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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
Original Article JFSF, Vol 7, No 3, September 2022, p.103-116
Induced frailty and acute sarcopenia are overlapping consequences of hospitalisation in older adults
Carly Welch, Carolyn Greig, Zeinab Majid, Tahir Masud, Hannah Moorey, Thomas Pinkney, Thomas Jackson
Keywords: Acute sarcopenia, Frailty, Induced frailty, Sarcopenia
Objectives: To determine the effects of hospitalisation upon frailty and sarcopenia. Methods: Prospective cohort study at single UK hospital including adults ≥70 years-old admitted for elective colorectal surgery, emergency abdominal surgery, or acute infections. Serial assessments for frailty (Fried, Frailty Index, Clinical Frailty Scale [CFS]), and sarcopenia (handgrip strength, ultrasound quadriceps and/or bioelectrical impedance analysis, and gait speed and/or Short Physical Performance Battery) were conducted at baseline, 7 days post-admission/post-operatively, and 13 weeks post-admission/post-operatively. Results: Eighty participants were included (mean age 79.2, 38.8% females). Frailty prevalence by all criteria at baseline was higher among medical compared to surgical participants. Median and estimated marginal CFS values and Fried frailty prevalence increased after 7 days, with rates returning towards baseline at 13 weeks. Sarcopenia incidence amongst those who did not have sarcopenia at baseline was 20.0%. However, some participants demonstrated improvements in sarcopenia status, and overall sarcopenia prevalence did not change. There was significant overlap between diagnoses with 37.3% meeting criteria for all four diagnoses at 7 days. Conclusions: Induced frailty and acute sarcopenia are overlapping conditions affecting older adults during hospitalisation. Rates of frailty returned towards baseline at 13 weeks, suggesting that induced frailty is reversible.
Original Article JFSF, Vol 7, No 3, September 2022, p.117-122
A comparison of CT-body composition measurements in non-cancer and cancer patients from a single UK centre
Josh McGovern, Ross D. Dolan, Donogh Maguire, Paul G. Horgan, Barry J. Laird, Donald C. McMillan
Keywords: Cancer, Obesity, Sarcopenia
Objectives: Establish the prevalence of low skeletal muscle index and density in our population, by comparing age and sex matched cohorts of patients with and without cancer, using standardized methodology for CT-Body composition (CT-BC). Methods: A retrospective analysis of prospectively collected data. Patients admitted to our institution between 17th March 2020 - 1st May 2020, with confirmed coronavirus disease and imaging suitable for CT-BC (n=52), were age and sex matched with patients undergoing resection for colorectal cancer (n=52). Results: 104 patients were included in the final analysis. 43% (n=45) were male, 77% (n=80) were aged 65 years or older, 50% (n=50) were overweight (BMI ≥25) and 53% (n=55) were systemically inflamed (mGPS ≥1). The prevalence of a low SMI (56% vs. 65%) and low SMD (83% vs. 67%) was similar between cohorts. A low SMI and SMD were both associated with age (p<0.05 and p<0.01, respectively) on univariate analysis. On multivariate analysis, a low SMD was independently associated with age (OR 2.38 (1.34-4.22), p=0.003) and mGPS (OR 2.10 (1.20-3.68), p=0.01). Conclusions: In conclusion, the prevalence of a low SMI and low SMD was similar in non-cancer and cancer cohorts in our institution.
