Objectives: Little is known about the views of key stakeholders on frailty in Primary Care in Ireland. The aim of this study was to explore the views of Irish healthcare professionals and patients on frailty and its management in Primary Care. Methods: A qualitative descriptive design was used. Seventeen healthcare professionals and three patients were recruited using purposive sampling. Data were collected using semi-structured interviews which were analysed thematically. Results: Three themes were identified: (i) Perceptions of Frailty (ii) Current Management of Frailty and (iii) Comprehensive Geriatric Assessment in Primary Care. The results demonstrated variability in perspectives on frailty. Healthcare professionals described a fragmented service often delivering substandard care to frail older patients. The general consensus was that frailty management required an adequately resourced Primary Care service. Support for frailty screening and Comprehensive Geriatric Assessment was evident while the suitability of the current pathway for patients requiring assessment was questioned. Conclusion: This study highlights an absence of a shared and complete understanding of frailty among healthcare professionals and a fragmented model of care for community-dwelling frail older patients. Based on these findings, inter-professional training, investment in Primary Care, the development of a frailty pathway and an interface service is recommended.

This review summarizes the current literature on the correlation between frailty and urinary tract infections (UTIs), as well as the potential causes and measures that can be taken to prevent and treat these frailty associated UTIs (FaUTIs). A narrative review of the literature was carried out using the keywords and other associated terms (catheter associated UTIs and frailty, causes of UTIs, prevention of UTIs in the frail, treatment of UTIs in the frail). As it is shown in the literature, many risk factors that are associated with frailty such as dehydration, reduced mobility and cognitive impairment, as well as other anatomical or functional abnormalities can make frail patients prone to UTIs that are also more difficult to treat. Early correction of these risk factors (for example avoiding long term catheters, increasing hydration, treating lower urinary tract obstruction or incontinence), can prevent UTIs and improve the quality of life of frail patients. Prompt and individualized antimicrobial treatment of UTIs in the frail population can result in decreasing mortality rates but also minimize unnecessary antimicrobial drug use.

Objectives: Progressive resistance training can successfully target functional decline in healthy older community-dwelling adults. There are concerns about the safety and acceptance of its use in frail older populations. The aim of this study was to evaluate the feasibility of using progressive resistance training in an older, post-acute, inpatient setting. Methods: A randomised controlled feasibility study was conducted. Appropriate older inpatients undergoing post-acute rehabilitation were recruited. Feasibility measures examined were safety, recruitment, outcome measurement, adherence and retention rates and satisfaction. A range of clinical measures were used to capture changes in body structure and function, activity and participation. Assessments were performed on admission to the study and six weeks later. Results: A sample of 33 patients were included and randomised to the treatment group (n=16) or the control group (n=17). There were no serious adverse events, adherence rates were 63% and retention rates were 82%. While both groups improved between time 1 and 2, there were no significant differences in clinical measures between the groups. Conclusion: Progressive resistance training is a safe and acceptable intervention for use with this population. Further work on the effectiveness of progressive resistance training in this setting is now required.

Objective: We aim to determine the association of monocyte chemotactic protein-1 (MCP-1) and dickkopft-1 (DKK-1) as potential biomarkers that may predict changes in body composition and physical performance in healthy older adults from Singapore. Methods: Two-hundred community-dwelling older adults (mean age: 67.9 years; 68.5% females) were classified into elevated versus non-elevated groups based on quintile cut-offs of MCP-1 and DKK-1 levels (156.02 pg/mL and 606.31 pg/mL, respectively). Multiple linear regression was performed to examine the relationship between MCP-1 and DKK-1 with body composition and physical performance, adjusted for age, gender and ethnicity. Results: MCP-1 was significantly associated with higher fat mass, fat mass index, percentage body fat, waist circumference and trunk-limb ratio for fat mass (all p<0.01), and repeated chair stand (p=0.004). DKK-1 was not associated with body composition and physical performance measures. Utilising the Asian Working Group for Sarcopenia (AWGS) 2019 criteria, there were 39 (19.5%) sarcopenia and 161 (80.5%) non-sarcopenia participants respectively, with MCP-1 levels significantly higher in sarcopenia compared with non-sarcopenia (p=0.046), but not for DKK-1 (p=0.525). Conclusions: Elevated MCP-1 are associated with changes in fat composition, physical performance and sarcopenia, suggesting its usefulness in identifying at-risk group with sarcopenic obesity.

