Sonoelastography to Assess Muscular Stiffness Among Older Adults and its Use for the Diagnosis of Sarcopenia: A Systematic Review

AbstractChanges in muscle stiffness have been reported with sarcopenia. Sonoelastography is an accessible and non-radiating imaging technique allowing quantification of elastic properties of tissue. We performed a systematic review of the literature to investigate whether sonoelastography can be a reliable method to assess sarcopenia in older patients. We searched Medline, Google Scholar, Scopus, SpringerLink and Science direct from January 1, 1990 to April 1, 2020. Three independent review authors assessed trial eligibility, extracted the data, and assessed risk of bias. We intended to learn which types of elastography have been tested, if such measures are repeatable, and if they have been compared to the currently accepted diagnostic method. Ten studies met the inclusion criteria. Most followed a cross-sectional design with young and older adult subgroups. The gastrocnemius, rectus femoris, and vastus intermedius appeared most frequently. Nine of the included studies used shear wave elastography and one-strain elastography. The passive elastic constant was significantly greater in sarcopenic versus healthy subjects after passive stretching (124.98 ± 60.82 vs. 46.35 ± 15.85, P = 0.004). However, even in non-sarcopenic patients, the age of the patient was responsible for about 45.5 % of the variance in SWV. Among ten included articles, four reported higher stiffness in the muscles of older adults, two reported lower stiffness, and four found no significant difference. Due to the substantial heterogenicity of actual data, we could not make any conclusions about the potential usefulness of elastography to assess sarcopenia. Further studies are needed, including a larger sample of older patients and using a standardized and reproducible protocol.

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BASELINE DRIVING MILEAGE PREDICTS STATE-REPORTED CRASHES ACROSS 5 YEARS

Innovation in Aging ◽

10.1093/geroni/igz038.1242 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S343-S343

Author(s):

Junyan Tian ◽

Sara A Freed ◽

Lesley Ross

Keyword(s):

Older Adults ◽

Population Density ◽

The United States ◽

Future Research ◽

Cross Sectional ◽

Healthy Older Adults ◽

Crash Data ◽

Significant Difference ◽

Cross Sectional Design ◽

Testing Site

Abstract Although annual driving mileage has frequently been examined as a predictor of crashes among older adults, most research used cross-sectional design and relied on self-reported crash data. This study used multivariate regression to examine the number of state reported at-fault crashes between groups of low (14,000km) self-reported annual distance over five years. Additionally, key factors of interest including age, gender, and population density were examined as predictors. The sample included 519 healthy older adults aged 65-90 (M=73.17, SD=5.56) across five sites in the United States. 12% of participants experienced a crash across five years, and among those who crashed, the majority (87%) experienced one crash (range 0-3 crashes). After controlling for age, gender and testing site, people in the high annual mileage group had a greater number of crashes compared to the low mileage group (β=.14, t(513)=2.37, p=.02). There was not a significant difference in number of prospective crashes between the low and medium group. Also, people who drove in sites with low population density had more crashes than those who in high population density sites (β=.10, t(513)=2.24, p=.03). Higher age was associated with a greater number of prospective crashes (β=.01, t(513)=3.67, p =.002); however, gender was not a significant predictor of crashes. Our results highlight the importance of examining prospective crashes over time, and taking mileage and population density into consideration. Future research should examine trajectories of driving exposure in relation to prospective crashes using multilevel modeling.

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The Potential of Optometrists’ Referrals of Older Patients to Community-Based Exercise Programs: Findings From a Mixed-Methods Study

Journal of Aging and Physical Activity ◽

10.1123/japa.2018-0442 ◽

2020 ◽

Vol 28 (2) ◽

pp. 194-207

Author(s):

Christina E. Miyawaki ◽

Rebecca L. Mauldin ◽

Carolyn R. Carman

Keyword(s):

Older Adults ◽

Mixed Method ◽

Older Patients ◽

Exercise Program ◽

Mixed Methods Study ◽

Routine Practice ◽

Exercise Programs ◽

Community Based ◽

Cross Sectional ◽

Cross Sectional Design

Exercise is important for older adults in order to prevent falls and live safer, healthier lives. Visual impairment is a risk factor for falling. Older adults tend to visit optometrists frequently; however, assessing patients’ physical exercise levels is not a routine practice for optometrists. The purpose of this study was to examine the potential for optometrists’ referrals to exercise programs. This study used a mixed-method, cross-sectional design. In focus groups, optometry patients (N = 42) discussed the acceptability of an optometrist’s prescription for exercise programs. The vast majority of optometry patients (90%) indicated that they would follow such a prescription for exercise from their optometrists. Texas optometrists (N = 268) were surveyed about the potential for exercise program prescriptions, and 97% indicated a willingness to prescribe exercise programs to their patients. The results suggest that there is an opportunity for community–clinical partnerships to prevent falls and to improve the health of older patients.

