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JFSF 2022

Original Article JFSF, Vol 7, No 1, March 2022, p.1-12
Evaluation of strategies to recruit and retain older people with dementia and their informal carers into a Tai Chi Trial to improve balance and prevent falls
Michelle Heward, Layla Johnson, Samuel R. Nyman
Keywords: Dementia, Exercise, Falls, Recruitment and retention, Trial
Objectives: Randomised control trials (trials) involving people with dementia lack detailed analysis of recruitment and retention strategies. To address this, we examined the effectiveness of strategies in “The TACIT Trial: TAi ChI for people with demenTia”. Methods: We recruited dyads (people with dementia and carers) from 3 South of England sites utilising different strategies. Recruitment strategy effectiveness was measured by percent yield (number randomised of total referrals) and cost per randomised participant. Our retention strategy (maintaining contact with participants during weekly telephone calls) was measured by percent yield (number retained by six-month follow-up). Results: Of 359 dyads, 24% were randomised into the study (n=85). The most resource-intensive strategy (research nurses spending 30 minutes explaining the study) had the highest referral to randomisation rate. An incremental cost-effectiveness ratio suggested an alternative approach (nurses and doctors spending 5 minutes explaining the study) was most cost-effective. Retention rates were 86% (n=36/42; intervention group) and 81% (35/43 control group); main reasons for attrition were worsening health and lack of study interest. Conclusions: The results demonstrate person-centred strategies enabling staff to spend time with participants were effective in supporting recruitment and retention. Those designing future trials must consider such strategies and the associated costs.
Original Article JFSF, Vol 7, No 1, March 2022, p.13-17
Achieving the hip fracture Best Practise Tariff during the COVID-19 pandemic
Mohammed Ali, Ahmed Fadulelmola, Marie Urwin, Cristian Nita
Keywords: Best Practise Tariff, Covid-19 Infection, Hip Fracture, 30-day Mortality
Objectives: Achieving the hip fracture best practice tariff is associated with decreased mortality rates. The aim of this study is to evaluate the impact of Covid-19 pandemic on achieving Best Practice Tariff. Methods: We retrospectively reviewed all adult hip fractures admitted to our unit between March and June 2020. Patient’s characteristics, place of residence, delirium assessment, and mobility status were recorded. All the Best practice Tariff criteria have been analysed. Covid-19 was diagnosed using reverse transcriptase polymerase chain reaction. Results: 178 patients with a mean age of 82.8 years presented with hip fractures during the study period. 18 patients (10.1%) tested positive for COVID-19. 44.4% failed to achieve the BPT from the COVID-19 positive group and 22.5% from the negative group. Conclusion: Based on this study, hip fractures associated with Covid-19 infection are more likely to fail the BPT and have higher 30-day mortality rates compare to the COVID-19 negative patients.
Review Article JFSF, Vol 7, No 1, March 2022, p.18-28
Recommendations for physical activity in the elderly population: A scoping review of guidelines
Christos Nikitas, Dimitris Kikidis, Athanasios Bibas, Marousa Pavlou, Zoi Zachou, Doris-Eva Bamiou
Keywords: Clinical guidelines, Older adults, Physical activity
Physical inactivity and sedentary time are associated with all-cause mortality, chronic non-communicable diseases and falls in the elderly. Objective of this review is to assess and summarize recommendations from clinical guidelines for physical activity (PA) of older adults in general and related to falls. A scoping review of the existing clinical guidelines was conducted. The included studies should have been developed under the auspices of a health organization and their methodology should be described in detail. Nine clinical guidelines providing specific recommendations for the elderly were identified. There was a strong agreement across the guidelines regarding goals, activities parameters, adverse effects of PA, in addition to reference for preventing falls. Keeping even the minimum of physical activity, introducing balance exercises and strengthening exercises for preventing falls, avoiding unexpected accelerations in the intensity of the activities, applying the necessary precautions and consulting a health professional are the main pillars of recommendations. Despite any deficiencies in definitions, monitoring and optimal dosage consistency of recommendations, is an ideal incentive for countries and organizations to adopt and enhance physical activity as an antidote to the degeneration of human’s health and quality of life.