Sarcopenia is reported as an important health issue. This study investigates with Google Trends whether the clinical importance of sarcopenia is reflected in public interest in the disease. The study was performed between January and March 2020. Data were collected using Google Trends (worldwide). The compared topics were dementia, frailty, polypharmacy, osteoporosis and sarcopenia. A comparison of the topics revealed that “dementia’’ displayed the highest relative search volume followed by “osteoporosis” and “frailty”. The relative search volume of ‘‘sarcopenia’’ was very low and the lowest relative search volume was contributed to “polypharmacy”. In conclusion, despite the growing interest in the clinical and research community, it is still a relatively unknown topic for the general public. Taking in account the preventive potential of interventions against sarcopenia, it is important to increase the awareness among lay people. In this set-up, Google Trends could be an important tool to evaluate public interest in geriatric topics. It could help to convince policy makers that there is need for awareness programs on sarcopenia.

Objectives: 1) To develop an understanding of the thoughts and opinions of older women diagnosed with osteoporosis regarding sedentary behaviour and 2) Investigate strategies used to reduce sedentary behaviour for future intervention development. Methods: Eleven older women with osteoporosis (mean age=68.2y±6.6(SD)) participated in semi-structured interviews (March-May 2020). They were recruited from the Royal Osteoporosis Society (Scottish) support group networks and the Strathclyde Age-Friendly-Academy. Telephone interviews were recorded, transcribed verbatim and thematically analysed using Braun & Clarke (2006). Results: Three main themes emerged: ‘Older Women’s Knowledge’, ‘Motivators to reduce Sedentary Behaviour’ and ‘Older Adult’s and Technology’. Participants reported an increase/maintenance of physical activity levels after osteoporosis diagnosis, had a good understanding and awareness of sedentary behaviour and how it affects health holistically. Participants identified motivators to interrupt sedentary behaviour (e.g. family/friends) and facilitators of sedentary behaviour (e.g. Television). Technology appeared to be used widely among participants to track movement patterns (e.g. Fitbit) but access and usability were identified as potential barriers when using technology to reduce sedentary behaviour among older adults. Conclusion: Knowledge does not appear to be a factor that needs addressing in relation to sedentary behavior in older women diagnosed with osteoporosis. Identified motivators and barriers could increase awareness of sedentary behaviour among older adults.

Objectives: To assess the association between poor handgrip strength (HGS) determined by clinical criterion and incidence of falls in older women. Methods: The cohort included 195 women (68.1±6.2 years) who were assessed for HGS (Jamar Dynamometer) at baseline and were prospectively followed for 18 months. FNIH Sarcopenia threshold of HGS adjusted for body mass index (<0.56) was used for clinical determination of poor HGS. Association between poor HGS and incidence of falls was analyzed using Cox hazard models in the total cohort and in a stratified analysis by balance status. Results: During the follow-up, 53 (27%) women experienced at least one fall. In a multivariable model, poor HGS was associated with approximately 3-fold increased risk for falls [Hazard Ratio (HR)=2.73, 95% Confidence Interval (CI)=1.28–5.82, p=0.009]. In a stratified analysis, women with impaired balance exhibited even greater risk for falls (HR=3.85, 95%CI=1.47–10.12, p=0.011), although no association was found in women with normal balance (p=0.459). Conclusions: Poor HGS based on clinical criterion is independently associated with higher risk of falls in older women, particularly in those with impaired balance. These results suggest potential prognostic value of FNIH Sarcopenia threshold for risk stratification and referring high-risk individuals to fall prevention programs.

