Sex-specific differences in risk factors for sarcopenia amongst community-dwelling older adults

With considerable variation including potential sex-specific differential rate of skeletal muscle loss, identifying modifiable factors for sarcopenia will be pivotal to guide targeted interventions. This study seeks to identify clinical and biological correlates of sarcopenia in community-dwelling older adults, with emphasis on the role of anabolic and catabolic stimuli, and special reference to gender specificity. In this cross-sectional study involving 200 community-dwelling and functionally independent older adults aged ≥50 years, sarcopenia was defined using the Asian Working Group for Sarcopenia criteria. Comorbidities, cognitive and functional performance, physical activity and nutritional status were routinely assessed. Biochemical parameters included haematological indices, lipid panel, vitamin D level, anabolic hormones [insulin-like growth factor-1 (IGF-1), free testosterone (males only)] and catabolic markers [inflammatory markers (interleukin-6, C-reactive protein) and myostatin]. Multiple logistic regression was performed to identify independent predictors for sarcopenia. Age was associated with sarcopenia in both genders. Malnutrition conferred significantly higher odds for sarcopenia in women (OR = 5.71, 95 % CI 1.13–28.84.44, p = 0.035) while higher but acceptable range serum triglyceride was protective in men (OR = 0.05, 95 % CI 0.00–0.52, p = 0.012). Higher serum myostatin independently associated with higher odds for sarcopenia in men (OR = 1.11, 95 % CI 1.00–1.24, p = 0.041). Serum IGF-1 was significantly lower amongst female sarcopenic subjects, with demonstrable trend for protective effect against sarcopenia in multiple regression models, such that each 1 ng/ml increase in IGF-1 was associated with 1 % decline in odds of sarcopenia in women (p = 0.095). Our findings support differential pathophysiological mechanisms for sarcopenia that, if corroborated, may have clinical utility in guiding sex-specific targeted interventions for community-dwelling older adults.     

Limitations of SARC-F in the diagnosis of sarcopenia in community-dwelling older adults

PurposeThe SARC-F is a recommended screening tool for sarcopenia; however, its sensitivity is reported to be very low. This study aimed to confirm the diagnostic efficacy of the SARC-F and whether it is affected by population characteristics.MethodsIn this study, 2 cohorts of 1060 community-dwelling older adults, who were monitored by the Tokyo Metropolitan Institute of Gerontology, were included. In addition to the overall dataset, receiver operating characteristic curve analysis was performed to obtain the SARC-F results for sarcopenia among the datasets for only those older in age (over 75 years), those with higher frailty points (above the median total score for the Kihon Checklist points), those with lower grip strength (below the median), lower gait speed (below the median), and those with comorbidities (hypertension, cerebral vascular disease, heart disease, and diabetes mellitus).ResultsIn the overall dataset, sensitivity and specificity were 3.9% and 97.3%, respectively. In analyzing the area under the curve, sensitivity and specificity for older age and low physical function datasets were significant, but had low values. The diabetes dataset had higher values but did not effectively diagnose sarcopenia at a cutoff value of 4.ConclusionThe SARC-F had high specificity for the diagnosis of sarcopenia in community-dwelling older adults with low physical function. However, its sensitivity was low. Despite these limitations, it may be used as a screening tool for sarcopenia in selected populations, such as adults in hospitals or nursing homes.     

The prevalence and risk factors for sarcopenia in older adults and long-living older adults

PurposeSarcopenia is a muscular syndrome that is related to several adverse risks. The present study aimed to evaluate the prevalence of risk of sarcopenia and associated factors in older adults and long-living older adults.MethodsA crosssectional epidemiological study of older adults patients at a geriatric outpatient clinic. The older adults were evaluated for sarcopenia risk using the SARC-F questionnaire supplemented with the measurement of the calf circumference. In addition, nutritional status was characterized using the Mini Nutritional Assessment, and the relationship of sarcopenia with associated factors (comorbidities, polypharmacy, smoking).ResultsA total of 100 eligible older adults with a mean age of 77.2 ± 1.8 years in the older adults and 86.3 ± 4.2 years in the long-living older adults (p < 0.001) were evaluated. The long-living older adults (OR = 6.1; 95 % CI: 1.44–16.09; p = 0.01) and older adults at risk of malnutrition (OR = 13.6; 95 % CI: 1.55–11.38; p < 0.05) had a higher risk of sarcopenia, whereas BMI ≥ 27 kg/m 2 (OR = 0; 95 % CI: 0–0.06; p < 0.001) was a protective factor. The risk of sarcopenia was six times higher in the over-80 s (95 % CI = 1.44, 16.09), while the older adults with malnutrition or at nutritional risk ran a 13 times higher risk of sarcopenia (95 % CI = 1.55, 11.38).ConclusionThe prevalence of risk of sarcopenia was higher in the long-living older adults and the older adults at nutritional risk, making its early evaluation in clinical practice important.     

