Aging Clinical and Experimental Research最新文献

Background

Accurate assessment of appendicular skeletal muscle (ASM) is essential for diagnosing sarcopenia. While bioelectrical impedance analysis (BIA) is widely used, equation-derived estimates may be useful when device-based methods are unavailable. We evaluated agreement between BIA-measured ASM and two equations: the COCONUT Study Group formula (NHANES-based) and the Japanese equation by Furushima et al.

Methods

We conducted a cross-sectional study of hospitalized, multiethnic older adults in Singapore (n = 295). ASM was measured using multi-frequency BIA S10. Equation-derived ASM was calculated using calf circumference, age, and sex (COCONUT) or age, anthropometry, and handgrip strength (HGS; Furushima). Agreement with BIA was assessed by Lin’s concordance correlation coefficient (CCC) and Bland-Altman analysis. Diagnostic agreement for low appendicular skeletal muscle mass index (ASMI; AWGS 2019 cut-offs) was evaluated with Cohen’s κ and area under the receiver operating characteristic curve (AUC). Analyses were stratified by sex and obesity.

Results

Furushima’s equation showed stronger concordance with BIA than COCONUT (CCC 0.696 vs. 0.538) and smaller underestimate bias (1.56 vs. 3.03 kg). For low ASMI, Furushima achieved moderate agreement (κ = 0.48; AUC = 0.78) compared with poor agreement for COCONUT (κ = 0.17; AUC = 0.62). COCONUT performed poorly among women (CCC = 0.192; bias 4.40 kg), whereas Furushima improved performance but remained low overall (CCC = 0.371). Among obese patients, Furushima demonstrated the highest concordance (CCC = 0.862; bias 0.42 kg).

Conclusions

Furushima’s equation aligns better with BIA-measured ASM than COCONUT and may complement HGS in sarcopenia screening. Equation-based estimation could aid risk stratification when BIA is unavailable, though subgroup-specific biases require caution.

Background

Frequent hospital users (FHUs) show high risk of clinical instability. A hospital-at-home (HaH) service (“GIROT”) was created in Florence, Italy, to reduce hospitalizations in older adults vulnerable to hospital-related complications.

Aim

To investigate the association of frequent hospital use with all-cause mortality and hospitalization among HaH patients.

Methods

patients referred to GIROT between January 2022 and March 2024, participated in a prospective longitudinal study. Participants were stratified by prior-year hospital admissions (0–1, 2, and 3+) and FHUs were defined based on the association between admissions and risks of subsequent hospitalization and mortality. Multivariate Cox regression assessed the independent association between FHU status and outcomes.

Results

Among 219 patients (mean age 85.9, 55% female, 44% with severe disability), the median number of hospitalizations in the previous year was 2. Over a 6-month follow-up, mortality risk was 43% and hospitalization risk was 39%. Six-month mortality was higher in subjects with 2 (58%) and 3 + admissions (48%) versus 0–1 admissions (32%), with similar patterns for hospitalization. These findings led to defining FHUs as individuals with 2 + prior hospitalizations. Shorter time-to-death was independently associated with weight loss, severe disability, heart failure with reduced ejection fraction (HFrEF), and FHU status (adjHR 1.49, 95%CI 1.00-2.21). Time-to-hospitalization was independently predicted by HFrEF and FHU status (adjHR 1.80, 95%CI 1.08–3.01).

Conclusions

FHUs (i.e., 2 + hospitalizations in the previous year) showed an increased risk of re-admission and mortality among older adults receiving HaH. Extra-hospital care pathways, including HaH and palliative care, may help reduce admissions in this population.

Graphical Abstract

Background

Cognitive frailty (CF), defined by the IANA/IAGG criteria as the coexistence of physical frailty and cognitive impairment without dementia, is an emerging geriatric syndrome associated with disability and adverse health outcomes.

Aims

This study aimed to estimate the prevalence of CF and develop a prediction model among hospitalized older adults in Iran.

Methods

A cross-sectional survey was conducted on 300 patients aged ≥ 60 years admitted to Shahid-Beheshti Hospital, Kashan, between July and September 2024. Data were collected using structured interviews incorporating the Fried Frailty Phenotype, the Clinical Dementia Rating Scale, and a researcher-developed tool assessing demographic, clinical, nutritional, psychosocial, and economic factors. Descriptive statistics and multivariable logistic regression (backward method) were applied.