Perspective Article JFSF, Vol 7, No 1, March 2022, p.29-31
Physical Resilience: A novel approach for healthy aging
Jagadish K. Chhetri, Lina Ma, Piu Chan
Keywords: Aging, Functional ability, Healthy aging, Resilience
Population aging is evident globally. The traditional model of care based on disease management is not sufficient to develop a generation of functional older adult population. The construct of Physical Resilience (PR) holds great potential to make the agenda of healthy aging a reality if we were to properly understand it and develop intervention strategies to maintain PR through life. There are several difficulties and challenges with this novel construct that need to be resolved through research, so as to foster its vast possibilities to maintain functional ability in old age.
Mini Review JFSF, Vol 7, No 1, March 2022, p.32-37
B12 levels and frailty syndrome
Elisavet E. Pyrgioti, Nikolaos D. Karakousis
Keywords: Bioavailability, Cognitive disorders, Frailty syndrome, Sarcopenia, Vitamin B12
Vitamin B12, widely known as cobalamin, is a water-soluble vitamin crucial for human metabolism. It is synthesized only by prokaryotic organisms and since humans do not have the ability to synthesize it, they rely on its exogenous dietary intake. After its consumption, vitamin B12 undergoes a complicated procedure of absorption and assimilation and it is essential for cellular function, especially for nervous system, red blood cell production and DNA synthesis. Deficiency of vitamin B12 is considered as an important public health issue worldwide, while it is common in the elderly. Deficiency of this vitamin, as well as high levels, indicate a risk factor for morbidity with various clinical manifestations. Frailty is an age-related syndrome, which affects the elderly and is characterized by decreased function in many physiological systems, accompanied by vulnerability to stressors. A narrative non-systematic mini review of the literature was conducted and highlighted that vitamin B12 levels may have an impact on frailty and vice versa. As shown in several studies, vitamin B12 levels may be related to sarcopenia, cognitive and musculoskeletal disorders, neurological or psychiatric symptoms, which are closely linked to frailty. Furthermore, it is suggested that the extensions of frailty may affect the bioavailability of vitamin B12.
Original Article JFSF, Vol 7, No 1, March 2022, p.38-46
Computerized Tomography derived psoas muscle indices in a healthy young population in the United States
Maxwell A. Lawlor, Jennifer M. Oliveto, Jenenne A. Geske, Birgit N. Khandalavala
Keywords: Computerized Tomography Scans, Musculoskeletal Conditions, Muscle Disorders, Psoas Muscle Indexes, Spine-Low back
Objective: Psoas muscle metrics from diagnostic computerized tomography (CT) scans are emerging as clinically relevant biomarkers. Most muscle metrics from the US population are from older cohorts with co-morbidities. Published reports from a young or healthy population in the United States on psoas muscle metrics optimized for age, body mass index (BMI), and sex are lacking. This study determines the psoas muscle index (PMI) and psoas muscle density (PMD) for a normal young Midwestern US population. Methods: Retrospective cross-sectional analysis of pre-existent abdominal non-contrast CT scans from a young (19-40 years old), Midwestern, predominately Caucasian population was conducted within Aquarius iNtuition software automatically after manual identification of the psoas muscle. Electronic medical records provided access to subject data and archived CT scans were reviewed. Results: From 193 (45 male, 148 female) CT scans, for males, PMI was 5.9 cm2/m2 (SD=1.7) and PMD 48.4 HU (SD=5.5); for females PMI was 5.4 cm2/m2 (SD=1.4) and PMD 48.18 HU (SD=5.5). BMI was significantly correlated with PMI and PMD for both men (p<0.001, p<0.001 respectively) and women (p<0.001, p<0.001 respectively). Conclusion: Psoas muscle metrics are newly generated for PMI and PMD in a healthy population, allowing for future comparison studies determining muscle status.