Use of pain relieving drugs in community-dwelling older people with and without type 2 diabetes

AimsTo analyze the use of pain medication among community-dwelling people aged 65 years or older with and without type 2 diabetes in primary care.MethodsA total of 187 patients with and 176 patients without diabetes were randomly selected from a primary care sample of 389 patients with diabetes and 604 age- and gender-matched controls. Pain status was defined as no pain, nociceptive pain or neuropathic pain. Pain medication (paracetamol, NSAID, opioids, neuropathic pain medication) use was based on electronic patient records and checked by a physician during a health examination.ResultsSome pain was present in 90 (51%) patients without and in 106 (57%) patients with diabetes (p = 0.55). Of the patients without diabetes, 109 (62%) and with diabetes 123 (66%) used some pain medication (p = 0.45). The respective proportions for the regular use were 13% and 11% and for the as needed use 56% and 61%. Diabetes was not associated with any of the pain medications used. The use of pain-relieving drugs was most common for neuropathic pain.ConclusionsThe present study indicated that community-dwelling people with and without diabetes used pain medication similarly. Pain medication was used mostly as needed instead of being regular.     

High proportions of older people with normal nutritional status have poor protein intake and low diet quality

IntroductionThe Mini Nutritional Assessment (MNA) is a well-validated instrument examining the nutritional status of older people. The aim of this study was to examine how older people’s energy and nutrient intakes are associated with the MNA and to determine how sensitive and specific MNA is in identifying those having low energy and protein intakes.Materials and methodsThis cross-sectional study combined data from five nutritional studies (N = 900): both home-dwelling and institutionalized older people without and with disabilities. Their nutritional status was assessed with MNA, and nutrient intakes were retrieved from 1 to 3 day food diaries. Nutrient intakes were divided according to MNA status (normal nutritional status, at-risk of malnutrition, malnourished). Sensitivity, specificity, and likelihood ratios of MNA of various cut-off points were tested with recommended protein and energy intakes. ROC curves was constructed.ResultsEnergy, protein and most nutrient intakes showed logical linear trends according to MNA classes. However, more than three-fourths of the participants with MNA > 23.5 had lower than recommended protein intakes. Sensitivity of MNA ranged from 0.32 to 0.82 for recommended energy (F:1570 kcal/d/M:2070 kcal/d) and protein intakes (1.0 g/kg BW or 1.2 g/kg BW) cut-off points, and specificity from 0.75 to 0.25, respectively. AUC values were low (0.52–0.53).ConclusionsMNA status was consistently associated with nutrient intakes and diet quality. However, a high proportion of older people even with normal nutritional status had poor energy and protein intakes. Thus, MNA does not identify all those with poor nutrient intakes who may be at risk of developing malnutrition.     

Determinants of home-based formal help in community-dwelling older people in Finland

Knowledge of the determinants of use of formal home-based services among older people is of particular importance for predicting the need for and cost of care in the future. The aim of this study was to estimate the frequency of formal and informal help among community-dwelling older people and to assess the determinants of home-based formal help, with a special emphasis on the frequency of help from spouse, from children and other relatives and friends. We used nationally representative cross-sectional data from 1,166 community-dwelling Finnish persons aged 70–99. Determinants of formal help were assessed with logistic regression models. Receiving formal help was most strongly related to need factors such as age and functional capacity. Adjusted for need factors, receiving help from spouse or living with someone else than the spouse decreased the odds of receiving formal help. In contrast, the more frequently the children helped, the larger were the odds of receiving formal home-based help. Help from other informal sources did not affect receipt of formal help. Our results thus suggest that intra-household help from spouse or from other co-residents may partly offset expected cost increases in the formal care sector brought about by an aging population. The results further suggest that help from children and help from formal sources is likely to be concomitant and that children may act as agents seeking formal help also in a welfare state based on the universal and equal care services.

