Journal of frailty, sarcopenia and falls最新文献

Grip strength is commonly used to identify people with low muscle strength. It is unclear what impact the type of dynamometer used to measure grip strength has on the identification of low muscle strength so we aimed to assess this. Study participants were 118 men and women aged 45-74y from a randomised, repeated measurements cross-over study. Maximum grip strength was assessed using four hand-held dynamometers (Jamar Hydraulic; Jamar Plus+ Digital; Nottingham Electronic; Smedley) in a randomly allocated order. EWGSOP2 cut-points were applied to estimate prevalence of low muscle strength for each device. Agreement between devices was compared. Prevalence of low muscle strength varied by dynamometer ranging between 3% and 22% for men and, 3% and 15% for women. Of the 13 men identified as having low muscle strength by at least one of the four dynamometers, only 8% were identified by all four and 54% by just one. Of the 15 women classified as having low muscle strength by at least one of the four dynamometers, only 7% were identified by all four and 67% by only one. Variation in the measures of grip strength acquired by different hand-held dynamometers has potentially important implications when identifying low muscle strength.

Objectives: 7% of proximal femoral fractures occur in patients admitted to hospital for unrelated medical and surgical presentations. This comparative study will assess morbidity and mortality in patients sustaining proximal femoral fractures both as inpatients and in the community.

Methods: Retrospective review of patients admitted to a regional specialist hip unit with fracture of the proximal femur sustained both from the community and other inpatient settings. Patient demographics, risk factors and outcomes were recorded and analysed - with focus on 30-day and 1-year mortality.

Results: 3445 patients were admitted over a 10-year period, 292 of which sustained proximal femoral fractures as an inpatient. 30-day and 1-year mortality was 23.7% and 47.9% respectively in the inpatient group, compared to 6.9% and 22.4% respectively in the community group. Mean time from presentation to operating room was 27.8 hours for the inpatient group, compared to 25.2 hours for the community group.

Conclusion: Inpatients who sustain a proximal femoral fracture have significantly higher 30-day and 1-year mortality rates when compared to patients in the community sustaining the same injury. There is also a noted delay to theatre in this patient group.

Objective: To establish reliability, validity, and minimal detectable change in measures of function in older long-term cancer survivors.

Methods: Older cancer survivors were recruited to perform functional measures; 5 Times Sit-to-Stand (5xSTS), 30-second Timed Chair Rise (30sTCR), Short Physical Performance Battery (SPPB), Physical Performance Test-7 (PPT-7). Two testing sessions were completed two weeks apart. Test-retest reliability was examined using the intraclass correlation coefficient (ICC_2,1), convergent and discriminant validity using Spearman's rho and Minimal Detectable Change (MDC⁹⁵) was calculated.

Results: Forty-seven older long-term cancer survivors participated. Test-retest reliability was good for 5xSTS (ICC_2,1=0.86), 30sTCR (ICC_2,1=0.89), and SPPB (ICC_2,1=0.85) and poor for PPT-7 (ICC_2,1=0.48). Both convergent and discriminant validity was established.

Conclusions: SPPB, 5xSTS, and 30sTCR are reliable and valid tools to measure function in older long-term cancer survivors. MDC⁹⁵ values were larger than those reported in geriatrics and should be interpreted with caution. Residual effects of cancer treatment, comorbidity, and physical inactivity may contribute to decreased physical function in older long-term cancer survivors, therefore valid and reliable measures like SPPB and the timed chair rise tests should be used objectively measure function throughout the survivorship spectrum.

Falls efficacy is a widely studied construct. The understanding of falls efficacy has evolved over time. Falls efficacy was initially perceived to be suitably used as a measure of fear of falling. However, further research suggested that falls efficacy and fear of falling are distinct constructs, and therefore, would be inappropriate to be used as a proxy. Instead, some researchers posited that falls efficacy is synonymous with balance confidence. Falls efficacy has been conventionally understood as the perceived ability of individuals to perform activities without losing balance or falling. A recently conducted systematic review by the authors on existing falls efficacy related measures had revealed a fresh perspective of recognising falls efficacy as a perceived ability to manage a threat of a fall. Falls efficacy, with a broadened interpreted construct, relates to the individual's perceived self-efficacy of performing necessary actions needed in different scenarios, including pre-fall, near-fall, fall-landing and completed fall. The conventional interpretation of falls efficacy needs a rethinking of perspective. An extended understanding of falls efficacy would provide an integral approach towards improving the agency of individual to deal with falls and would enhance person-centred care.

Social capital aspects are playing an important role in activities of daily living (ADL) performance, thus on independent living. This paper was aimed to present an overview of the associations and adverse effects between social capital aspects and disability in ADL and health-related quality of life (HRQoL) in an older population aged 65 years old and over. Α scoping review was designed following the guidelines of PRISMA Extension for Scoping Reviews (PRISMA-ScR) and the review was conducted by 3 authors. A total of 185 primary studies were extracted and, finally, 40 studies did meet the inclusion criteria and critically appraised in two main categories; Category 1(29 studies) 'social capital and disability in ADL' deducing that as greater a social capital as better ADL performance and Category 2 (11 studies) 'Social capital and HRQoL' concluding that people 65 years old and over with lower social capital were presented with a poor HRQoL. Study synthesis highlights the impact of social capital suggesting that nurses caring for older people must focus on their engagement in terms of social diversity and trust in the community.

