Journal of frailty, sarcopenia and falls最新文献

Phase Angle (PA), derived from bioelectrical impedance analysis, reflects cellular health and may indicate physiological resilience in ageing. We examined the relationship between PA and blood pressure (BP) recovery following an orthostatic challenge in 107 older adults attending a specialist falls clinic. Participants underwent active stand testing with continuous, beat-to-beat BP monitoring over 180 seconds. PA was categorised into tertiles (low, medium, high), and changes in systolic (SBP) and diastolic BP (DBP) were analysed using linear mixed-effects models, adjusted for age, sex, diabetes, hypertension, and cardiovascular and psychotropic medication use. Compared to the low PA tertile, individuals in the medium and high PA tertiles demonstrated faster recovery in both SBP and DBP during the 10-20 second post-stand period (all p < 0.001). No significant differences were observed in recovery between the 20-30 and 30-40 second intervals. Furthermore, participants in the high PA tertile showed, in contrast to the low PA tertile, full mean BP recovery at 40 seconds, with no further upward trend thereafter (p = 0.001 for SBP, p = 0.005 for DBP). PA could be a simple, non-invasive biomarker of dynamic physiological resilience, potentially identifying older adults at increased risk of early orthostatic haemodynamic instability.

Objectives: The purpose of this study was to examine if fall risk scores were affected by the interaction between muscle strength and visual contrast sensitivity.

Methods: Ninety-one individuals aged 19-79 years completed assessments of knee extension strength, visual contrast sensitivity, and fall risk. Correlations and moderation analysis were completed in combination with analysis of variance. Data were categorized into groups: 1) higher strength-higher visual contrast sensitivity, 2) higher strength-lower visual contrast sensitivity; 3) lower strength- higher visual contrast sensitivity, and 4) lower strength-lower visual contrast sensitivity.

Results: Knee extension strength via peak torque relative to body mass (R= -0.57, P<0.001) and visual contrast sensitivity (R=-0.63, P<0.001) were both negatively correlated with age, while fall risk scores were positively correlated with age (R=0.34, P=0.001). The interaction between muscle strength and visual contrast sensitivity was a significant predictor of fall risk scores (t=2.420, P=0.018) when controlling for age. Participants exhibiting lower strength-lower contrast sensitivity (12.96 ± 1.93) had significantly worse fall risk scores compared to higher strength-higher visual contrast sensitivity (11.53 ± 1.75, P=0.045).

Conclusion: Lower levels of lower body muscle strength combined with lower visual contrast sensitivity interact to negatively influence fall risk.

Bioelectrical impedance analysis (BIA) is a non-invasive method used to assess body composition and estimate metabolic age (MA). However, the clinical significance of BIA-estimated MA remains poorly understood. We explored the associations of MA with chronological age (CA), multimorbidity, and physical frailty (PF) in falls clinic attendees. Participants aged ≥50 years were assessed for multimorbidity using the Cumulative Illness Rating Scale-Geriatric, PF using the SHARE Frailty Instrument for Primary Care, and underwent BIA. Among 107 participants (mean age 69.8 years, 57% women), MA showed a moderate correlation with CA (r=0.62, p<0.001). On bivariate analysis, participants with MA>CA were younger, had higher multimorbidity, and were frailer compared to those with MA

Objectives: Despite global guidelines and evidence, fall prevention services in Kuwait are limited. This study sought to understand older people's perspectives towards falls and falls prevention within the context of limited fall prevention services.

Methods: Qualitative interviews explored the perceptions of falls and fall prevention among Kuwaiti older people (50+ years) and their caregivers (N=16).

Results: Falls prevention was an unfamiliar issue; participants' knowledge of falls came from personal and others' experiences, which motivated individuals to eliminate what they perceived as risk factors, but gaps in understanding remained (theme 1). Older people were found to have positive attitudes towards preventing falls, and beliefs around fate and autonomy towards falls prevention were found to independently co-exist (theme 2). Attitudes towards falls prevention were shaped by simplified understanding and concerns about falling (theme 3). Social networks were important in older people's lives, and valuable sources of support and influence were identified (theme 4). A new concept of 'circular care benefits' was developed, contributing an understanding that caring for others helps build subjective norms.

Conclusions: The interview findings contribute to the Theory of Planned Behaviour in the context of falls prevention, with further contribution to the understanding of co-existing beliefs and 'subjective norms'.

Falls among older adults in residential long-term care (RLTC) remain a significant concern, with prevention efforts often yielding inconsistent results due to the complexity of implementation. This umbrella review synthesised evidence from ten systematic reviews to explore the factors influencing the implementation of falls prevention interventions in RLTC, using the i-PARIHS framework. Six EBSCO databases and Scopus were searched without date or language limiters. Risk of bias was assessed using the AMSTAR-2 checklist. The review was conducted in accordance with the PRIOR guideline for overviews of reviews. Seventy-three specific factors were identified. Interventions that are simple, engaging, tailored, and supported by leadership were more effectively adopted. Staff knowledge, clarity of roles, and multidisciplinary collaboration and co-design further facilitated implementation, while organisational constraints such as limited resources, rigid routines, and under-resourcing posed substantial barriers. External contextual influences, including funding mandates and policy frameworks. Moreover, this review identified four factors that did not fall under any of the key characteristics of the i-PARIHS framework: the technological fit of innovations, the health status of residents, changes within the RLTC population, and facilitators' skills in navigating complexity. This review underscores the importance of contextually sensitive, system-wide strategies that consider the evolving realities of RLTC.

Objectives: To examine shifts in frailty among spinal stenosis patients during the COVID-19 pandemic and associations with interventions and outcomes.

Methods: This retrospective analysis compared types of management and rates of in-hospital mortality between pre-pandemic (January 1, through December 31, 2019) and pandemic phases (March 5, 2020 through May 17, 2022) among spinal stenosis patients across a network of 76 hospitals in Germany, utilizing logistic generalized linear mixed models. Frailty was quantified using the Hospital Frailty Risk Score (HFRS) and categorized as low (<5 points), intermediate (5-15 points), and high (>15 points).

Results: Among the 59,130 patients with spinal stenosis, 39,448 were hospitalized during the pandemic, and 19,682 in 2019. During the pandemic, the proportion of patients with high frailty rose from 4.7%-5.5% to 6.2%-7.3% (p < 0.01), except in pandemic wave 5. Among low frailty patients, rates of decompressive surgery increased from 42.4%-46.0% to 48.4%-52.8% (p<0.001), and of fusion surgery from 15.7%-16.6% to 19.2%-22.8% (p<0.001). Throughout the pandemic, in-hospital mortality rates increased from 0.8%-1.0% to 1.0%-2.5% (p<0.017), yet without differences across frailty groups.

Conclusions: Among those hospitalized for spinal stenosis during the COVID-19 pandemic in Germany, frailty increased and low frailty was associated with rising rates of spine surgery.

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: 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.