Case Report JFSF, Vol 7, No 1, March 2022, p.47-51
Otago Exercise Program Delivery using Digital Practice: A Prospective Case Report
Cheryl J. Hardy-Gostin, Kelly J. Negley, Jade J. Bender-Burnett
Keywords: Balance, Exercise, Falls, Otago, Telehealth
Activity restrictions during the COVID-19 pandemic left many older adults without access to community-based falls prevention programs. Despite a lack of evidence to support the digital delivery of exercise and rehabilitation, these services were quickly implemented during the pandemic in an effort to prevent the transmission of COVID-19, yet support a continuity of care. Our report describes the novel practice and digital delivery of a condensed Otago Exercise Program, a well-documented falls prevention program, to an 83-year-old female with high falls risk. After four weeks of the Otago Exercise Program via digital delivery, the patient in our case had notable improvement in her scores on the Timed Up and Go, Five Times Sit to Stand, 30-Second Chair Stand Test and One Leg Stance tests. Our findings necessitate the additional exploration of the digital delivery of exercise for future community-based falls prevention programs and provide an alternate method of delivery for falls prevention for practitioners to consider.
Original Article JFSF, Vol 7, No 2, June 2022, p.52-59
The relationship between radiological paraspinal lumbar measures and clinical measures of sarcopenia in older patients with chronic lower back pain
Denys Gibbons, Jake M. McDonnell, Daniel P. Ahern, Gráinne Cunniffe, Rose-Anne Kenny, Roman Romero-Ortuno, Joseph S. Butler
Keywords: Low back pain, Lumbar spine, Radiology, Sarcopenia, Spine surgery
Objectives: Sarcopenia is postulated to be an influential factor in chronic low back pain. The aim of this study is to evaluate the relationship between traditional clinical measures of sarcopenia and novel radiographic methods which evaluate overall muscle status, such as adjusted psoas cross-sectional area (APCSA) and degree of fat infiltration (%FI) in paraspinal muscles, in patients with chronic low back pain. Methods: Prospective study performed at our institution from 01/01/19-01/04/19. Inclusion criteria were patients ≥65 years old not requiring surgical intervention presenting to a low back pain assessment clinic. Results: 25 patients were identified (mean age: 73 years, 62% male). On spearman’s analyses, %FI shared a significant relationship with hand grip strength (r=-0.37; p=0.03), chair rise (r=0.38; p=0.03), SC (r=0.64; p<0.01), and visual analogue scale scores (r=-0.14; p=0. 02). Comparably, a statistically significant correlation was evident between APCSA and %FI (r=-0.40; p=0.02) on analysis. Conclusion: The results of our study demonstrate a statistically significant relationship between APCSA and %FI in the multifidus and erector spinae muscles. Further significant associations of relatability were depicted with traditional clinical measures of sarcopenia. Thus, %FI may be a supplemental indicator of the sarcopenic status of patients presenting with chronic low back pain.
Original Article JFSF, Vol 7, No 2, June 2022, p.60-71
Balance Exercise Circuit for fall prevention in older adults: a randomized controlled crossover trial
Juliana N.A. Costa, Alexandre L.A. Ribeiro, Daniele B.G. Ribeiro, Silvia G.R. Neri, Daniel F. Barbosa, Bruna P. Avelar, Marisete P. Safons
Keywords: Aging, Circuit-based exercise, Muscle strength, Postural Balance, Quality of life
Objectives: This study aimed to assess the immediate and short-term effects of the Balance Exercise Circuit (BEC) on muscle strength, postural balance, and quality of life, with the aim of preventing falls in older adults. Methods: Twenty-two volunteers participated in this randomized controlled crossover study. Group A performed BEC training in the initial 3 months and received no intervention in the following 3 months. Group B received no intervention during the first 3 months and then participated in BEC training for the next 3 months. In addition, participants were followed for an additional 3 months. Muscle strength, postural balance, functional mobility, and quality of life were assessed, respectively, using an isokinetic dynamometer, force platform, TUG test, and the WHOQOL. Results: After 3 months of training, Group A presented improved balance and rate of force development (RFD), while Group B presented improvements in RFD, TUG performance, and WHOQOL physical and psychological domains. Regarding the short-term effects, the participants maintained the training effects in WHOQOL balance, RFD, and the social domain. In addition, the number of falls decreased during follow-up. Conclusion: The BEC intervention improved muscle strength, postural balance, and quality of life in older adults, in addition to reducing the risk of falls. Trial registration: Brazilian Registry of Clinical Trials (ReBEC) - RBR-5nvrwm.
