Peripheral IL-6 Levels but not Sarcopenia Are Predictive of 1-Year Mortality After Hip Fracture in Older Patients

Abstract Background Sarcopenic patients may have an increased risk of poor outcomes after a hip fracture. The objective of this study was to determine whether sarcopenia and a set of biomarkers were potential predictors of 1-year-mortality in older patients after a hip fracture. Methods About 150 patients at least 80 years old were hospitalized for the surgical treatment of a hip fracture. The primary outcome measure was the death in the first year after the hip fracture. Sarcopenia was defined at baseline by having both low muscle mass (bioimpedance analysis) and handgrip and using the updated European Working Group on Sarcopenia in Older People (EWGSOP2) definition of probable sarcopenia. Janssen’s (J) and Masanés (M) cutoff points were used to define low muscle mass. Results Mortality 1 year after the hip fracture was 11.5%. In univariate analyses, baseline sarcopenia was not associated with mortality, using neither of the muscle mass cutoff points: 5.9% in sarcopenic (J) versus 12.4% in non-sarcopenic participants (p = .694) and 16% in sarcopenic (M) versus 9.6% in non-sarcopenic participants (p = .285). Probable sarcopenia (EWGSOP2) was not associated with mortality. Peripheral levels of IL-6 at baseline were significantly higher in the group of participants who died in the year after the hip fracture (17.14 ± 16.74 vs 11.42 ± 7.99 pg/mL, p = .026). TNF-α peripheral levels had a nonsignificant trend to be higher in participants who died. No other biomarker was associated with mortality. Conclusions Sarcopenia at baseline was not a predictor of 1-year mortality in older patients after a hip fracture. IL-6 was associated with a higher risk of mortality in these patients, regardless of sarcopenia status.

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Older trauma patients are at high risk of delirium, especially those with underlying dementia or baseline frailty

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2020-000639 ◽

2021 ◽

Vol 6 (1) ◽

pp. e000639

Author(s):

Danielle Ní Chróinín ◽

Nevenka Francis ◽

Pearl Wong ◽

Yewon David Kim ◽

Susan Nham ◽

...

Keyword(s):

Older Patients ◽

Multivariable Analysis ◽

Primary Outcome Measure ◽

Hospital Length ◽

Assessment Tools ◽

Hospital Length Of Stay ◽

Trauma Patients ◽

Level Of Evidence ◽

Increased Risk ◽

History Of

BackgroundGiven the increasing numbers of older patients presenting with trauma, and the potential influence of delirium on outcomes, we sought to investigate the proportion of such patients who were diagnosed with delirium during their stay—and patient factors associated therewith—and the potential associations between delirium and hospital length of stay (LOS). We hypothesized that delirium would be common, associated with certain patient characteristics, and associated with long hospital LOS (highest quartile).MethodsWe conducted a retrospective observational cohort study of all trauma patients aged ≥65 years presenting in September to October 2019, interrogating medical records and the institutional trauma database. The primary outcome measure was occurrence of delirium.ResultsAmong 99 eligible patients, delirium was common, documented in 23% (23 of 99). On multivariable analysis, adjusting for age, frailty and history of dementia, frailty (OR 4.09, 95% CI 1.08 to 15.53, p=0.04) and dementia (OR 5.23, 95% CI 1.38 to 19.90, p=0.02) were independently associated with likelihood of delirium. Standardized assessment tools were underused, with only 34% (34 of 99) screened within 4 hours of arrival. On univariate logistic regression analysis, having an episode of delirium was associated with long LOS (highest quartile), OR of 5.29 (95% CI 1.92 to 14.56, p<0.001). In the final multivariable model, adjusting for any (non-delirium) in-hospital complication, delirium was independently associated with long LOS (≥16 days; OR 4.81, p=0.005).DiscussionIn this study, delirium was common. History of dementia and baseline frailty were associated with increased risk. Delirium was independently associated with long LOS. However, many patients did not undergo standardized screening at admission. Early identification and targeted management of older patients at risk of delirium may reduce incidence and improve care of this vulnerable cohort. These data are hypothesis generating, but support the need for initiatives which improve delirium care, acknowledging the complex interplay between frailty and other geriatric syndromes in the older trauma patients.Level of evidenceIII.

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The approach to patients with cognitive impairment and hip fracture: the role of orthogeriatric care

Reviews in Clinical Gerontology ◽

10.1017/s0959259814000100 ◽

2014 ◽

Vol 24 (3) ◽

pp. 219-227 ◽

Cited By ~ 2

Author(s):

Francisco J Tarazona-Santabalbina ◽

Juan R Doménech-Pascual ◽

Ángel Belenguer-Varea A ◽

Eduardo Rovira Daudi

Keyword(s):

Cognitive Impairment ◽

Hip Fracture ◽

Functional Recovery ◽

Functional Outcomes ◽

Older Patients ◽

Future Research ◽

Research Perspectives ◽

Increased Risk ◽

Risk Of Falls

SummaryHip fracture is very common among older patients, who are characterized by increased co-morbidities, including cognitive impairment. These patients have an increased risk of falls and fractures, poorer functional recovery and lower survival both in hospital and 12 months after discharge. We review the survival and functional outcomes of older patients with cognitive impairment and hip fracture managed in orthogeriatric units, and highlight the gaps in our knowledge of the efficacy and efficiency of specific orthogeriatric programmes for such patients and the future research perspectives in this field.