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The Measurement of Stiffness for Major Muscles with Shear Wave Elastography and Myoton: A Quantitative Analysis Study

Diagnostics ◽

10.3390/diagnostics11030524 ◽

2021 ◽

Vol 11 (3) ◽

pp. 524

Author(s):

Youngjin Lee ◽

Minkyoung Kim ◽

Haneul Lee

Keyword(s):

Shear Wave ◽

Shear Wave Elastography ◽

Rectus Femoris ◽

Biceps Femoris ◽

Voluntary Contraction ◽

Muscle Stiffness ◽

Medial Gastrocnemius ◽

Strong Correlations ◽

Significant Difference ◽

The Relationship

The present study was performed to assess the relationship between hand-held myotonometer MyotonPRO and shear wave elastography (SWE) measurements of lower limb muscle stiffness during resting and active voluntary contraction. Forty healthy young adults, (20 males and 20 females) participated in the study. The stiffness of each subject’s rectus femoris (RF), biceps femoris (BF), tibialis anterior (TA), and medial gastrocnemius (MG) was measured repeatedly by MyotonPRO and SWE. Moderate to strong correlations between the two methods’ measurements were found for both resting and active voluntary contraction. (r = 0.416–0.669, p < 0.05; r = 0.398–0.594, p < 0.05, respectively). Muscle stiffness at rest was significantly lower compared contraction in all four muscles measured by both methods (p < 0.05). Intra-rater reliabilities were generally lower when measurements were taken during contraction. Additionally, when compared by gender, muscle stiffness measured by MyotonPRO was significantly higher at rest in men compared to women, except for the TA. However, a significant difference was found in TA muscle stiffness by gender when measured with SWE. When muscles were contracted, all muscles showed significantly higher stiffness in men compared to women. There were moderate to good correlations in muscle stiffness between measurements of SWE and MyotonPRO at rest and during active voluntary contraction. Additionally, both instruments showed good intra-rater reliability.

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Effects of static stretching duration on muscle stiffness and blood flow in the rectus femoris in adolescents

Medical Ultrasonography ◽

10.11152/mu-1859 ◽

2019 ◽

Vol 21 (2) ◽

pp. 136 ◽

Cited By ~ 2

Author(s):

Emine Caliskan ◽

Orkun Akkoc ◽

Zuhal Bayramoglu ◽

Omer Batin Gozubuyuk ◽

Doga Kural ◽

...

Keyword(s):

Blood Flow ◽

Shear Wave Elastography ◽

Rectus Femoris ◽

Muscle Stiffness ◽

Static Stretching ◽

Male Athletes ◽

Warm Up ◽

Significant Difference ◽

Rehabilitation Protocols ◽

Superb Microvascular Imaging

Aims: To compare the effects of 2 and 5 min of passive static stretching (SS) on stiffness and blood flow in the rectus femoris in adolescent athletes using shear wave elastography (SWE) and superb microvascular imaging (SMI).Material and methods: This prospective study included 20 male athletes with median age of 14.5 (12.5–16.5) years. The subjects were divided into two groups based on the SS duration as follows: 2 min (n=10) and 5 min (n=10). At rest and after 2 and 5 min of SS, stiffness and blood flow values were compared in the rectus femoris for each group. Inter-operator reliability was also analysed.Results: There was no significant difference between resting and 2 min of SS in terms of stiffness. The stiffness values decreased significantly from resting to 5 min of SS. The blood flow increased significantly from resting to 2 and 5 min of SS. Inter-operator reliability was moderate to perfect for SWE and SMI measurements (ICC: 0.52–0.83).Conclusions: SWE and SMI can be used to acquire reliable quantitative data about muscle stiffness and blood flow in adolescents. While stiffness parameters significantly decreased from resting after only 5 min, blood flow significantly increased both after 2 and 5 min. For physical rehabilitation protocols, 5 min of SS may be chosen to reduce stiffness. For competitions, 2 min of SS may be sufficient for warm-up exercise because it increases the blood flow optimally. Five min of SS may be preferred for the cool-down exercise to enhance recovery.