Results

The mean age of participants was 71.8 ± 8.0 years, and 54.3% were male. The prevalence of CF and potentially CF was 22.7% and 23%, respectively. Protective factors included positive self-rated health (OR = 0.179), non-smoking (OR = 0.150), higher handgrip strength (OR = 0.798), good nutritional status (OR = 0.330), larger mid-upper arm and calf circumferences, and adequate appetite (OR = 0.107). Conversely, higher BMI (OR = 1.315), physical inactivity (OR = 5.966), diabetes (OR = 3.692), comorbidities (OR = 8.77), frequent physician visits (OR = 6.974), stressful life events (OR = 4.764), and poor economic status (OR = 2.724) were associated with increased risk. The model demonstrated strong predictive validity (Nagelkerke R²=0.678; Specificity = 0.921).

Conclusions

CF is prevalent among hospitalized older adults in Iran and is strongly influenced by modifiable factors. Early detection and multidomain interventions—targeting nutrition, physical activity, chronic disease control, and psychosocial well-being—may prevent CF and improve quality of life in this vulnerable group.

Background

This study examines the epidemiology of sarcopenic obesity (SO) in China, focusing on national prevalence, modifiable influencing factors, and its longitudinal association with dementia risk in middle-aged and older adults.

Methods

Using the 2015 wave of the China Health and Retirement Longitudinal Study (CHARLS), SO prevalence was estimated nationally and regionally using Bayesian spatial modeling. Modifiable influencing factors were identified via multivariable logistic regression, with their relative contributions quantified using Extreme Gradient Boosting (XGBoost). The association between baseline SO (2015) and incident dementia risk (2018) was assessed using multivariable logistic regression.

Results

Among 10,256 participants aged ≥ 45 years, the national SO prevalence was 6.40% (95% Bayesian confidence intervals [BCIs]: 6.39–6.41%), with significant regional variation (Northern region: 8.60% [8.59–8.61%]; Southern region: 4.90% [4.86–4.94%]). Older age, female sex, hypertension, and depressive symptoms showed statistically significant associations with SO. Age emerged as the strongest predictor in XGBoost analysis. Compared to normal-weight individuals without sarcopenia, those with normal-weight sarcopenia had 63% higher dementia risk (odds ratio [OR] = 1.63; 95% confidence interval [CI]: 1.04–2.58), while SO individuals showed 89% increased risk (OR = 1.89; 95% CI: 1.67–2.15).

Conclusion

These findings emphasize the significant geographic disparity in SO prevalence across China and reveal that SO is associated with a substantially elevated risk of dementia, underscoring the need for targeted interventions in aging populations.

Background

The prevalent preoperative nutritional evaluations in surgical settings tend to rely on isolated biochemical parameters, such as albumin levels, which demonstrate limited precision in forecasting postoperative complications and mortality rate. The primary objective of this study is to evaluate the predictive accuracy of nutrition screening tools in identifying postoperative risks and mortality in various orthopedic surgeries, and to determine which tools are the most reliable.

Methods

A comprehensive search was conducted in PubMed, CNKI, EMBASE, and Cochrane Central databases for studies on the relationship between nutritional status and postoperative outcomes in older orthopedic surgery patients. The search period was from the establishment of the databases to May 2025. Subgroup analyses evaluated the impact of various factors on outcomes. Meta-regression was performed to further explore heterogeneity.

Results

The current investigation encompasses 11 studies, inclusive of 201,338 geriatric orthopedic surgery patients. The result showed that malnutrition assessed by nutrition screening tools was significantly associated with postoperative complications (RR = 1.65, 95% CI: 1.26–2.15), and postoperative mortality as well (RR = 2.17, 95% CI: 1.58-3.00). Significant statistical heterogeneity was observed in the primary analyses, but sensitivity analyses confirmed the robustness of the primary findings. Subgroup analyses revealed variations based on factors like study design, geographic location, and Surgical procedure. Meta-regression identified study design as a significant predictor of postoperative complications.

Conclusion

Nutrition screening tools are effective in identifying preoperative malnutrition and can be utilized as predictive factors for the risk of adverse outcomes in older patients undergoing orthopedic surgeries.

Background

The global rise in obesity increasingly includes extreme forms, notably BMI ≥ 50 kg/m², which present disproportionate health risks, especially among older adults. Despite this, most epidemiological research aggregates all obesity (BMI ≥ 30 kg/m²), potentially underestimating the burden of extreme obesity. Understanding trends in this subgroup is critical for targeted public health and clinical responses.

