Volume 9, Issue 1, March 2024

Objectives

Osteoporosis is associated with greater risk of fracture, which can lead to increased morbidity and mortality. DEXA scans are often inaccessible for patients, leaving many cases of osteoporosis undetected. A portable 3D topographical scan offers an easily accessible and inexpensive potential adjunct screening tool. We hypothesized that 3D scanning of arm and calf circumference and volume would correlate with DEXA T-scores.

Methods

96 female patients were enrolled. Patients were consented and completed a topographical scan of bilateral arms and lower legs with a mobile 3D scanner for arm and calf circumference and volume in clinic. Patient charts were then retrospectively reviewed for DEXA T-scores.

Results

Forearm DEXA T-score was positively correlated with arm circumference (r = 0.49, p<0.01), arm volume (r=0.62, p<0.01), and calf volume (r=0.47, p<0.01). Femoral neck DEXA T-score was positively correlated with calf circumference (r=0.36, p<0.01) and calf volume (r=0.36, p<0.01).

Conclusions

Our results showed significant correlations between DEXA T-scores and topographical measurements from mobile device acquired 3D scans, although these were in the “moderate” range. Mobile device-based 3D scanning may hold promise as an adjunct screening tool for osteoporosis when DEXA scanning is not available or feasible for patients, although further studies are needed to elucidate the full potential of its clinical utility. At a minimum, identifying a patient as high risk may promote earlier diagnostic DEXA scanning.

Objective

This study aimed to assess the association between measures of frailty phenotype (FP) and malnutrition, and sarcopenia measured by bioelectrical impedance analysis (BIA), in individuals aged 50 and above attending an outpatient falls clinic.

Methods

The Survey of Health, Ageing and Retirement in Europe Frailty Instrument (SHARE-FI) gauged FP status, while nutritional assessment relied on the Mini Nutritional Assessment-Short Form (MNA^®-SF). Body composition, specifically appendicular skeletal muscle mass (ASMM), was determined through TANITA^® DC-430MA BIA. Multivariable binary logistic regression models were used to predict pre-frailty or frailty based on SHARE-FI and at-risk of malnutrition or malnutrition based on MNA^®-SF.

Results

Out of the 123 participants (68 women, 55 men), 56.1% were classified as robust, 27.6% as living with pre-frailty, and 16.3% as living with frailty according to SHARE-FI. MNA^®-SF results were available for 116 patients, with 54.3% categorised as normal, 39.7% at risk of malnutrition, and 6.0% as malnourished. Among the 118 patients who underwent BIA, ASMM was independently associated with pre-frail/frail status, but there was no significant association between abnormal MNA^®-SF and sarcopenia.

Conclusion

SHARE-FI, a modified FP tool, demonstrated an independent association with sarcopenia as measured by BIA.

Objectives

The most efficient way to adjust skeletal muscle area (SMA) derived from chest CT to body size remains unclear. We hypothesized that vertebral body area (VBA) measurement would allow such efficient adjustment.

Methods

We conducted a retrospective observational study of chest CT imaging in a cohort of critically ill COVID-19 patients. We measured paravertebral SMA at T5 level and T5 vertebral body anteroposterior length, width, and area. We used linear regression and multivariable modelling to assess the association of VBA with SMA.

Results

In 48 COVID-19 patients in ICU, T5 VBA could be easily derived from simple width and anteroposterior length linear measurements. T5 VBA (measured manually or estimated from width and length) performed similarly to height (R² of 0.22) as an adjustment variable for SMA, with R² of 0.23 and 0.22, respectively. Gender had the strongest correlation with SMA (R² = 0.28). Adding height or age to a model using gender and VBA did not improve correlation.

Conclusions

Gender and estimated VBA from simple linear measurements at T5 level on CT images can be utilized for adjustment of SMA without the need for height. Validation of these findings in larger cohorts of critically ill patients is now needed.

Objectives

To assess the link between ultrasonographic measurements of the biceps brachii and total muscle mass measured by bio-impedancemetry in hospitalized older patients.