Identifying sources of strength: resilience from the perspective of older people receiving long-term community care

This study seeks to explore the sources of strength giving rise to resilience among older people. Twenty-nine in-depth interviews were conducted with older people who receive long-term community care. The interviews were subjected to a thematic content analysis. The findings suggest that the main sources of strength identified among older people were constituted on three domains of analysis; the individual-, interactional and contextual domain. The individual domain refers to the qualities within older people and comprises of three sub-domains, namely beliefs about one’s competence, efforts to exert control and the capacity to analyse and understand ones situation. Within these subdomains a variety of sources of strength were found like pride about ones personality, acceptance and openness about ones vulnerability, the anticipation on future losses, mastery by practising skills, the acceptance of help and support, having a balanced vision on life, not adapting the role of a victim and carpe-diem. The interactional domain is defined as the way older people cooperate and interact with others to achieve their personal goals. Sources of strength on this domain were empowering (in)formal relationships and the power of giving. Lastly, the contextual domain refers to a broader political-societal level and includes sources of strength like the accessibility of care, the availability of material resources and social policy. The three domains were found to be inherently linked to each other. The results can be used for the development of positive, proactive interventions aimed at helping older people build on the positive aspects of their lives.     

Association between sarcopenia and pneumonia in older people

Pneumonia is a major cause of death in older people, and the number of such deaths is increasing. Present guidelines for pneumonia management are based on a pathogen‐oriented strategy that relies on the optimal application of antibiotics. Older pneumonia inpatients show the high incidence of aspiration pneumonia. The main cause of aspiration pneumonia is an impairment in the swallowing and cough reflexes. These facts suggest a limitation of present management strategies and a requirement for new strategies for aspiration pneumonia. Sarcopenia is the loss of muscle strength and mass, and declining physical function with aging. Recently, a decrease in the mass or strength of the swallowing muscles was suggested to be associated with reduced swallowing function. Accordingly, dysphagia caused by sarcopenia of the systemic and swallowing‐related muscles was named sarcopenic dysphagia. Presently, few studies have shown associations between aspiration pneumonia and sarcopenic dysphagia. As for the cough reflex, strong cough prevents aspiration pneumonia, and its strength is regulated by respiratory muscles. A few studies have reported a relationship between muscles and pneumonia in older people. Sarcopenia is a risk factor for pneumonia in older people, and aspiration pneumonia inpatients with low muscle mass show high mortality rates. Aspiration pneumonia induced muscle atrophy in respiratory, swallowing, and skeletal muscles in an animal model and humans. Associations between respiratory muscle strength and pneumonia are currently under investigation. Evaluation and management of sarcopenia could potentially become a new strategy to prevent and treat pneumonia in older patients, and research has only recently been launched. Geriatr Gerontol Int 2020; 20: 7–13 .     

Association of sarcopenia with depressive symptoms and functional status among ambulatory community-dwelling elderly

ObjectiveSarcopenia, functional disability, and depression are common problems in the elderly. Sarcopenia is associated with physical disability, functional impairment, depression, cardiometabolic diseases, and even mortality. This study aims to determine the association of sarcopenia with depression and functional status among ambulatory community-dwelling elderly aged 65 years and older.Materials and methodThe sample of this cross-sectional study consisted of 28,323 people, aged 65 years and older, living in Bornova, Izmir. Multi-stage sample selection was performed to reach 1007 individuals. However, 966 elderly people could be reached, and 861 elderly people who can walk were included in the study. The data were collected by the interviewers at home through face-to-face interview.ResultsThe mean age was 72.2 ± 5.8 (65–100) years. The prevalence of functional disability, depressive symptoms, and sarcopenia were 21.7%, 25.2%, and 4.6%, respectively. In multivariate analysis depression was associated with sarcopenia, being illiterate and divorced, perception of the economic situation as poor/moderate, increased number of chronic diseases, and having at least one physical disability. IADL associated functional disability with sarcopenia, being illiterate/literate and female, increased age and number of medications, and the BMI.ConclusionSarcopenia in ambulatory community-dwelling elderly is significantly associated with depressive symptoms and functional disability. Elderly people at high risk of sarcopenia should be screened for functional disability and depression. Appropriate interventions should also be implemented.     