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Prevalence of sarcopenia in community-dwelling older adults using the definition of the European Working Group on Sarcopenia in Older People 2: findings from the Korean Frailty and Aging Cohort Study

Age and Ageing ◽

10.1093/ageing/afz091 ◽

2019 ◽

Vol 48 (6) ◽

pp. 910-916 ◽

Cited By ~ 22

Author(s):

Miji Kim ◽

Chang Won Won

Keyword(s):

Older Adults ◽

Cohort Study ◽

Muscle Strength ◽

Older People ◽

Muscle Mass ◽

Working Group ◽

Community Dwelling ◽

European Working ◽

Definition Of ◽

Community Dwelling Older Adults

Abstract Background in October 2018, the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) updated their original definition of sarcopenia to reflect the scientific and clinical evidence that has accumulated over the last decade. Objective to determine the prevalence of sarcopenia in a large group of community-dwelling older adults using the EWGSOP2 definition and algorithm. Design a cross-sectional study. Setting the nationwide Korean Frailty and Aging Cohort Study (KFACS). Subjects a total of 2,099 ambulatory community-dwelling older adults, aged 70–84 years (mean age, 75.9 ± 4.0 years; 49.8% women) who were enrolled in the KFACS. Methods physical function was assessed by handgrip strength, usual gait speed, the five-times-sit-to-stand test, the timed up-and-go test, and the Short Physical Performance Battery. Appendicular skeletal muscle mass (ASM) was measured by dual-energy X-ray absorptiometry. Results according to the criteria of the EWGSOP2, the sarcopenia indicators of combined low muscle strength and low muscle quantity were present in 4.6–14.5% of men and 6.7–14.4% of women. The severe sarcopenia indicators of combined low muscle strength, low muscle quantity and low physical performance were present in 0.3–2.2% of men and 0.2–6.2% of women. Using the clinical algorithm with SARC-F as a screening tool, the prevalence of probable sarcopenia (2.2%), confirmed sarcopenia (1.4%) and severe sarcopenia (0.8%) was low. Conclusions the prevalence of sarcopenia among community-dwelling older individuals varied depending on which components of the revised EWGSOP2 definition were used, such as the tools used to measure muscle strength and the ASM indicators for low muscle mass.

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Comparison of the 2010 and 2019 diagnostic criteria for sarcopenia by the European Working Group on Sarcopenia in Older People (EWGSOP) in two cohorts of Swedish older adults

BMC Geriatrics ◽

10.1186/s12877-021-02533-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ola Wallengren ◽

Ingvar Bosaeus ◽

Kerstin Frändin ◽

Lauren Lissner ◽

Hanna Falk Erhag ◽

...

Keyword(s):

Diagnostic Criteria ◽

Muscle Mass ◽

Reference Population ◽

Operational Definition ◽

Proportional Hazard ◽

Birth Cohorts ◽

T Score ◽

Cox Proportional Hazard ◽

European Working ◽

Definition Of

Abstract Background The operational definition of sarcopenia has been updated (EWGSOP2) and apply different cut-off points compared to previous criteria (EWGSOP1). Therefore, we aim to compare the sarcopenia prevalence and the association with mortality and dependence in activities of daily living using the 2010 (EWGSOP1 and 2019 (EWGSOP2 operational definition, applying cut-offs at two levels using T-scores. Methods Two birth cohorts, 70 and 85-years-old (n = 884 and n = 157, respectively), were assessed cross-sectionally (57% women). Low grip strength, low muscle mass and slow gait speed were defined below − 2.0 and − 2.5 SD from a young reference population (T-score). Muscle mass was defined as appendicular lean soft tissue index by DXA. The EWGSOP1 and EWGSOP2 were applied and compared with McNemar tests and Cohen’s kappa. All-cause mortality was analyzed with the Cox-proportional hazard model. Results Sarcopenia prevalence was 1.4–7.8% in 70-year-olds and 42–62% in 85 years-old’s, depending on diagnostic criteria. Overall, the prevalence of sarcopenia was 0.9–1.0 percentage points lower using the EWGSOP2 compared to EWGSOP1 when applying uniform T-score cut-offs (P < 0.005). The prevalence was doubled (15.0 vs. 7.5%) using the − 2.0 vs. -2.5 T-scores with EWGSOP2 in the whole sample. The increase in prevalence when changing the cut-offs was 5.7% (P < 0.001) in the 70-year-olds and 17.8% (P < 0.001) in the 85-year-olds (EWGSP2). Sarcopenia with cut-offs at − 2.5 T-score was associated with increased mortality (hazard ratio 2.4–2.8, P < 0.05) but not at T-score − 2.0. Conclusions The prevalence of sarcopenia was higher in 85-year-olds compared to 70-year-olds. Overall, the differences between the EWGSOP1 and EWGSOP2 classifications are small. Meaningful differences between EWGSOP1 and 2 in the 85-year-olds could not be ruled out. Prevalence was more dependent on cut-offs than on the operational definition.