Original Article JFSF, Vol 7, No 2, June 2022, p.72-80
Assessment of frailty syndrome with coexisting hypertension and depression among older individuals, aged >80 years of age
Anugna Avvari, Bana Manishaa Reddy, Enakshi Ganguly, Pawan Kumar Sharma
Keywords: Depression, Frailty, Hypertension, India, Oldest-old
Objectives: The objective was to determine odds of frailty syndrome with coexistence of hypertension and depression among oldest-old adults. Methods: We analysed secondary data from 167 community-dwelling hypertensive participants aged 80 years and older from a cross-sectional study of frailty conducted in India. Data included sociodemographic, medical history, physical performance, functional limitations, mobility-disability, cognition, depression, sleep, frailty syndrome and chronic diseases. Odds of frailty syndrome was compared among individuals having only hypertension, and individuals having hypertension and depression. Chi-square test, t-test and logistic regression were performed to determine odds of frailty. Results: Frailty was significantly higher (OR:4.93;95%CI:1.89–12.84) among individuals having hypertension and coexisting depression, compared to individuals having only hypertension. Men (OR:5.07;95%CI:1.02-25.17) and women (OR: 4.58;95%CI:1.36-15.40) with hypertension and depression showed a higher risk of frailty, compared with hypertension alone. Logistic regression models were adjusted for age, sex, cognitive impairment, chronic obstructive pulmonary disease, cardiovascular diseases, anaemia, diabetes, obesity, physical performance, activities of daily living and 4-meter walking speed. Conclusion: Coexistence of hypertension and depression increased risk of frailty syndrome among men and women above 80 years of age by almost 5 folds. Treating depression in hypertensive older individuals may reduce the risk of frailty among them.
Original Article JFSF, Vol 7, No 2, June 2022, p.81-87
The prevalence of polypharmacy and fall-risk-increasing drugs after hospital discharge for hip fracture: A retrospective study
Christiana Zidrou, Angelo V. Vasiliadis, Maria Tsatlidou, George Charitoudis, Anastasios Beletsiotis
Keywords: Elderly, Fall-risk-increasing drugs, Falls, Polypharmacy
Objectives: To evaluate the incidence of polypharmacy and the use of fall-risk-increasing drugs (FRIDs) in patients >65 years of age. Methods: 478 patients >65 years old, discharged from an Orthopaedic Department because of hip-fracture surgery, capable of walking before surgery, were included. The baseline characteristics of the patients and the total numbers of drugs and FRIDs were recorded from the electronic hospital registration system. Polypharmacy was defined as the average daily use of five or more drugs. The gender differences in drug prescriptions were calculated. Results: All the patients took medications except for eight (1.7%); 46% of the patients were taking <5 medications, while 386 (80.8%) were taking ≤3 FRIDs. The female patients were taking more drugs (5±2.7) and FRIDs (2.4±1.3) than the male ones (4.5±3 and 1.9±1.3) (both p<0.01). The average numbers of drugs and FRIDs prescribed at discharge were 4.9±2.8 and 2.3±1.3, respectively. The Barthel Index was higher for patients taking <5 drugs, while the length of hospital stay was greater for patients taking ≥5 medications. Increased age was associated with taking ≥5 medications (p<0.05). Conclusions: Polypharmacy and FRID use are prevalent among patients over 65 years old who have been hospitalized and surgically treated because of hip fractures.