Shortened and fragmented sleeping patterns occupying modern industrialized societies may promote metabolic disturbances accompanied by increased risk of weight gain and skeletal muscle degradation. Short-term sleep restriction may alter energy homeostasis by modifying dopamine brain receptor signaling, leading to hyperpalatable food consumption and risk of increased adiposity. Concomitantly, the metabolic damage caused by lower testosterone and higher cortisol levels may stimulate systemic inflammation, insulin resistance, and suppress pathways involved in muscle protein synthesis. These changes may lead to dysregulated energy balance and skeletal muscle metabolism, increasing the risk of sarcopenic obesity, an additional public health burden. Future trials controlling for food intake and exploring further the influence of sleep deprivation on anabolic and catabolic signaling, and gut peptide interaction with energy balance are warranted.

Objectives: The effects of a rehabilitation program on static balance, mobility, and strength of lower limbs in elderly fallers operated after a hip fracture and non-operated were studied. Methods: Ninety-one elderly (>65 years) were divided in two groups, the Operated Group (OG, 43 fallers) and the Non-Operated Group (NOG, 48 fallers). Posture during bipedal stance (30s), mobility (Up-and-Go, Falls Efficacy Scale, Berg Balance Scale) and isokinetic strength of several muscular groups in both limbs were evaluated before and after a rehabilitation intervention, consisting in 20 sessions (3 sessions/week) including kinesiotherapy and occupational therapy. Results: After intervention, the average velocity of Center of Pressure displacement decreased significantly for OG and NOG (p<0.005). Similarly, all other variables describing static balance, mobility (p<0.05) and isokinetic strength (p<0.005) were improved significantly for both groups. Conclusions: The applied intervention led to improvement in static balance, mobility, and strength of lower limbs after hip fracture. Physical and Rehabilitation Medicine physicians should prescribe evidence-based rehabilitation protocols in elderly fallers because they could show just as remarkable improvements as non-operated patients when the program is carefully designed.

Objectives: Risk stratification scores are used in hip fracture surgery, but none incorporate objective tests for low muscle strength. Grip strength testing is simple and cheap but not routinely assessed for patients with hip fracture. This project aimed to assess the feasibility of implementing grip strength testing into admission assessment of patients with hip fracture. Methods: A scalable protocol and a corresponding training programme of instructional presentations and practical assessments were designed and delivered by and for physiotherapy staff. Grip strength values were collected pre-surgery on patients with hip fracture at a single centre whilst supine in bed. Implementation of the process was evaluated using narrative, quantitative and cost measures. Results: 53 hip fracture patients with a mean age 80.6 (SD 10.4), of which 36 (67.9%) were female, were included. Testing was offered to 42/52 (81%) patients. Cognitive impairment prevented 14/42 (33%) of patients from completing testing; one patient declined testing. Of the 27 patients who completed testing, 14/27 (52%) had low grip strength as defined by EWGSOP2 criteria. The projected cost of testing for one year was £2.68-£2.82 per patient. Fidelity to the protocol was high using multiple criteria. Conclusions: Grip strength assessment is acceptable to physiotherapy staff and can be rapidly and cost-effectively implemented into hip fracture admission assessment.

Objective: The aim of the study was to compare, Modified Frailty Index (mFI), EAARN (LVEF <22%, Atrial Fibrillation, Age ≥70 years, Renal function (eGFR <60 mL/min/1.73m²), NYHA class IV), and ScREEN (female Sex, Renal function (eGFR ≥60 mL/min/1.73m²), LVEF ≥25%, ECG (QRS duration ≥150 ms) and NYHA class ≤III) score for predicting cardiac resynchronization therapy (CRT) response and all-cause mortality. Methods: In this prospective, non-randomized, single-center, observational study we enrolled 93 patients receiving CRT from August 2016 to August 2019. Pre-implant scores were calculated, and patients were followed for six months. Performance of each score for prediction of CRT response (defined as ≥15% reduction in left ventricular end-systolic volume [LVESV]) and all-cause mortality was compared. Results: Optimal CRT response was seen in seventy patients with nine deaths. All the three scores exhibited modest performance for prediction of CRT response and all-cause mortality with AUC ranging from 0.608 to 0.701. mFI has an additional benefit for prediction of prolonged post-procedure stay and 30-day rehospitalization events. Conclusion: mFI, ScREEN and EAARN score can be used reliably for predicting all-cause mortality and response to CRT.