Objective: This community-based study evaluated the prevalence and associated risk factors of recurrent falls among middle-aged community-dwelling women in Southern-Sri Lanka.

Methods: Randomly selected 285 middle-aged women (40-60years, Mean±SD;51.7±6.1years) participated. History of falls within the previous 12-months was inquired and those who reported two or more falls within 6-month period were considered as recurrent fallers. Age, menopausal status, weight (kg), height (m), waist-circumference (WC, cm), appendicular-skeletal-muscle-mass (ASMM, kg by DXA), hand-grip-strength (HGS, kg) and gait-speed (GS, m/s) were evaluated. Body-mass-index (BMI, kg/m2) and relative-ASMM-index (RSMI, kg/m²) were calculated.

Results: The prevalence of recurrent falls was 13% (95%CI; 9.4%-17.5%) (n=37). Recurrent falls were higher among postmenopausal women compared to premenopausal women, older middle-aged women (51-60years) compared to young middle-aged women (40-50years), those with low RSMI compared to normal RSMI, low HGS compared to normal HGS and low GS compared to normal GS (p<0.01). BMI and WC did not show significant associations with recurrent falls. Risk factors associated with recurrent falls were age (OR;7.41, 95%CI; 1.23-44.43, p=0.02), RSMI (OR;3.21, 95%CI; 1.00-10.32, p=0.04) and HGS (OR;3.19, 95%CI; 1.26-8.09, p=0.01).

Conclusions: The prevalence of falls among middle-aged women was considerably high. Falls were associated with advanced age, low muscle mass and muscle strength.

Objectives: The aim of this study was to describe the associations between sarcopenia and variables derived from wrist accelerometry in community-dwelling older adults attending a day hospital service in Ireland.

Methods: An observational cross-sectional study was carried out using a consecutive series of older adults attending a day hospital service. Sarcopenia was diagnosed using the latest European Working Group of Sarcopenia in Older People guidelines. Accelerometers were worn by each participant for a 7-day period on their non-dominant wrist.

Results: Thirty-eight out of forty-one participants (93%) met the accelerometer wear time criterion and were included in statistical analyses. Included participants had a mean age of 81.1 years (standard deviation 6.2). Both sarcopenia (Grip) and sarcopenia (Lower limb) were associated with increased time spent in low physical activity and reduced average of Kcals per hour. Only sarcopenia (Lower limb) was associated with increased time in sedentary behaviour as well as reduced number of steps taken in a week.

Conclusions: Accelerometer data can be used in an older day hospital population to track physical activity levels and sedentary behaviours. The assessment tool used to assess muscle strength and the cut-off criteria for physical activity behaviour influences the association with sarcopenia.

Objectives: The aim of this study is to find the significance of different ASA grades in achieving the Best Practice Tariff (BPT) and their outcomes in patients with fracture neck of femur.

Methods: A retrospective study over a five years period. Patient demographics, ASA grading, hospital admission timing, time to theatre and discharge date were recorded. The 30 day mortality rate and length of stay were calculated for each ASA grades for patients who met and failed BPT.

Results: 1798 patients were included in the study. 54% was ASA grade 3, grade 4 represented 22% and grade 2, 19%. The mean AMT score was 6.4 who met BPT and 4.4 who failed BPT (p<0.001). 319 patients with ASA≤2 met BPT and 53 patients failed to meet BPT. In ASA ≥3, 1200 patients who met BPT and 225 patients failed BPT. The 30-day mortality in patients with ASA≤2 who met BPT was 2.57% and those who failed were 1.92%. In ASA ≥3 the 30-day mortality was 12.63% and who failed BPT was 25% which is statistically significant.

Conclusion: In patients with ASA≥3 the 30-day mortality is significantly higher in those who failed BPT compared to ASA≤2 patients whether they achieved BPT or not.

The aim of this research (Motor control Home ergonomics Elderlies' Prevention of falls; McHeELP study) was to develop a novel intervention combining motor control home-based exercises and a home ergonomic safety-improvement strategy in order to reduce falls in frail ambulatory older adults. A randomized controlled trial of a novel intervention is proposed including motor control exercises and home ergonomic assessment and modification in older adults who have at least one fall experience. Participants are randomized to control or intervention group in a 1:1 ratio. Participants will be assessed three times: at baseline, at 3^rd month (end of intervention period) and again at 6^th month (follow-up measurement). The primary outcome is of the effect on functional mobility using the Timed Up and Go test. Secondary outcomes include assessments of functionality, fear of falling and quality of life. This will be the first study to develop an exercise intervention approach that combines home-based motor control exercise intervention with home assessment and modification. This study is expected to explore a low-cost, easy-to-popularize, and effective exercise intervention approach for improving functional mobility and prevent falls among older adults.