Health related quality of life and its associated factors among community-dwelling older people in Sri Lanka: A cross-sectional study

BackgroundPopulation ageing has become a public health issue as it is associated with increased morbidity, institutionalization and death. These may directly affect health-related quality of life (HRQOL) of older people.PurposeThe aim of the study was to investigate HRQOL and its associated factors among community-dwelling older people in Kandy district, Sri Lanka.MethodThis cross-sectional survey involved 1300 older people. The Euro 5D-3L, International Physical Activity Questionnaire, body mass index, handgrip strength were used to measure HRQOL, physical activity and nutritional status of older people respectively. Factors associated with health-related quality of life were identified through complex sample logistic regression analysis.ResultsMajority of older people (81.9%) reported poor health-related quality of life. Middle old (aOR: 12.06, 95% CI: 5.76, 25.23), very old (aOR: 174.74, 95% CI: 39.74, 768.38), vegetarian diets (aOR: 2.13, 95% CI: 1.14, 3.96), under-nutrition (aOR: 3.41, 95% CI: 1.65, 7.04) and over-nutrition (aOR: 1.85, 95% CI: 1.04, 3.28) were significantly associated with poor HRQOL. Using dentures (aOR: 0.05, 95% CI: 0.28, 0.90) was found as a protective factor for poor HRQOL.ConclusionsHRQOL was poor among community-dwelling older people in Kandy district. Nutrition-related factors need to be further investigated to improve HRQOL among older people.     

Association of mean corpuscular volume with sarcopenia and visceral obesity in individuals without anemia

Aims/IntroductionSarcopenia and visceral obesity are major global public health issues, and higher mean corpuscular volume (MCV) levels are related to adverse outcomes. Nevertheless, no study has determined the association between MCV and body composition. Therefore, we evaluated the association between MCV levels and trunk muscle quality, muscle quantity and visceral fat area.Materials and MethodsIn our cross‐sectional study, we investigated 702 middle‐aged Japanese individuals without anemia and with normal MCV levels who underwent physical checkups. The cross‐sectional area of skeletal muscle or visceral fat was analyzed by computed tomography.ResultsIn the adjusted model, the MCV was independently associated with the visceral fat area index (β = −0.107, P = 0.0007), total skeletal muscle index (β = 0.053, P = 0.0341) and total skeletal muscle density (β = 0.099, P = 0.0012). MCV as a continuous variable was related to the prevalence of sarcopenia (odds ratios [OR] 0.93, 95% confidence intervals (CI) 0.88–0.98, per 1.0 fL increment; P = 0.0097) and visceral obesity (OR 0.91, 95% CI 0.86–0.97, per 1.0 fL increment; P = 0.0046). The highest MCV quartile was independently associated with the prevalence of sarcopenia (OR 0.48, 95% CI 0.27–0.83; P = 0.0089) and visceral obesity (OR 0.49, 95% CI 0.27–0.88; P = 0.0170), compared with the lowest quartile.ConclusionsIn individuals without anemia and with normal MCV levels, a lower MCV was associated with unfavorable body composition, including lower muscle quality, lower muscle quantity, sarcopenia and visceral obesity.     

Nutrient intake in relation to central and overall obesity status among elderly people living in the Mediterranean islands: The MEDIS study

Background and Aim

The aim of the present work was to evaluate the relationship between energy-generating nutrients and the presence of central and overall obesity after correcting for socio-demographic, lifestyle and clinical characteristics, among healthy elders.

