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.     

Association between sarcopenia and respiratory function in elderly orthopedic outpatients

The relationship between sarcopenia and respiratory function has not been investigated in elderly Japanese orthopedic outpatients. This study aimed to assess the relationship between sarcopenia and respiratory function in elderly orthopedic outpatients in Japan.Elderly outpatients (n = 102; aged ≥65 years) with orthopedic diseases were enrolled in the study. Muscle mass was measured using the bioelectrical impedance analysis. Grip strength and walking speed were measured (2 trials). The respiratory function (e.g., percent vital capacity [VC] and percent forced expiratory volume in 1 second) was also measured. The association between sarcopenia and respiratory function was assessed using logistic regression analysis, adjusting for sex, comorbidities, and smoking status.The mean ages for men and women were 77.7 ± 8.3 and 76.5 ± 6.8 years, respectively, and the overall prevalence of sarcopenia was 25.5% (30.0% and 24.4% in men and women, respectively). The study demonstrated that low respiratory function, which was represented by decreased percent VC, was associated with sarcopenia in outpatients visiting an orthopedic department (odds ratio, 1.73; 95% confidence interval: 1.02–2.97).Sarcopenia was significantly associated with a lower percentage of VC in orthopedic outpatients after adjustment for sex, comorbidity, and smoking. Further studies are needed to determine the causality.     

老年冠心病患者合并肌肉减少症的相关性研究

目的:肌肉减少症是随增龄出现的骨骼肌肌肉质量进行性减少和(或)肌强度下降及肌肉生理功能减退的综合征,是老年人动脉粥样硬化性心血管疾病的独立危险因素。对老年冠心病患者合并肌肉减少症的相关情况进行分析,有助于优化老年冠心病患者的治疗。方法:选取2014-12-2018-04于北京大学第一医院老年病内科住院治疗的老年冠心病患者为研究对象,收集入选对象的临床资料并建立数据库。将患者分组为肌少症及非肌少症组,对比两组患者的一般临床资料、理化指标、身体成分及心脏结构及功能等指标,并进行统计学分析。结果:(1)老年冠心病患者同时患肌肉减少症者占26.69%,其中男性、女性分别为25.10%、34.62%,随着年龄增长患病率升高。(2)肌少症组平均年龄及吸烟率更高,肌酐清除率、血红蛋白浓度、高密度脂蛋白胆固醇(HDL-C)、25-羟基维生素D、三酰甘油(TG)及血尿酸水平更低。(3)肌少症组的内脏脂肪面积、腹部皮下脂肪面积、体脂肪质量及BMI均低于非肌少症组;(4)肌少症组左房前后径、左室舒张末内径明显增大,B型钠尿肽(BNP)水平更高,最大运动功量及Berthel指数评分显著低于非肌少症组(均P<0.05)。结论:老年冠心病患者更易患肌少症,合并肌少症的患者心脏结构、功能及运动耐量更差,更需早期干预。     

肌少症的发病机制

肌少症,亦称骨骼肌减少症（sarcopenia）或者说是增龄性骨骼肌减少,是以骨骼肌质量、力量以及功能的降低为主要特征的退行性综合征。肌少症的发生机制复杂多样,包括运动量下降、神经-肌肉功能衰退及运动单位重组、蛋白质摄入与合成减少、激素水平变化、脂肪组织增加与慢性炎症反应、细胞凋亡、骨骼肌线粒体功能紊乱及基因与种族等。深入研究肌少症的发病机理对老年人肌少症的防治具有重要意义。     

N-乙酰半胱氨酸治疗老年吸入性肺炎的疗效观察

目的 观察N-乙酰半胱氨酸治疗老年吸入性肺炎疗效和安全性.方法 将68例老年吸入性肺炎的患者随机分为治疗组和对照组,两组均给予常规治疗,治疗组加用N-乙酰半胱氨酸,然后比较两组血氧饱和度恢复时间、呼吸困难改善时间、吸痰次数、病灶吸收显效时间及平均住院天数等方面的差异.结果 治疗结束时,两组血氧饱和度恢复时间、呼吸困难改善时间、吸痰次数、病灶吸收显效时间及平均住院天数等方面差异有显著性(P＜0.01),且安全性较高.结论 应用N-乙酰半胱氨酸治疗老年吸入性肺炎能明显改善患者的临床症状,缩短疗程,改善预后,无明显副反应.     