Objectives: To investigate the impact of the body mass index (BMI) change on risk of falling in postmenopausal women with osteopenia or osteoporosis. Also, we aimed to evaluate and associate the individuals’ functionality, mobility and balance with the risk of falling. Methods: This one-year prospective observational study assessed 498 postmenopausal Greek women over the 50th year of age suffering from either osteoporosis or osteopenia. Parameters such as the height, weight and BMI were documented. Furthermore, the subjects were asked whether they experienced a fall the preceding year. Balance was evaluated using the Berg Balance Scale, the Timed-Up-And-Go test, and the 30 Seconds Sit-to-Stand test. Hand-grip strength was assessed with the Jamar Hydraulic Hand Dynamometer. Results: The observed one-year BMI change was associated with falls in postmenopausal osteopenic and osteoporotic women over the age of 70. Additionally, there were statistically significant changes in the BBS, TUG, 30CST and the hand-grip strength on both hands at the one-year follow-up but there were not associated with an increased fall risk. Conclusion: The one-year change in BMI was associated with the risk of falling in postmenopausal osteopenic and osteoporotic women over the 70^th year of age. Whereas, the one-year change in balance, mobility and grip strength were not linked to an increased risk of falling.

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: Sarcopenia is prevalent among geriatric patients and it has a high rate of negative health related outcomes. Diagnostic and assessment approaches are not always feasible. The aim of the study was to detect a valid screening tool for sarcopenia that could be used easily in acute care setting. Methods: A cross sectional study was conducted in Geriatrics department, Ain Shams University Hospital. 127 inpatient elderly participants were recruited. Sarcopenia was defined according to the European Working Groups on Sarcopenia in Older People (EWGSOP) criteria as low skeletal muscle mass with either low handgrip strength or slow gait speed. Muscle mass was measured by bioelectrical impedance analysis (BIA). Two screening methods for sarcopenia were investigated, namely SARC-F questionnaire and Ishii equation including age, handgrip, and calf circumference (CC). Results: Both SARC-F questionnaire and Ishii equation can detect sarcopenia in both genders and both showed good agreement with the standard diagnostic method. Combining SARC-F to Ishii equation improved the diagnostic accuracy, with a higher sensitivity and specificity. Conclusions: SARC-F and Ishii equation could be used as a valid simple screening tool in acute hospital setting. Combing these two screening tools resulted in better diagnostic accuracy with higher sensitivity and specificity.

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.

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.

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.

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 3rd 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.

Objectives: To determine the acceptability of an exercise programme and to identify barriers and facilitators to compliance with the programme from the participants’ perspective. Methods: Patients aged 75 years or older were recruited within the first 36 hours of hospital admission. Participants were randomised to complete two strengthening-based (intervention arm) or stretching-based (control arm) exercise sessions per-day. At hospital discharge, participants were asked to take part in interviews with a member of the research team exploring the barriers and facilitators to adherence to the intervention. Results: 15 participants (7 intervention arm, 8 control arm) were recruited before the trial was stopped due to COVID-19. Both groups showed reductions in knee-extension strength, and improvements in functional mobility at discharge from hospital. A total of 23/60 intervention sessions were classed as ‘complete’, 12/60 as partially complete, and 25/60 were missed entirely. Eight participants took part in interviews. Intrinsic factors that impacted participation in the research, related to current health, health beliefs, and experience of multi-morbidity or functional decline. Staff had both a positive and negative effect on participant adherence to the intervention. Conclusions: The exercise intervention was well received, with most participants describing health benefits, though intervention fidelity was lower than expected.