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Magnetic resonance elastography (MRE) shows significant reduction of thigh muscle stiffness in healthy older adults

GeroScience ◽

10.1007/s11357-019-00147-2 ◽

2019 ◽

Vol 42 (1) ◽

pp. 311-321 ◽

Cited By ~ 4

Author(s):

Paul Kennedy ◽

Eric Barnhill ◽

Calum Gray ◽

Colin Brown ◽

Edwin J.R. van Beek ◽

...

Keyword(s):

Older Adults ◽

Magnetic Resonance ◽

Vastus Lateralis ◽

Rectus Femoris ◽

Magnetic Resonance Elastography ◽

Muscle Stiffness ◽

Thigh Muscle ◽

Cross Sectional ◽

Healthy Older Adults ◽

Fat Fraction

AbstractDetermining the effect of ageing on thigh muscle stiffness using magnetic resonance elastography (MRE) and investigate whether fat fraction and muscle cross-sectional area (CSA) are related to stiffness. Six healthy older adults in their eighth and ninth decade and eight healthy young men were recruited and underwent a 3 T MRI protocol including MRE and Dixon fat fraction imaging. Muscle stiffness, fat fraction and muscle CSA were calculated in ROIs corresponding to the four quadriceps muscles (i.e. vastus lateralis (VL), vastus medialis (VM), vastus intermedius (VI), rectus femoris (RF)), combined quadriceps, combined hamstrings and adductors and whole thigh. Muscle stiffness was significantly reduced (p < 0.05) in the older group in all measured ROIs except the VI (p = 0.573) and RF (p = 0.081). Similarly, mean fat fraction was significantly increased (p < 0.05) in the older group over all ROIs with the exception of the VI (p = 0.059) and VL muscle groups (p = 0.142). Muscle CSA was significantly reduced in older participants in the VM (p = 0.003) and the combined quadriceps (p = 0.001), hamstrings and adductors (p = 0.008) and whole thigh (p = 0.003). Over the whole thigh, stiffness was significantly negatively correlated with fat fraction (r = − 0.560, p = 0.037) and positively correlated with CSA (r = 0.749, p = 0.002). Stepwise regression analysis revealed that age was the most significant predictor of muscle stiffness (p = 0.001). These results suggest that muscle stiffness is significantly decreased in healthy older adults. Muscle fat fraction and muscle CSA are also significantly changed in older adults; however, age is the most significant predictor of muscle stiffness.

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Clinical features and outcomes of COVID-19 in older adults: a systematic review and meta-analysis

BMC Geriatrics ◽

10.1186/s12877-021-02261-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sunny Singhal ◽

Pramod Kumar ◽

Sumitabh Singh ◽

Srishti Saha ◽

Aparajit Ballav Dey

Keyword(s):

Systematic Review ◽

Older Adults ◽

Critically Ill ◽

Clinical Features ◽

Older Patients ◽

Clinical Characteristics ◽

Meta Analysis ◽

Severe Infection ◽

Factors Affecting ◽

Pooled Prevalence

Abstract Background Few studies have focused on exploring the clinical characteristics and outcomes of COVID-19 in older patients. We conducted this systematic review and meta-analysis to have a better understanding of the clinical characteristics of older COVID-19 patients. Methods A systematic search of PubMed and Scopus was performed from December 2019 to May 3rd, 2020. Observational studies including older adults (age ≥ 60 years) with COVID-19 infection and reporting clinical characteristics or outcome were included. Primary outcome was assessing weighted pooled prevalence (WPP) of severity and outcomes. Secondary outcomes were clinical features including comorbidities and need of respiratory support. Result Forty-six studies with 13,624 older patients were included. Severe infection was seen in 51% (95% CI– 36-65%, I2–95%) patients while 22% (95% CI– 16-28%, I2–88%) were critically ill. Overall, 11% (95% CI– 5-21%, I2–98%) patients died. The common comorbidities were hypertension (48, 95% CI– 36-60% I2–92%), diabetes mellitus (22, 95% CI– 13-32%, I2–86%) and cardiovascular disease (19, 95% CI – 11-28%, I2–85%). Common symptoms were fever (83, 95% CI– 66-97%, I2–91%), cough (60, 95% CI– 50-70%, I2–71%) and dyspnoea (42, 95% CI– 19-67%, I2–94%). Overall, 84% (95% CI– 60-100%, I2–81%) required oxygen support and 21% (95% CI– 0-49%, I2–91%) required mechanical ventilation. Majority of studies had medium to high risk of bias and overall quality of evidence was low for all outcomes. Conclusion Approximately half of older patients with COVID-19 have severe infection, one in five are critically ill and one in ten die. More high-quality evidence is needed to study outcomes in this vulnerable patient population and factors affecting these outcomes.