Review Article JFSF, Vol 7, No 2, June 2022, p.88-94
Nutritional management of individuals with SARS-CoV-2 infection during rehabilitation
Amalia Tsagari, Grigoris Risvas, Jannis V. Papathanasiou, Yannis Dionyssiotis
Keywords: COVID-19, Nutrition, Rehabilitation
The combination of poor dietary intake and increased healthcare needs predisposes COVID-19 patients to malnutrition and sarcopenia. The scope of this narrative review is tο present epidemiology and etiology of malnutrition and sarcopenia in COVID-19 patients, their consequences as well as the content and delivery mode of optimum nutritional services for malnourished/sarcopenic COVID-19 patients in the rehabilitation setting. This narrative review also summarizes nutritional recommendations, consensus statements and treatment pathways developed by scientific societies for COVID-19 patients. COVID-19 patients are prone to malnutrition and sarcopenia due to inactivity, comorbidities, cytokine response, nutritional deficiencies, anosmia, loss of taste, anorexia and treatment with dexamethasone. Thus, all COVID-19 patients, including those who are overweight or obese, should be regularly screened for malnutrition and sarcopenia at admission to the rehabilitation setting, using a validated tool to identify those with (or at risk of) malnutrition. As a consequence of malnutrition and sarcopenia, COVID-19 patients demonstrate diminished immune potential, lower respiratory function, swallowing dysfunction, and low resilience to metabolic stress. COVID-19 patients have increased energy (27-30 kcal/day) and protein needs (1-1.5 g/kg body weight/day). Personalized nutritional education and counseling, food fortification with energy dense and/or protein rich whole foods or with powdered supplements and use of high protein, energy dense oral nutritional supplements are recommended.
Short Communication JFSF, Vol 7, No 2, June 2022, p.95-100
Scoring the Clinical Frailty Scale in the Emergency Department: The Home FIRsT Experience
Owen Thorpe, Elva McCabe, Elena Marie Herrero, William Ormiston Doyle, Aoife Dillon, Lucinda Edge, Sinéad Flynn, Anna Mullen, Aisling Davis, Aoife Molamphy, Anna Kirwan, Robert Briggs, Amanda H. Lavan, Darragh Shields, Geraldine McMahon, Arthur Hennessy, Una Kennedy, Paul Staunton, Emer Kidney, Sarah-Jane Yeung, Deirdre Glynn, Frances Horgan, Conal Cunningham, Roman Romero-Ortuno
Keywords: Clinical Frailty Scale, Disability, Emergency Department, Geriatric Assessment, Mobility
We evaluated predictors of the Clinical Frailty Scale (CFS) scored by an interdisciplinary team (Home FIRsT) performing comprehensive geriatric assessment (CGA) in our Emergency Department (ED). This was a retrospective observational study (service evaluation) utilising ED-based CGA data routinely collected by Home FIRsT between January and October 2020. A linear regression model was computed to establish independent predictors of CFS. This was complemented by a classification and regression tree (CRT) to evaluate the main predictors. There were 799 Home FIRsT episodes, of which 740 were unique patients. The CFS was scored on 658 (89%) (median 4, range 1-8; mean age 81 years, 61% women). Independent predictors of higher CFS were older age (p<0.001), history of dementia (p<0.001), mobility (p≤0.007), disability (p<0.001), and higher acuity of illness (p=0.009). Disability and mobility were the main classifiers in the CRT. Results suggest appropriate CFS scoring informed by functional baseline.
Obituary JFSF, Vol 7, No 2, June 2022, p.101-102
Martin Runge (1949-2021)
Rainer Rawer, Jörn Rittweger, Yannis Dionyssiotis, Eckhard Schönau
Keywords: Obituary