Objectives: The objective of this study was to assess the prevalence rate of probable sarcopenia and to determine the factors associated with it in older people living in Western Greece. Methods: Probable sarcopenia was estimated based on cut-off values for handgrip strength (HGS) as recommended by EWGSOP2. Information about socio-demographic, chronic diseases, fear of falls and lifestyle of the participants were also collected. HGS was assessed using a SAEHAN dynamometer. Calf circumference was assessed with inelastic tape. A logistic regression analysis was performed in order to determine associated risk factors. Results: The sample comprised 402 participants (292 women;110 men), with a mean age of 71.51±7.63 years. Overall, 25.4% of the elderly participants were diagnosed with probable sarcopenia (men:36.4%; women:21.2%). The findings of this study demonstrated that probable sarcopenia was positively associated with age (OR=0.14, 95% CI=0.008 to 0.200), gender (OR=-0.6, 95% CI=-0.700 to -0.530), Body mass Index (OR=0.01, 95% CI=-0.030 to -0.005), Skeletal muscle mass index (OR=0.05, 95% CI=0.030 to 0.080), calf circumference (OR=0.02, 95% CI=0.007 to 0.040), and comorbidities (OR=0.04, 95% CI=0.030 to 0.080). Conclusion: There was a 25.4% prevalence of probable sarcopenia in Greek elderly. The results highlight the importance of the detection of HGS and probable sarcopenia in older people in order to develop effective strategies of prevention and intervention of sarcopenia.

Objectives: The health and well-being of older women may be influenced by frailty and low socioeconomic status (SES). This study examined the association between frailty and SES, healthcare utilisation and quality of life (QOL) among older women in regional Australia. Methods: Cross-sectional analysis of the Geelong Osteoporosis Study was conducted on 360 women (ages ≥60yr) in the 15-year follow up. Frailty was identified using modified Fried’s phenotype. Individual SES measures and healthcare utilisation were documented by questionnaire. Area-based SES was determined by cross-referencing residential addresses with the Australian Bureau of Statistics Index of Relative Socio-economic Advantage and Disadvantage (IRSAD). QOL was measured using the Australian World Health Organisation Quality of Life Instrument (WHOQoL-Bref). Multinomial logistic regression was conducted with frailty groupings as outcome. Results: Sixty-two (17.2%) participants were frail, 199 (55.3%) pre-frail and 99 (27.5%) robust. Frail participants were older with higher body mass index. Frailty was associated with lower education but not marital status, occupation or IRSAD. Strong associations with frailty were demonstrated for all WHOQoL-Bref domains. Frailty was associated with more primary care doctor visits (p<0.001). Conclusions: This population-based study highlights the significant impact of frailty on older women, indicating reduced QOL and increased primary care doctor visits.

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.

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.

Osteosarcopenia has been proposed as a syndrome in a subset of frail individuals at higher risk of falls, fractures and institutionalization. In this paper, we will go over the translational aspects of sarcopenia and osteoporosis research and highlight outcomes from different interventions. In addition, preventative measures and therapeutic interventions that can benefit both muscle and bone simultaneously will be analysed also. A new holistic concept called Osteosarcopenia School will be presented. This new concept is based on counselling and education of patients as part of a rehabilitation program, aiming to reduce the risk of social isolation, falls and fractures, and subsequent disability through muscle strengthening and balance training. In this patient group, the combination of pharmaceutical treatments and specific exercise programmes are essential to counteract the consequences of osteosarcopenia. Finally, educational programmes targeting patient functionality through social reintegration may have a substantial impact on their daily living activities and overall quality of life.

As the lifespan increases, special attention has been given to the supportive care needs of the elderly. Frailty is an important issue in third age, since it is related to poor quality of life and mortality. The prevalence of pathological conditions related to sodium levels, specifically hyponatremia, is also present in the elderly. Yet, it is unclear, if hyponatremia and frailty are related to each other. This review summarizes the current state of knowledge regarding hyponatremia and frailty and analyzes five independent studies which searched for an association between those two parameters. As indicated by this study results, hyponatremia consists a risk factor for frailty. This could be explained by an effect of hyponatremia on sarcopenia and on cognitive function, which consist components of frailty. Thus, it is essential to monitor sodium levels in the elderly and to develop related interventions (e.g. using arginine vasopressin antagonists) in order to prevent frailty.