + HS + age) were 0.86, 0.73, and 2.01 (kg), respectively (p < 0.05). In contrast, a systematic error was identified between the BIA-measured ALM and ALM calculated by the estimation equations by the Bland-Altman analysis.

Conclusions: This study developed the formula using FC, which can predict ALM with less influence of edema, but it may over- or underestimate ALM in older adults requiring care.

Objectives: The primary objective was to test the influence of age on lean body mass (LBM), muscle strength, and isokinetic performance adaptation following a 6-week blood-flow restriction training (BFRT) intervention.

Methods: A total of 38 young adults (23.5±3.1) and 34 older adults (72.7±5.5) completed a 6-week BFRT program. Exercises were performed three times per week at 30% of 1-repetition maximums (1-RMs) and 60% of each limb's arterial occlusion pressure. Body composition was assessed using dual-energy X-ray absorptiometry, muscle strength was measured using 1-RMs, and muscular performance was measured using an isokinetic dynamometer.

Results: A significant increase in LBM was observed in young adults (0.9±1.5kg; p<0.001) but not in older adults (0.3±1.3kg; p>0.05) following the intervention. Both age groups significantly improved 1-RMs for knee extension, knee flexion, and chest press, with the young group displaying greater improvements (all ps<0.001). A significant increase in knee flexion torque and power was observed in young adults (all ps<0.001) but not in older adults, while a significant difference between groups was observed (p<0.05).

Conclusions: The results from our study suggest that young adults improve LBM and muscle performance following 6-weeks of BFRT, while older adults enhance performance, despite a lack of improvement in LBM. Clinicaltrials.gov ID: NCT05615831.

Objectives: This study examines relationships between frailty, concerns about falling (CaF), and fall risk in community-dwelling older adults (≥60 years old).

Methods: Frailty, CaF, and fall risk were cross-sectionally assessed using the FRAIL, short FES-I, and STEADI questionnaires in 178 participants. Spearman correlations, logistical regression, and ordinal regression analysis were performed.

Results: 38.2% of participants were robust, 48.9% pre-frail, and 12.9% frail. Logistic regressions revealed that frail individuals were 91.4% more likely to have CaF compared to non-frail individuals, and individuals with lower fall risk were 5.7 times less likely to have CaF than those with no fall risk. Pre-frail individuals were more likely to have fall risk than non-frail individuals. Individuals with low CaF were 6 times less likely to have fall risk than those with high CaF. Ordinal logistic regressions revealed that for individuals with no CaF and no fall risk, the odds of being frail were 69.5% and 86.7% lower, respectively, than those with high CaF and high fall risk.

Conclusions: Frailty relationships with fall risk and CaF indicate the importance of addressing frailty to aid in fall prevention in older adults. Further, addressing the CaF mentality is important in fall prevention in older adults. ClinicalTrials.gov ID: NCT05778604.

Objectives: While chronological aging does not necessarily impair oncological outcomes after radical prostatectomy, the role of frailty remains less clear. This study aimed to evaluate whether frailty significantly affects early continence rates following radical prostatectomy and to explore the potential association between frailty and postoperative complications.

Methods: A retrospective cohort study of 212 patients undergoing radical prostatectomy was conducted. Preoperative frailty assessment employed a multimodal evaluation encompassing cardiovascular, respiratory, neurological, and urinary systems, supplemented by conventional risk measures such as physical performance status and biochemical markers. The primary endpoint was early continence recovery, while secondary outcomes included 30-day postoperative complications.

Results: Comparative analysis revealed no statistically significant differences in baseline characteristics, oncological outcomes, or complication rates between the open and robotic-assisted surgical cohorts. However, frailty was strongly associated with reduced early continence recovery, irrespective of surgical technique (p<0.001). No significant association was detected between frailty and 30-day postoperative complications (p=0.36).

Conclusions: This study highlights frailty as a pivotal predictor of early continence outcomes. The lack of association between frailty and postoperative complications suggests that comprehensive frailty assessment may be more relevant for anticipating functional recovery than predicting immediate surgical risks. These findings support integrating frailty evaluation into preoperative decision-making frameworks.