Original Article JFSF, Vol 7, No 3, September 2022, p.123-132
Moderate to vigorous physical activity, leucine, and protein intake contributions to muscle health in middle age
Kara A. Stone, Allison M. Barry, Christopher J. Kotarsky, Nathan D. Dicks, Sherri N. Stastny, Wonwoo Byun, Steven Mitchell, Ryan McGrath, Kyle J. Hackney
Keywords: Aging muscle, Leucine, Middle-age, Physical activity, Protein
Objective: Identify contributors to differences in the muscle size and strength of sedentary and active young and middle-aged adults. Methods: This cross-sectional study included 98 participants aged 20-65 years. Participants were categorized based on age and self-reported physical activity (PA) habits. Participants completed a strength assessment of knee extensors (KEPT), knee flexors (KFPT), plantar flexors (PFPT), and dorsiflexors (DFPT), a 3-day dietary intake log, 7-day accelerometry, and a magnetic resonance imaging (MRI) scan for muscle cross-sectional area analysis of the right quadriceps (CSAq). Results: There were significant age and activity-related group effects for relative protein intake (p<0.001), relative energy intake (p=0.04), KEPT (p=0.01), CSAq (p=0.002), PFPT (p=0.004) and DFPT (p=0.003). Moderate, moderate-to-vigorous, and vigorous PA were positively associated with CSAq (R2=0.69- 0.71; p<0.05), KEPT (R2=0.61-0.63; p<0.05), and PFPT (R2=0.31-0.36; p<0.05). Relative protein intake and daily leucine intake were significantly and positively associated with CSAq (R2=0.70 and 0.67 respectively; p<0.05), KEPT (R2=0.62 and 0.65 respectively; p<0.05), and PFPT (R2=0.29 and 0.28 respectively; p<0.05). Conclusion: Muscle size and strength were lower in middle age relative to younger age, but increased PA, protein intake, and leucine intake was associated with the preservation of muscle size and strength in larger muscle groups of the lower body.
Original Article JFSF, Vol 7, No 3, September 2022, p.133-146
Development and validation of a fall risk Questionnaire in Greek community-dwelling individuals over 60 years old
Chrysoula Argyrou, Yannis Dionyssiotis, Antonios Galanos, Ingka Kantaidou, John Vlamis, Ioannis K. Triantafyllopoulos, George P. Lyritis, Ismene A. Dontas, Efstathios Chronopoulos
Keywords: Community-dwelling adults, Elderly, Older adults, Questionnaire, Risk of falls
Objectives: The purpose of this study was to develop a questionnaire that can reliably recognize Greek individuals over the age of 60 with increased risk of falls. Methods: An 11-item self-reported Questionnaire (LRMS) was developed and delivered to 200 individuals. Collected data were compared to Timed Up and Go (TUG), Falls Efficacy Scale-International (FES-I), Tinetti Assessment Tool, Geriatric Depression Scale-15 (GDS-15) and Morse fall scale. The results were statistically analyzed. Results: Correlation between LRMS and the examined tools was high TUG (r=0. 831), FES-I (r=–0.820), Tinetti balance (r=–0.812), Tinetti gait (r=–0.789), GDS-15 (r=–0.562), and Morse fall scale (r=0.795). Cronbach’s alpha for LRMS total score was 0.807. ICC of the LRMS total score was 0.991. The area under the curve of LRMS was 0.930 (cut-off point 10.5, 95% C.I. 0.88 - 0.98, p<0.001, sensitivity=86%, specificity=98%) with TUG as gold standard, 0.919 (cut-off point 11.5, 95% C.I. 0.88 - 0.96, p<0.001, sensitivity=85%, specificity=89%) with FES-I and 0.947 (cut-off point 10.5, 95% C.I. 0.91 - 0.98, p<0.001, sensitivity=93%, specificity=91%) with Tinetti. Conclusions: The LRMS Questionnaire showed sufficient internal consistency, excellent test–retest reliability and high correlation with the already established tools for fall risk assessment. It is short and easy to use without assistance from specially trained personnel.
Original Article JFSF, Vol 7, No 3, September 2022, p.147-150
Outcomes of radical cystectomy in pT4 bladder cancer frail patients: Α high-volume single center study
Panagiotis Velissarios Stamatakos, Dimitrios Moschotzopoulos, Ioannis Glykas, Charalampos Fragkoulis, Nikolaos Kostakopoulos, Georgios Papadopoulos, Georgios Stathouros, Odysseas Aristas, Athanasios Dellis, Athanasios Papatsoris, Konstantinos Ntoumas
Keywords: Outcomes of radical cystectomy in pT4 frail patients, Radical cystectomy in frail patients, Radical cystectomy in pT4 patients, Radical cystectomy in pT4 and frail patients
Objectives: This study aims to evaluate the effect of frailty in patients undergoing radical cystectomy (RC) for locally advanced bladder cancer. Methods: In this retrospective, single center study we evaluated 51 patients with pT4 bladder cancer treated with radical cystectomy between 2016-2020. Patient frailty was assessed with the Clinical Frailty Scale (CFS). Furthermore, six separate parameters (early mortality index within 30 days after surgery, death after one year, length of stay, respiratory complications, readmission index, total hospital charges) were also evaluated. The patients were categorized on three groups (Group 1, 2, 3) based on the CFS. Results: A total of 51 pT4 RC patients were included in the study. Mean age was 75.6 years. Early mortality rate at 30 days after surgery was low all the groups. One year mortality rate was higher in Group 2 (22%) and 3 (69%). The length of stay and the number of patients with respiratory complications were also higher in the frailer groups. 30 days readmission rate was 22% in Group 2 and 38% in Group 3. Conclusions: Preoperative frailty is associated with worse postoperative results after RC. CFS is an objective tool for patient risk stratification and can predict postoperative complications and mortality.