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Comparison of adaptive versions of the Hong Kong-specific criteria and 2015 Beers criteria for assessing potentially inappropriate medication use in Hong Kong older patients

BMC Geriatrics ◽

10.1186/s12877-021-02324-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Huanyu ZHANG ◽

Eliza L. Y. WONG ◽

Samuel Y. S. WONG ◽

Patsy Y. K. CHAU ◽

Benjamin H. K. YIP ◽

...

Keyword(s):

Older Adults ◽

Hong Kong ◽

Older Patients ◽

Inappropriate Medication ◽

Female Gender ◽

Potentially Inappropriate Medication ◽

Multivariable Logistic Regression Analysis ◽

Beers Criteria ◽

Medical Conditions ◽

Cross Sectional

Abstract Background The Hong Kong-specific criteria have been established in 2019 to assess potentially inappropriate medication (PIM) use in older adults and improve the local prescribing quality. The aim of this study was to compare the adaptive versions of the Hong Kong-specific criteria and 2015 Beers criteria for assessing the prevalence and correlates of PIM use in Hong Kong older patients. Methods A cross-sectional study was performed from January 1, 2014 to December 31, 2014 using the Hospital Authority (HA) database. A total of 489,301 older patients aged 65 years and older visiting general outpatient clinics (GOPCs) during the study period were included in the study. Two categories of PIM use included in the Hong Kong-specific criteria and 2015 Beers criteria, i.e. PIMs independent of diagnoses and PIMs considering specific medical conditions, were adapted to assess the prevalence of PIM use among the study sample. Characteristics of PIM users and the most frequently prescribed PIMs were investigated for each set of the criteria. Factors associated with PIM use were identified using the stepwise multivariable logistic regression analysis. Results The adaptive Hong Kong-specific criteria could detect a higher prevalence of patients exposed to at least one PIM than that assessed by the adaptive Beers criteria (49.5% vs 47.5%). Meanwhile, the adaptive Hong Kong-specific criteria could identify a higher rate of patients exposed to PIMs independent of diagnoses (48.1% vs 46.8%) and PIMs considering specific medical conditions (7.3% vs 4.9%) compared with that of the adaptive Beers criteria. The most frequently prescribed PIMs detected by the adaptive Beers criteria were all included in the adaptive Hong Kong-specific criteria. The strongest factor associated with PIM use was number of different medications prescribed. Patients with female gender, aged 65 ~ 74 years, a larger number of GOPC visits, and more than six diagnoses were associated with greater risk of PIM use, whereas advancing age was associated with lower risk of PIM use. Conclusions The adaptive Hong Kong-specific criteria could detect a higher prevalence of PIM use than the adaptive Beers criteria in older adults visiting GOPCs in Hong Kong. It is necessary to update the prevalence and correlates of PIM use regularly in older adults to monitor the burden of PIM use and identify vulnerable patients who need further interventions.

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What is the impact of multimorbidity on the risk of hospitalisation in older adults? A systematic review study protocol

BMJ Open ◽

10.1136/bmjopen-2021-049974 ◽

2021 ◽

Vol 11 (6) ◽

pp. e049974

Author(s):

Luciana Pereira Rodrigues ◽

Andréa Toledo de Oliveira Rezende ◽

Letícia de Almeida Nogueira e Moura ◽

Bruno Pereira Nunes ◽

Matias Noll ◽

...