Methods and Results

During 2005-2007, 553 elderly men and 637 elderly women (mean age 74 ± 7 years) from eight Mediterranean islands in Greece and Cyprus, were enrolled. The retrieved information included demographic, bio-clinical and dietary characteristics. MedDietScore assessed adherence to the Mediterranean dietary pattern.The prevalence of obesity was 27% in males and 39% in females (p < 0.001), while 73% of males and 87% of females had central obesity. The prevalence of diabetes, hypercholesterolemia and hypertension was higher in the obese than in the non-obese participants (p < 0.01). After adjusting for various confounders, a 1% increase in carbohydrate consumption was associated with a 12% (95% CI 0.78-0.99) lower likelihood of having central obesity, while a 1% increase in carbohydrate and protein consumption was associated with a 14% (95% CI 0.78-0.95) and 16% (95% CI 0.72-0.97) lower likelihood of being obese, respectively. Vegetable protein was found to be associated with a 15% (95% CI 0.77-0.93) lower likelihood of being obese while, only low glycemic index carbohydrates seem to be associated with a 6% (95% CI 0.90-0.98) lower likelihood of having central obesity.

Conclusions

The presented findings suggest that a diet high in carbohydrates and vegetable protein is associated with a lower likelihood of being obese and may help elderly people to preserve normal weight.     

Preventive home visits to older home-dwelling people and different functional decline patterns

A preventive home visitation scheme has been part of Danish legislation since 1996. The aim of this study was to describe functional trajectories of older home-dwelling people, and to identify whether education of the preventive home visitation staff and individual risk factors were related to specific functional decline patterns. The study is a secondary analysis of a population-based prospective controlled cohort study. Participation totalled 3,129 non-disabled 75- and 80-year-old men and women without mobility disability at baseline living in 34 municipalities. Self-reported functional ability was measured at baseline and after 1½, 3 and 4½ years follow-up. No functional decline was seen in 58% of the participants. A total of 17% developed catastrophic decline, 6% progressive and 7% showed a reversible decline pattern. The remaining 12% showed mixed patterns. Education of the preventive home visitation staff was associated with a reduced risk of progressive decline, RR = 0.66 (CI 95% 0.50–0.86, p = 0.002). Not receiving home visits and living alone were associated with increased risk of catastrophic decline. Younger age (75 at baseline) was less associated with all decline patterns compared with older age (80 at baseline). Men had less risk of developing progressive, reversible and mixed decline patterns than women, but an increased risk of developing catastrophic decline. A feasible educational preventive staff intervention was associated with a reduced risk of progressive functional decline but not with other functional decline patterns. Early signs of functional decline may serve as an important trigger for when to intensify the search for and actively seek to ameliorate preventable conditions.     

Association between sarcopenia and mortality in healthy older people

Aim: To evaluate the association between loss of fat‐free mass and mortality among older people. Methods: Information of healthy Chilean older people evaluated by dual energy X‐ray absorptiometry was used, identifying those who died in a period of 12 years. A Cox proportional hazards model was used to identify mortality predictors. Life tables were constructed calculating survival using predictive variables. Results: Information from 1413 participants aged 74.3 ± 5.6 years (1001 women), was obtained. During the follow‐up (median 1594 days), 221 participants died. The Cox model identified age and appendicular fat‐free mass as predictors of death (hazard ratios 1.08 and 0.85, respectively). According to life tables, participants in the lower sex‐specific quartile for appendicular fat‐free mass/height had significantly higher mortality. This association was significant among participants aged over 73 years. Conclusion: A low fat‐free mass was predictive of mortality in older people.     

Validation of the Geriatric Anxiety Inventory in Chilean older people

ObjectiveCurrently in Chile there is a lack of validated tools for measuring anxiety in the elderly population. Considering this, the purpose of this study was to validate the Geriatric Anxiety Inventory (GAI) in the country.MethodAn analysis of the psychometric properties of the GAI was carried out, using a non-clinical sample of 301 older adults in the Metropolitan and Valparaíso regions of Chile. Older people were asked about anxiety, rumination, depression, well-being and sociodemographic data.ResultsAn excellent internal reliability was obtained with a Cronbach score of 0.931. An adequate convergent validity was observed with the Depression scales (CES-D) (Rho = 0.549, p < .01), Rumination (RSS) (Rho = 0.618; p < 0.01) and Experiential avoiding (Rho = 0.485; p < 0.01). On the other hand, the discriminant validity of the psychological well-being scale presented a negative correlation of Rho = -0.699 (p < 0.01). Finally, and Exploratory Factor Analysis was made, revealing a one-dimensional model of the instrument.ConclusionThe Geriatric Anxiety Inventory has very good psychometric properties measuring anxiety in elderly people, being an adequate instrument for the screening of anxiety on this population.     