Review Article JFSF, Vol 7, No 3, September 2022, p.151-164
Interventions and measurement instruments used for falls efficacy in community-dwelling older adults: A systematic review
Shawn Leng-Hsien Soh, Judith Lane, Ashleigh Yoke-Hwee Lim, Mariana Shariq Mujtaba, Chee-Wee Tan
Keywords: Falls efficacy, Interventions, Older adults, Outcome measures, Systematic review
Falls efficacy has been defined as perceived self-belief in the prevention and management of falls. In the case of community-dwelling older adults, it is essential that interventions should address the different aspects of falls efficacy in terms of balance confidence, balance recovery confidence, safe landing confidence and post-fall recovery confidence to improve their agency to deal with falls. This review aims to provide the current landscape of falls efficacy interventions and measurement instruments. A literature search of five electronic databases was conducted to extract relevant trials from January 2010 to September 2021, and the CASP tool for critical appraisal was applied to assess the quality and applicability of the studies. Eligibility criteria included randomised controlled trials evaluating falls efficacy as a primary or secondary outcome for community-dwelling older adults. A total of 302 full texts were reviewed, with 47 selected for inclusion involving 7,259 participants across 14 countries. A total of 63 interventions were identified, using exercise and other components to target different aspects of falls efficacy. The novel contribution of this article is to highlight that those interventions were applied to address the different fall-related self-efficacies across pre-fall, near-fall, fall landing and completed fall stages. Appropriate measurement instruments need to be used to support empirical evidence of clinical effectiveness.
Review Article JFSF, Vol 7, No 3, September 2022, p.165-174
Identifying the key characteristics of falls management programmes in UK care homes - A scoping review of grey literature
Katie R. Robinson, Adam L. Gordon, Pip A. Logan, Stephen Timmons, Meri Westlake, Alison Cowley
Keywords: Falls, Grey literature, Long-term care, Training
Trial literature on falls management in care homes may provide limited detail on current practice and instead this information may be found in grey literature. This scoping review aimed to identify the key characteristics of current falls management programmes for UK care homes identified from the grey literature. A scoping review was conducted and evidence sources were included if they were targeted at UK care homes for older people and included any component of falls management (assessment, intervention, training). Search activities included searches of electronic databases, professional websites and contacting care homes for current examples. The principles of intervention component analysis were conducted to describe the features of falls management. Forty-eight evidence sources were included (17 online resources, 10 online articles, 9 policies and standards and 12 examples provided by individual care homes). 67 themes were identified under eight domains. The core domains detailed the characteristics of Assessment, Interventions and Training. The approach taken to managing falls was an overarching domain, with supporting domains including how to report and monitor falls, when to complete assessments and interventions, governance and accountability, and involvement of the wider healthcare system.
Research Protocol JFSF, Vol 7, No 3, September 2022, p.175-182
Effectiveness of multimodal circuit exercises for chronic musculoskeletal pain in older adults: A randomized controlled trial protocol
Daniele B.G. Ribeiro, Paulo R.V. Gentil, Renan A. Resende, Rodrigo L. Carregaro, Sérgio T.D. Fonseca, Wagner R. Martins
Keywords: Aged, Exercise, Musculoskeletal Pain, Chronic Pain
Studies have shown that musculoskeletal pain is one of the most prevalent health conditions that affects many individuals worldwide. In older adults, persistent pain is a widely prevalent and a disabling condition of multiple contributing factors: physical, mental, and social. Consequently, their quality of life is hampered. We aimed to analyze the effectiveness of a multimodal circuit exercise program on chronic musculoskeletal pain and disabling in older adults. This is a randomized parallel study (two arms) with blinded outcome assessments. The participants’ recruitment will be done by a non-probabilistic sampling resulting from invitations to Basic Health Units (BHU). The sample size estimation indicated 164 participants. Participants will be allocated, by means of a randomization process, to one of two groups (82 for each group): Experimental Group (multimodal circuit exercise) or Control Group (cycle of multidisciplinary lectures on pain and stretching exercise). All analyses will be processed using the RStudio software, with significance when a p-value of 2 tails is less than 5% (p<0.05). Statistical analysis will follow the intention to treat.