Keyword(s):

Systematic Review ◽

Older Adults ◽

Study Protocol ◽

Average Length ◽

Length Of Hospital Stay ◽

Case Control Studies ◽

Cross Sectional ◽

Increased Risk ◽

Review Study ◽

The Impact

IntroductionThe development of multiple coexisting chronic diseases (multimorbidity) is increasing globally, along with the percentage of older adults affected by it. Multimorbidity is associated with the concomitant use of multiple medications, a greater possibility of adverse effects, and increased risk of hospitalisation. Therefore, this systematic review study protocol aims to analyse the impact of multimorbidity on the occurrence of hospitalisation in older adults and assess whether this impact changes according to factors such as sex, age, institutionalisation and socioeconomic status. This study will also review the average length of hospital stay and the occurrence of hospital readmission.Methods and analysisA systematic review of the literature will be carried out using the PubMed, Embase and Scopus databases. The inclusion criteria will incorporate cross-sectional, cohort and case–control studies that analysed the association between multimorbidity (defined as the presence of ≥2 and/or ≥3 chronic conditions and complex multimorbidity) and hospitalisation (yes/no, days of hospitalisation and number of readmissions) in older adults (aged ≥60 years or >65 years). Effect measures will be quantified, including ORs, prevalence ratios, HRs and relative risk, along with their associated 95% CI. The overall aim of this study is to widen knowledge and to raise reflections about the association between multimorbidity and hospitalisation in older adults. Ultimately, its findings may contribute to improvements in public health policies resulting in cost reductions across healthcare systems.Ethics and disseminationEthical approval is not required. The results will be disseminated via submission for publication to a peer-reviewed journal when complete.PROSPERO registration numberCRD42021229328.

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Prevalence and determinants of potentially inappropriate medication use in Hong Kong older patients: a cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2021-051527 ◽

2021 ◽

Vol 11 (7) ◽

pp. e051527

Author(s):

Huanyu Zhang ◽

Eliza LY Wong ◽

Samuel YS Wong ◽

Patsy YK Chau ◽

Benjamin HK Yip ◽

...

Keyword(s):

Older Adults ◽

Regression Analysis ◽

Hong Kong ◽

Older Patients ◽

Inappropriate Medication ◽

Cross Sectional Study ◽

Potentially Inappropriate Medication ◽

Multivariable Logistic Regression Analysis ◽

Sectional Study ◽

Cross Sectional

ObjectivesTo assess the prevalence of potentially inappropriate medication (PIM) use in Hong Kong older patients visiting general outpatient clinics (GOPCs) between 2006 and 2014 and to identify factors associated with PIM use among older adults visiting GOPCs in 2014.DesignCross-sectional study.SettingGOPC.ParticipantsTwo study samples were constructed including a total of 844 910 patients aged 65 and above from 2006 to 2014 and a cohort of 489 301 older patients in 2014.MeasurementsTwo subsets of the 2015 American Geriatrics Society Beers criteria—PIMs independent of diagnosis and PIMs due to drug–disease interactions—were used to estimate the prevalence of PIM use over 12 months. PIMs that were not included in the Hospital Authority drug formulary or with any specific restriction or exception in terms of indication, dose or therapy duration were excluded. Characteristics of PIM users and non-PIM users visiting GOPCs in 2014 were compared. Independent associations between patient variables and PIM use were assessed by stepwise multivariable logistic regression analysis.ResultsThe 12-month period prevalence of PIM use decreased from 55.56% (95% CI 55.39% to 55.72%) in 2006 to 47.51% (95% CI 47.37% to 47.65%) in 2014. In the multivariable regression analysis, the strongest factor associated with PIM use was the number of different drugs prescribed (adjusted OR, AOR 23.01, 95% CI 22.36 to 23.67). Being female (AOR 0.89, 95% CI 0.85 to 0.87 for males vs females) and having a greater number of GOPC visits (AOR 1.83, 95% CI 1.78 to 1.88) as well as more than six diagnoses (AOR 1.43, 95% CI 1.36 to 1.52) were associated with PIM use.ConclusionsThe overall prevalence of PIM use in older adults visiting GOPCs decreased from 2006 to 2014 in Hong Kong although the prevalence of PIM use was still high in 2014. Patients with female gender, a larger number of medications prescribed, more frequent visits to GOPCs, and more than six diagnoses were at higher risk for PIM use.

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