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Volume 7, Issue 3, September 2022

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.