Objective: Parkinson's patients will experience mobility disturbances with disease progression. Beneficial effects of physical therapy are short-lasting. Novel interventions are needed to maintain these benefits.

Methods: Fourteen Parkinson's patients (71±4.08 years) participated in a randomized controlled examiner-blinded feasibility clinical trial. After 12 physical therapy sessions, the intervention group received a height-adjustable desk that facilitates stepping while standing, for 4 months. Explorative outcome measures included MDS-UPDRS II, III, TUG, 8.5m walking test, PDQ-39, sABC, sFES, DEXA scans, and lower extremity strength.

Results: Post-physical-therapy, everyone significantly improved on the MDS-UPDRS II, III, TUG, and 8.5m walking test, and PDQ-39. (p<0.05) After 4 months, the control group regressed towards pre-physical-therapy values. In the intervention group, sedentary behavior decreased beyond desk use, indicating a carry-over effect. MDS-UPDRS II, PDQ-39, sFES, sABC, TUG, 8.5m walking test, activity time, sitting time, hip strength all improved with clinically relevant effect sizes.

Conclusion: Post-physical therapy in-home reduction of sedentary behavior was associated with maintenance of physical benefits and additional improvements in mobility, activity time, balance and quality of life.

Objectives: Fall-related injuries occur at a similar prevalence rate in middle-aged and older adults and may increase concerns about falling and future falls. No research to date has examined how experiences of falls and related concerns, differ between middle-aged and older fallers. This study aimed to address this using qualitative interviews.

Methods: Ten middle-aged (55-64 years) and ten older adults (68-83 years) were interviewed about their experiences of falls and concerns about falling. Guided by a social constructivist epistemology, reflexive thematic analysis was used to categorise themes within the data.

Results: Five overarching themes were identified. Four themes showed distinctions between groups (i) perceptions of age-related decline; (ii) ageism: stigma associated with 'fallers'; (iii) concerns about loss of independence; and (iv) unravelling perceived control. The fifth theme (v) perceptions of falls risk: concerns and awareness, demonstrated the most similarities.

Conclusions: Whilst middle-aged and older fallers showed similar ratings of concern about falling, the behaviours underlying these were qualitatively different. For older adults, concerns led to protective adaptations to reduce their fall risk. Contrastingly, middle-aged adults showed a lack of personal responsibility over their fall risk. The findings highlight the importance of early educational intervention to reduce future falls and frailty.

Objectives: This study aims to determine whether modified Hospital Frailty Risk Score (mHFRS) can identify frail hospitalised older adults by comparing mHFRS to HFRS and Clinical Frailty Scale (CFS).

Methods: A retrospective review was undertaken in patients =>65 years hospitalised following an Emergency Department attendance between 1^st July 2022 and 31^st March 2023. Predictive models were evaluated with correlation and measure of agreement between frailty risk scores, CFS and HFRS, CFS and modified HFRS (mHFRS) using the Spearman's rank correlation and Cohen's kappa (κ).

Results: Of 3042 patients, CFS categorised 1635 (53.7%) patients as non-frail (CFS 1-4) and 1407 (46.3%) as frail (CFS 5-9,p<0.001). Frail patients were more likely to be female (55.9%), older (81.8 years, SD 8.41 vs 75.3 years, SD 7.20, p<0.001), with longer LOS (52.5% % vs 31.5%, p<0.001), higher 30-day emergency re-admission (18.5% vs 9.9%, p<0.001) and higher mortality at all time points. We could compute mHFRS for 1623 (53.4%) patients, of whom, 37.5% were low risk, 40.5% intermediate risk and 22.1% high frailty risk. mHFRS showed significant correlation with CFS (p<0.001) and HFRS (p<0.001), respectively and achieved comparable association with clinical outcomes.

Conclusion: mHFRS was better at identifying non-frail patients and provides a novel, standardised and comparable frailty risk stratification tool for screening older hospitalised patients.