Trial registration: NCT04719130, January 20, 2021.
Original Article JFSF, Vol 7, No 4, December 2022, p.183-191
Is handgrip strength a useful tool to detect slow walking speed in older Indian adults: A cross-sectional study among geriatric outpatients in a tertiary care hospital in South India
Reuben Jerrald Felix, Rakesh Mishra, Jini Chirackel Thomas, Benny Paul Wilson, Antonisamy Belavendra, Gopinath Kango Gopal
Keywords: Frailty, Gait, Handgrip strength, Sarcopenia, Walking speed
Objectives: To determine whether handgrip strength can be used as a proxy for detecting slow walking speed in older adults. Measuring walking speed in older adults can be challenging as cognitive and functional decline may have a significant impact on test performance. Methods: Hundred subjects aged >/= 60 were recruited. Slow walking speed was defined as walking speed <1.0 m/s. Handgrip strength was measured using handheld dynamometer. Multiple linear regression analysis was used to determine the relationship between the two. Results: The mean age of the study participants was 67.8±6.2 years. There were 63 males and 37 females. The mean handgrip strength of the participants was 23±5.9 kgs. Older subjects had slow gait speed (r=-0.40, p<0.001) while patients with higher BMI (r=0.36, p<0.001), handgrip strength (r=0.72, p<0.001) and appendicular lean mass (r=0.53, p<0.001) had normal gait speed. On multiple linear regression analysis, only handgrip strength (OR 0.71; 95% CI 0.58-0.87, p=0.001) and nutritional status (OR 8.60; 95% CI 1.98 - 37.40, p=0.004) were found to have a significant association with walking speed. Conclusions: Our study shows that handgrip strength assessment can be used as a surrogate indicator for detecting slow walking speed. Large population studies are warranted to examine its validity.
Original Article JFSF, Vol 7, No 4, December 2022, p.192-198
Muscle measurements in daily clinical practice: correlations between ultrasound, bioelectrical impedance analysis and hand grip strength
Elisa Cassiers, Sophie Bastijns, Stany Perkisas, Maurits Vandewoude, Anne-Marie De Cock
Keywords: Sarcopenia, Muscle ultrasound, Bioelectrical impedance analysis, Hand grip strength
Objectives: Muscle ultrasound is gaining importance as a measurement tool to evaluate sarcopenia in daily clinical practice. This study sought to collect reference values of the biceps brachii (BB) in healthy subjects, and to correlate them to bioelectrical impedance analysis (BIA) and hand grip strength (HGS). Methods: Ultrasound was used to measure muscle thickness (MT), cross-sectional area (CSA) and muscle stiffness (EG). Lean mass (LM), fat mass (FM) and phase angle (PhA) were measured by BIA. HGS was measured using a Jamar dynamometer. Intra-rater reliability was calculated using intraclass correlation (ICC). Correlations were investigated using Pearson correlation (PCC). Results: One-hundred-twenty-three Caucasian individuals (51 male and 72 female subjects) between 18 and 69 years old were included. ICC for ultrasound was 0.99 (CI 0.98-0.99). LM, PhA and HGS showed significant correlations with MT and CSA in the entire population (PCC>0.684). These correlations were more significant and stronger in male than in female subjects (PCC>0.419 and >0.279 resp.). Significant correlations with respect to FM and EG were seen exclusively in female subjects. Conclusion: Significant correlations were observed between parameters of muscle quantity measured by ultrasound, BIA and HGS. Intra-rater reliability was excellent. Future studies in larger populations are needed to clarify the observed gender differences.