Methods

A prospective observational study was conducted. The study included patients older than 65 years admitted in internal medicine, acute geriatrics, orthogeriatrics and rehabilitation departments. All measurements, ultrasonographic measurements and muscle mass and function by bio-impedancemetry and dynamometry, were taken within the first 48 hours of admission.

Results

In total 19 patients were included, the mean age was 85.4 ± 3.9 years and 7 (36.8%) were females. Very strong direct correlations were obtained in the entire cohort in both biceps brachii cross-sectional area and muscle thickness with skeletal muscle mass displayed in kilograms.

Conclusion

Biceps brachii looks like a very good muscle measuring tool: easy, comfortable, fast, good correlated with total body muscle mass. This muscle could effectively be used for the assessment of muscle mass in the diagnosis of sarcopenia since it reflects muscle mass precisely, however more studies are needed to provide reference values in all age cohorts.

Objective

To implement and evaluate a Frailty Care Bundle (FCB) targeting mobilisation, nutrition, and cognition in older trauma patients to reduce hospital associated decline.

Methods

We used a two group, pretest-posttest design. The FCB intervention was delivered on two orthopaedic wards and two rehabilitation wards, guided by behaviour change theory (COM-B) to implement changes in ward routines (patient mobility goals, nurse assisted mobilisation, mealtimes, communication). Primary outcomes were patient participants' return to pre-trauma functional capability (modified Barthel Index - mBI) at 6-8 weeks post-hospital discharge and average hospital daily step-count. Statistical analysis compared pre versus post FCB group differences using ordinal regression and log-linear models.

Results

We recruited 120 patients (pre n=60 and post n=60), and 74 (pre n=43, post n=36) were retained at follow-up. Median age was 78 years and 83% were female. There was a non-significant trend for higher mBI scores (improved function) in the post compared to pre FCB group (OR 2.29, 95% CI 0.98-5.36), associated with an average 11% increase in step-count.

Conclusion

It was feasible, during the Covid-19 pandemic, for multidisciplinary teams to implement elements of the FCB. Clinical facilitation supported teams to prioritise fundamental care above competing demands, but sustainability requires ongoing attention.

ISRCTN registry:

ISRCTN15145850

This systematic review and meta-analysis aimed to explore the differences in the number of prescribed medications and polypharmacy risk between patients with heart failure (HF) and frailty vs. those with HF but without frailty. Eligible studies included observational or experimental studies in patients aged ≥50 years. Thirteen studies met the criteria and were included in the final analysis. Patients with frailty and HF exhibited a higher risk of polypharmacy (OR: 1.87, 95% CI 1.72 - 2.04, I² = 0%, P<0.01) compared to those without frailty. Results remained significant after adjusting for comorbidity status. Additionally, patients with frailty and HF were prescribed more medications compared to those without (k = 6; MD: 1.43, 95% CI 0.31 - 2.55, I2 = 94%, P = 0.01), with a high degree of heterogeneity. However, results were non-significant after adjustment for comorbidity status. Patients with HF and frailty have a higher need of polypharmacy compared to those without frailty, which may increase the risk of potentially inappropriate medications (PIM). Investigating the real-world prevalence of PIM may support clinicians in their routine assessment as part of a comprehensive management strategy in patients with HF and frailty

Physical activity and exercise can limit the development of sarcopenia in Parkinson's Disease. This review aims to evaluate the potential effects of behavioural change (BC) interventions on exercise self-efficacy and adherence in people with Parkinson's. We searched nine databases and included randomised and non-randomised studies reporting exercise self-efficacy, quality of life (QoL), physical function and/or exercise adherence. Two reviewers independently screened, data extracted, and assessed risk of bias and certainty of evidence. The interventions were mapped to the Theoretical Domains Framework. Eleven studies (n=901) were included. Four were randomised trials and risk of bias was mixed. Most interventions were multi-component, including education, behavioural techniques, and support groups. The most effective domains appear to be Behavioural regulation, Belief about Capabilities, Social influences, Reinforcement and Goals. Future research should examine multi-component BC interventions encompassing the five most effective TDF domains.