Prospective study of fever and pneumonia after flexible fiberoptic bronchoscopy in older people

OBJECTIVES: To assess the frequency of fever and pneumonia after fiberoptic bronchoscopy (FOB) in older people and to evaluate increased risk for these two adverse events with increasing age. DESIGN: Prospective study. SETTING: University hospital system. PARTICIPANTS: Three hundred fifty-eight patients, with 165 (46.1%) patients aged 70 and older, undergoing bronchoscopy. MEASUREMENTS: Indications, abnormal bronchoscopic findings, sampling procedures, final diagnosis, and fever and pneumonia after bronchoscopy. RESULTS: With regard to the indication for bronchoscopy and abnormal bronchoscopic findings, there was no statistical difference between elderly patients (> or =70) and younger patients (<70). Procedures such as forceps biopsy, brushing, and curetting were not performed more often in elderly patients, although final diagnosis of lung cancer was significantly more common in the elderly group (P=.002). The overall incidence of fever after FOB was 6.7%, and that of pneumonia after FOB was 5.6%. The patients aged 70 and older had an incidence of fever after FOB of 3.6% and an incidence of pneumonia of 4.2%, which were not higher than those in patients younger than 70. CONCLUSION: Increasing age is not associated with increasing fever and pneumonia after FOB, and chronological age should not be considered a limiting factor in the decision of whether to perform FOB when it is clinically indicated.     

Dysphagia,dystussia, and aspiration pneumonia in elderly people

Despite the development and wide distribution of guidelines for pneumonia, death from pneumonia is increasing due to population aging. Conventionally, aspiration pneumonia was mainly thought to be one of the infectious diseases. However, we have proven that chronic repeated aspiration of a small amount of sterile material can cause the usual type of aspiration pneumonia in mouse lung. Moreover, chronic repeated aspiration of small amounts induced chronic inflammation in both frail elderly people and mouse lung. These observations suggest the need for a paradigm shift of the treatment for pneumonia in the elderly. Since aspiration pneumonia is fundamentally based on dysphagia, we should shift the therapy for aspiration pneumonia from pathogen-oriented therapy to function-oriented therapy. Function-oriented therapy in aspiration pneumonia means therapy focusing on slowing or reversing the functional decline that occurs as part of the aging process, such as “dementia → dysphagia → dystussia → atussia → silent aspiration”. Atussia is ultimate dysfunction of cough physiology, and aspiration with atussia is called silent aspiration, which leads to the development of life-threatening aspiration pneumonia. Research pursuing effective strategies to restore function in the elderly is warranted in order to decrease pneumonia deaths in elderly people.     

乌鲁木齐市米东区社区中老年肌肉减少症患病率及影响因素

目的了解乌鲁木齐市米东区社区中老年肌肉减少症的患病率及影响因素,为制定肌肉减少症防治策略提供依据.方法采用现况调查方法收集社区中老年人的信息.采用In Body 270人体成分分析仪测量人体骨骼肌质量;使用握力器、4m步速方法评估中老年居民的肌肉力量和肌肉功能;了解中老年居民肌肉减少症的患病率及影响因素.结果本次共调查680例中老年人,年龄50~75岁,平均年龄(61.86±6.91)岁.中老年人群肌肉减少症总体患病率5.6%,其中男性患病率6.7%,女性患病率5.0%,不同性别间肌少症患病率差异无统计学意义(χ^2=0.815,P>0.05).中年人群肌少症患者3例,患病率1.1%;老年人群肌少症患者35例,患病率8.4%.中老年人群肌肉减少症组四肢骨骼肌质量指数(appendicular skeletal muscle mass index,ASMI)(t=7.059,P<0.001)、步速(t=3.170,P<0.001)、握力(t=5.538,P<0.001)、体质量指数(body mass index,BMI)(t=5.476,P<0.001)、蛋白质(t=5.872,P<0.001)、腰臀比(t=2.863,P<0.001)、矿物质均(t=5.399,P<0.001)较非肌肉减少症组降低,差异有统计学意义(P<0.05);肌肉减少症患病率影响因素的单因素分析结果显示,年龄、学历、BMI、是否患骨质疏松症是肌肉减少症的影响因素;二分类Logistics回归分析结果显示,年龄、BMI、骨质疏松症是肌肉减少症发生的独立影响因素.结论乌鲁木齐市米东区肌少症患率较低,男性高于女性.建议中老年社区居民应适当增加体质量,尤其是瘦体质量(肌肉质量),以提高自身BMI值从而降低肌肉减少症的患病率,建议加强营养和运动,积极预防骨质疏松症以减少肌肉减少症的发生、发展.     