Factors associated with the prevalence of sarcopenia and frailty syndrome in elderly university workers

BackgroundFrailty and sarcopenia are highly prevalent, as a part of geriatric syndrome, among elderly individuals. However, little is known about how these syndromes can affect elderly individuals who continue to work.ObjectiveTo estimate the prevalence of sarcopenia and frailty, and their individual and occupational factors among elderly individuals.MethodsThis cross-sectional study included elderly individuals working in a public university in Brazil, who were classified according to their sarcopenia and frailty profiles. They answered a structured questionnaire comprising potential explanatory variables: individual sociodemographic factors, work related factors, and health behaviors. Additionally, they performed a physical performance test. Multinomial logistic regression was used to estimate odds ratios and respective 95% confidence intervals (95% CIs). All analyses were conducted using the Stata 13.0 software, considering a significance of 5%.ResultsRespectively, 55.8% and 6.3% of the elderly participants were classified in the Sarcopenia and Severe Sarcopenia groups. Frailty prevalence was 9.4%, with 62.5% classified as Pre-frail. Sarcopenia prevalence was significantly higher among men, and among those living with a partner, with a university degree, exhibiting poor lower limb function, and with multiple work demands. Frailty prevalence was significantly higher among women, and among those living without a partner, having a low educational level, with less work experience, working in an unhealthy/dangerous environment, and whose job was predominantly physical.ConclusionThis study identified different potential trigger factors for the development of sarcopenia and frailty. These findings confirm that individual and work factors could explain the incidence of sarcopenia and frailty syndrome.     

Preventive home visits to home-dwelling older people and hospital admissions: a municipality-randomised intervention trial

Preventive home visits to older home-dwelling people have been part of national policy in Denmark since 1996. The aim was to evaluate whether education of home visitors and GPs was associated with hospital admission rates. In a population-based prospective controlled intervention trial in 34 municipalities, intervention municipality visitors received regular education during 3 years and GPs were introduced to a short assessment programme. Participation totalled 4,034 75- and 80-year-old home-dwelling persons, of which 3,132 (78%) had no mobility disability at baseline. Complete data on hospital services were obtained for all participants. No difference was observed in time to first admission between older people living in the intervention municipalities compared with people living in the control municipalities, HR 0.93 (95%CI: 0.85, 1.02, P = 0.17). Duration of first hospital stay was the same in the two groups (7.3 days). The mean number of admissions was not associated with intervention. Accepting and receiving home visits was associated with a reduced risk of hospital admission, HR 0.84 (95%CI: 0.76, 0.92), especially among the initially disabled. Hospital admission rates were associated with functional decline patterns. Persons experiencing catastrophic and progressive decline had the highest risk. Persons experiencing reversible functional decline were more often hospitalised in the intervention municipalities, and fewer persons living in the intervention municipalities experienced progressive decline. Education of primary care professionals was not associated with risk for first hospital admission among all older people living in the community, but may be associated with older people’s different functional decline patterns.     

Determination of the costs of falls in the older people according to the decision tree model

Purpose of the researchThe primary aim of this study is to hypothetically examine the costs of falls experienced by the older people living in the community and fall prevention interventions implemented by nurses using the decision tree model. The secondary purpose of the study is to determine the factors affecting the cost of falls.The materials and methodsThis study was planned as a costing and cost-effectiveness study. Two thousand seventy-five patient files were examined by following the research criteria. In the present study, a hypothetical analytical decision tree model was used. Three different scenarios were set up in the study, and the decision tree analyses were performed according to these scenarios. Falls will decrease by 12 % in the pessimistic scenario, by 27 % in the optimal scenario, and by 39 % in the optimistic scenario. The SPSS 22.0 (2014) and TreeAge Pro Suit (2009) programs were used for data analysis.The principal resultsThe average cost for a person admitted to a hospital due to falls was $396.51 ± $1429.35.It was determined that costs varied according to the type of the injury.The results of this present study demonstrated that the three scenarios tested were costly but also more effective. Hence, the applicability of these interventions should be considered by policy makers taking both the costs and effectiveness into account.Major conclusionsMultidisciplinary research should be carried out in order to increase the effectiveness of the fall prevention programs to be implemented in the future, and multifaceted fall prevention programs should be developed.