Original Article JFSF, Vol 7, No 4, December 2022, p.199-206
Comparison of Habitual and Maximal Gait Speed and their Impact on Sarcopenia Quantification in German Nursing Home Residents
Daniel Haigis, Silas Wagner, Gorden Sudeck, Annika Frahsa, Ansgar Thiel, Gerhard W. Eschweiler, Andreas M. Niess
Keywords: EWGSOP2, Gait speed, Nursing home, Quantification, Sarcopenia
Objectives: Sarcopenia is characterized by loss of muscle strength and muscle mass. The EWGSOP2 specifications include physical functioning determination for quantification of the sarcopenia severity. However, there is a lack in the use of habitual and maximal gait speed and their influence on sarcopenia quantification. We hypothesize differences in sarcopenia quantification using habitual and maximal gait speed. Methods: Sixty-six residents from five nursing homes were examined. Habitual and maximal gait speed were measured by 4-meter-walking-Test. McNemar-Test and χ2-test were used to identify quantification differences. Effect sizes of both gait speeds were calculated with Spearman’s rank-correlation-coefficient. Results: Significant difference was identified for twenty-two residents in physical functioning classification by McNemar-Test (p<.001). χ2-Test identified a significant frequency distribution for sarcopenia categories between both gait speeds (χ2 (df2)=11.215, p=.004; Cramer’s V=.412). Significant correlations (p<.05) were only shown for maximal gait speed in variables falls in the last three months (|rs|=.326), Barthel-Index (|rs|=.415), and SARC-F (|rs|=. 335). Conclusions: The use of habitual and maximal gait speed has a significant impact on sarcopenia quantification in nursing home residents. An adapted standardization in the EWGSOP2 specifications should follow.
Original Article JFSF, Vol 7, No 4, December 2022, p.207-221
Association of Obesity with Cognitive Impairment and Depression among Oldest Old Population having Frailty syndrome
Gunampalli Anaika, Sai Sruthi Regalla, Bana Manishaa Reddy, Enakshi Ganguly, Pawan Kumar Sharma
Keywords: Cognitive Impairment, Depression, Elderly, Frailty, Obesity
Objectives: The objectives were to estimate prevalence of obesity among frail individuals aged ≥80 years and examine the association of obesity with cognitive impairment and depression among frail individuals aged ≥80 years. Methods: Two-hundred community-dwelling participants aged ≥80 years, were enrolled; 166 frail participants were further analyzed. Obesity and adiposity were determined by Body Mass Index (BMI), Waist Circumference (WC) and Body Fat Percentage (BF%). Cognitive impairment and Depression were assessed using Mini Mental State Examination (MMSE) and Geriatric Depression Scale (GDS-15). Frailty was assessed by Fried criteria. Chi-Square, t-test, trend-analysis and Logistic Regression (LR) were done. Results: Obesity among Frail individuals aged ≥80 years was 40% using BMI and 73.2% using WC. Obesity was inversely associated with cognitive impairment and depression among frail individuals. Severity of cognitive impairment and depression was lower among obese frail than non-obese frail. Trend-analysis showed decreasing cognitive impairment and depression with increasing BF%. On LR, obesity among frail individuals had inverse association with cognitive impairment and depression. Conclusion: Obesity among frail individuals aged ≥80 years was associated with lower odds of cognitive impairment and depression in our population. Positive effects of weight gain in oldest old frail individuals and development of cognitive impairment and dementia should be explored in further researches.
Original Article JFSF, Vol 7, No 4, December 2022, p.222-230
Identification of Probable sarcopenia based on SARC-F and SARC-CalF in older adults from a low-resource setting
Claudia L. Vidal-Cuellar, Guiliana Mas, Pamela Ayamamani-Torres, Toshio Yazawa, Oscar Rosas-Carrasco, Tania Tello
Keywords: Low-resource setting, Probable sarcopenia, SARC-F, SARC-CalF, Sarcopenia
Objectives: We aimed to investigate the frequency of probable sarcopenia and to compare the performance of SARC-F and SARC-CalF for detecting this condition in outpatient older adults from a low-resource setting. Methods: We conducted a retrospective, cross-sectional study in outpatient older adults aged ≥60 years attending a hospital in Peru, between August 2019 and February 2020. Probable sarcopenia was defined as low handgrip strength (<27 kg in men and <16 in women). We used SARC-F and SARC-CalF with their standard cut-off points (≥4 and ≥11, respectively). Low calf circumference was defined as ≤33 cm in women and ≤34 cm in men. We performed sensitivity and specificity analyses. Results: We included 206 older adults, 102 (49.5%) aged ≥75 years old and 140 (67. 9%) females. Probable sarcopenia was present in 36.40% of the participants. SARC-F ≥4 was observed in 29.61% and SARC-CalF ≥11 in 41.26% of the population. SARC-F≥4 showed 41.33% sensitivity and 77.10% specificity, whereas SARC-Calf ≥11 had 50.67% sensitivity and 64.12% specificity. Conclusion: We found that one out of three of the population had probable sarcopenia. SARC-Calf showed superior but still low sensitivity than SARC-F, while both had moderate specificity and thus may be useful for ruling out the disease in clinical practice.