Methods

We analyzed data from the English Longitudinal Study of Ageing (ELSA) across four waves (2004–2005 to 2016–2017). Data were analysed on the entire population and also for those aged ≥ 65 years. BMI was calculated from measured or self-reported height and weight and classified using WHO standards. Poisson regression with robust error variance was used to assess trends across BMI categories, adjusting for age and sex.

Results

Extreme obesity (BMI 50–59.9 kg/m²) increased by 50% over the 12-year period, and for the first time, individuals with BMI ≥ 60 kg/m² were observed in 2016–2017. Among older adults, mild obesity (BMI 30–39.9 kg/m²) declined slightly, while class II obesity (BMI 40–49.9 kg/m²) rose significantly. However, no individuals aged ≥ 65 years were recorded in the ≥ 60 kg/m² category. Though absolute numbers remain small, the upward trend is clear and clinically significant.

Conclusions

Extreme obesity is rising disproportionately, including among older adults, and requires urgent recognition as a distinct public health challenge. Healthcare systems must adapt to the complex needs of this population, including appropriate medical infrastructure, specialized care pathways, and enhanced clinical guidelines. Ongoing surveillance and tailored interventions are essential to address this growing burden.

Background

The self-reported FRAIL scale is suitable for frailty assessment in the busy primary care practice setting.

Aim

To estimate the association between phenotypic frailty assessed by FRAIL and subsequent health care costs in older men and women.

Methods

Prospective study of 7947 community-dwelling adults (mean age 79.2 years, 52.6% female) enrolled in 4 cohort studies of older adults linked to U.S. Medicare claims. The primary predictor was the FRAIL scale categorized into 3 levels (robust, pre-frail, and frail). A multimorbidity index (Hierarchical Conditions Category score) and the Kim frailty indicator (approximating the deficit accumulation index) were derived from U.S. Medicare claims. Annualized total and sector-specific health care costs (U.S. 2023 dollars) for 36 months after the index examination were ascertained from claims. Generalized linear models with gamma variance and log link functions were used to estimate the association of FRAIL category with subsequent health care costs.

Results

After accounting for claims-based indicators of multimorbidity and frailty, estimated annualized mean total health care costs for individuals categorized as robust were $9742 in women and $13,319 in men. Compared with robust individuals, adjusted mean annualized incremental costs for prefrailty were $4104 (95% C.I. 604–5604) in women and $1955 (95% C.I. 102–3808) in men and for frailty were $9028 (95% C.I. 6653–11402) in women and $6604 (95% C.I. 3168–11039) in men.

Discussion and conclusion

Pre-frailty and frailty assessed using the self-reported FRAIL scale are associated with higher subsequent total health care costs, even after accounting for claims-based indicators of multimorbidity and frailty.

Background

Denosumab, a monoclonal antibody targeting RANKL, is widely used for the treatment of osteoporosis. In addition to its skeletal benefits, emerging evidence suggests that denosumab may also exert positive effects on muscle health by modulating inflammation, myostatin expression, and insulin sensitivity through the RANK/RANKL/OPG pathway.

Aims

To systematically review the available literature on the effects of denosumab on muscle-related outcomes, including muscle strength, muscle mass, physical performance, and fall risk.

Methods

A systematic review was conducted in accordance with PRISMA guidelines. Databases including PubMed, Embase, and Cochrane Library were searched through May 2025 for studies evaluating the impact of denosumab on muscle health in human subjects. Outcomes of interest included grip strength, lean muscle mass, gait speed, fall incidence, and physical performance tests.

Results

Seven studies met the inclusion criteria, including randomized trials and observational cohorts. Most reported favorable outcomes for denosumab compared to bisphosphonates or placebo, particularly in grip strength and physical performance. Preclinical studies further support the biological role of RANKL in muscle dysfunction. However, one recent randomized controlled trial in older adults residing in long-term care settings found no significant effect on muscle outcomes, highlighting inconsistencies in the evidence.

Discussion

Denosumab shows potential for improving muscle-related outcomes in older adults, particularly those with osteosarcopenia.

Conclusions

Current evidence is heterogeneous and inconclusive. Further high-quality randomized trials are needed to clarify the effects of denosumab on muscle health and its possible role in sarcopenia prevention and management.