Community-acquired pneumonia in older people: the need for a broader perspective

Community-acquired pneumonia (CAP) poses a substantial threat to the health of older adults. The incidence of this infection and mortality associated with it increase with age. Despite the considerable effect of CAP on older adults, little is known about the effect of socioeconomic and environmental factors on CAP in older people. This paper argues that broader determinants, including socioeconomic status (SES), nutrition, and factors in the physical environment such as exposure to tobacco smoke and air pollution need to be evaluated as potential risk factors for CAP in older adults. Data suggesting a relationship between low SES and risk of acquiring CAP exist; possible causal pathways include increased exposure through crowding or increased susceptibility to infection. Inadequate nutrition, exposure to tobacco smoke, air pollution, and not receiving immunization may predispose older people to lower respiratory tract infection. This study reviews current evidence for these potential risk factors and suggests priorities for research. A thorough understanding of these factors and their underlying biological mechanisms is needed to develop successful health-promotion strategies such as better immunization strategies and educational programs about nutrition. Determining the effect of air pollution on CAP in older adults is important in terms of reducing personal risk to older individuals and for healthcare agencies charged with formulating policy to protect the health of older adults.     

Prevalence of sarcopenia and associated factors in hospitalised older patients: A cross‐sectional study

Objective

To estimate the prevalence and factors associated with sarcopenia in a sample of older inpatients.

Methods

A cross‐sectional study was conducted in three acute geriatric wards in 2012. Sarcopenia was defined according to the criteria of the Asian Working Group for Sarcopenia.

Results

We included 407 patients aged 81.0 ± 8.0 years. The prevalence of sarcopenia was 31% in the whole study population. Multiple logistic regression showed that being a female (odds ratio (OR) 4.75, 95% confidence interval (CI) 2.45–9.20), smoking (OR 2.94, 95% CI 1.26–6.69), cognitive impairment (OR 2.08, 95% CI 1.10–3.95), polypharmacy (OR 2.36, 95% CI 1.28–4.34) and body mass index (OR 0.75, 95% CI 0.68–0.83) were independently associated with sarcopenia.

Conclusion

Sarcopenia was highly prevalent in older inpatients. In addition to factors previously reported to be associated with sarcopenia, we found that polypharmacy was associated with sarcopenia. As the direction of causality remains uncertain, these relationships deserve further study.     

Relationship between age and serum thyrotropin among asymptomatic older people in Taiwan

Hypothyroidism is a common disorder in older people, and may be asymptomatic and hard to be diagnosed. The main purpose of this study was to evaluate the distribution of serum thyrotropin (thyroxin-stimulating hormone, TSH) among asymptomatic older people in Taiwan, and to evaluate the relationship between age and serum TSH. In 2007, all subjects participating in the annual elderly health examinations at Taipei Veterans General Hospital were invited for study and were enrolled when they were fully consented. In total, 1716 asymptomatic elderly people (mean age: 73.2 ± 4.4 years, 56.3% males) participated in this study after careful exclusion of 38 subjects with past history of thyroid disorders. All participants were divided into two groups: (1) younger old (age 65-79) and (2) older old (age over 80) for further analysis. The mean serum levels of TSH were similar between younger old and older old groups (2.43 ± 5.36 μIU/ml for younger old and 2.36 ± 3.51 μIU/ml for older old, p = 0.444). The overall prevalence of suspected hypothyroidism was 9.2% among asymptomatic older people in Taiwan, which was significantly lower than in Caucasians. The prevalence of suspected hypothyroidism may reach 25.9% if the TSH cutoff was lowered to 2.5 μIU/ml. Further study is needed to determine the normal reference range of serum TSH in older people.