Review Article JFSF, Vol 7, No 4, December 2022, p.231-250
The effect of weight-bearing exercise on the mechanisms of bone health in young females: A systematic review
Tommy J. Cartledge, Joey Murphy, Charlie E. Foster, Byron Tibbitts
Keywords: Female, Healthy ageing, Paediatric, Peak bone mass, Physical activity
Weight-bearing exercise (WBE) has been identified as an appropriate approach for increasing peak bone mass, however, there is a lack of specific physical activity recommendations in this area. Thus, the aim of this systematic review is to determine the optimal mode of WBE, specifically identifying the intensity, duration, frequency, and load, to elicit the optimal effect on bone mass in young females, aged 5-18. A literature search was conducted from the 28th of June to the 20th of July 2021 using PubMed/Medline, Web of Science and SPORTDiscus. The search produced 1405 results, of which 15 were deemed appropriate for inclusion. The majority of studies (n=12) found a significant positive effect for at least one bone measure through their respective WBE exposure (p<0.05). Bone mass accrual was found to be site-specific depending on WBE exposure type, load, and maturity status. Also, longitudinal effects on bone mass accrual were found exclusively in gymnastics participants, even if participation level decreased (i.e., retirement). The results of this study support the use of WBE to improve parameters of bone health. However, further research is needed as the optimal mode of WBE to elicit the optimal effect on bone mass is still unclear.
Case Report JFSF, Vol 7, No 4, December 2022, p.251-256
Periprosthetic fracture of total hip replacement in patients with osteopetrosis: A case presentation and review of literature
Eftychios Papagrigorakis, Athanasios Galanis, Christos Vlachos, Michail Vavourakis, Dimitrios Zachariou, John Vlamis, Spiros Pneumaticos
Keywords: Internal fixation, Open reduction, Osteopetrosis, Periprosthetic fracture, Total hip arthroplasty
Osteopetrosis is a rare inherited bone disease characterized by impaired osteoclast activity. Total joint replacement is often necessary in these patients, as osteoarthritis is an early manifestation of the disease. However, only a few cases of periprosthetic fractures have been reported in the literature. A 73-year-old female patient sustained a periprosthetic fracture of the right femur after a fall from standing height. The patient had undergone a total hip arthroplasty surgery 10 years ago. Intraoperatively both the acetabular cup and the femoral stem were found stable, thus the fracture was treated using plating with locking screws and cables. No postoperative complication was observed and the fracture was completely healed after 6 months. Periprosthetic fracture management poses special difficulties and technical issues in patients with osteopetrosis. Hematologist consultation is an important part of the preoperative preparation, while a careful postoperative follow-up is crucial due to the high rates of postoperative complications. The intraoperative technical challenges in the management of an osteopetrotic bone are many due to the abnormal bone density. Orthopedic surgeons have to engage specific strategies to avoid pitfalls as interventions are technically challenging, leading to prolonged operative time and increased blood loss.
Corrigendum JFSF, Vol 7, No 4, December 2022, p.257
Corrigendum to: Sarcopenia in Hemiplegia
Maria C. Papadatou
The author regrets the originally published manuscript Sarcopenia in Hemiplegia, JFSF Vol 5, No 2, June 2020, p.38-41, contained an error in the “Therapeutic approach and management” section. Specifically, instead of selective androgen receptor modulators (SARMs), mistakenly it is written selective estrogen receptor modulators (SERMs).