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Volume 7, Issue 2, June 2022

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