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DESIGNING DRUG TRIALS FOR SARCOPENIA IN OLDER ADULTS WITH HIP FRACTURE – A TASK FORCE FROM THE INTERNATIONAL CONFERENCE ON FRAILTY AND SARCOPENIA RESEARCH (ICFSR)

Journal of Frailty & Aging ◽

10.14283/jfa.2014.24 ◽

2014 ◽

pp. 1-6

Author(s):

B. VELLAS ◽

R. FIELDING ◽

R. MILLER ◽

Y. ROLLAND ◽

S. BHASIN ◽

...

Keyword(s):

Clinical Trials ◽

Hip Fracture ◽

Diagnostic Criteria ◽

Task Force ◽

National Institutes Of Health ◽

Pharmaceutical Companies ◽

Working Definition ◽

Age Related ◽

Increased Risk ◽

Definition Of

In May 2012, a Sarcopenia Consensus Summit was convened by the Foundation of the National Institutes of Health (FNIH), National Institute of Aging (NIA), and the U.S. Food and Drug Administration (FDA); and co-sponsored by five pharmaceutical companies. At this summit, sarcopenia experts from around the world worked to develop agreement on a working definition of sarcopenia, building on the work of previous efforts to generate a consensus. With the ultimate goal of improving function and independence in individuals with sarcopenia, the Task Force focused its attention on people at greatly increased risk of muscle atrophy as a consequence of hip fracture. The rationale for looking at this population is that since hip fracture is a recognized condition, there is a clear regulatory path forward for developing interventions. Moreover, patients with hip fracture may provide an appropriate population to advance understanding of sarcopenia, for example helping to define diagnostic criteria, develop biomarkers, understand the mechanisms that underlie the age-related loss of muscle mass and strength, and identify endpoints for clinical trials that are reliable, objective, and clinically meaningful. Task Force members agreed that progress in treating sarcopenia will require strengthening of partnerships between academia, industry, and government agencies, and across continents to reach consensus on diagnostic criteria, optimization of clinical trials design, and identification of improved treatment and preventive strategies. In this report, the main results of the Task Force discussion are presented.

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Sarcopenia and Predictors of Skeletal Muscle Mass in Elderly Men With and Without Obesity

Gerontology and Geriatric Medicine ◽

10.1177/2333721417713637 ◽

2017 ◽

Vol 3 ◽

pp. 233372141771363 ◽

Cited By ~ 4

Author(s):

Katja Stoever ◽

Anke Heber ◽

Sabine Eichberg ◽

Klara Brixius

Keyword(s):

Physical Activity ◽

Skeletal Muscle ◽

Muscle Mass ◽

Gait Speed ◽

Strong Correlations ◽

Elderly Men ◽

Skeletal Muscle Index ◽

European Working ◽

Upper And Lower Extremities ◽

Definition Of

Objectives: The aim of this study was to determine the variables which show the highest association with muscle mass and to identify the most important predictors for muscle mass in elderly men with and without sarcopenia. Methods: A total of 71 men participated, aged ≥65 years. Sarcopenia was assessed using the definition of the European Working Group on Sarcopenia in Older People with determining skeletal muscle index (SMI), hand-grip strength (HGS), and Short Physical Performance Battery. In addition, maximum strength at upper and lower extremities and physical activity were measured. Results: Strong correlations existed between SMI and gait speed, HGS, maximum isometric strength at leg and chest press. Physical activity showed low correlations with muscle strength. Regression analysis revealed HGS and gait speed as key predictors for SMI. Discussion: The recommendation is measuring gait speed and HGS in clinical practice at first followed by measuring muscle mass for determining sarcopenia.

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Early mobility after fragility hip fracture: a mixed methods embedded case study

BMC Geriatrics ◽

10.1186/s12877-021-02083-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Lynn Haslam-Larmer ◽

Catherine Donnelly ◽

Mohammad Auais ◽

Kevin Woo ◽

Vincent DePaul

Keyword(s):

Hip Fracture ◽

Healthcare Provider ◽

Functional Decline ◽

Healthcare Providers ◽

Early Mobility ◽

Fragility Hip Fracture ◽

Increased Risk ◽

Poor Outcomes ◽

Embedded Case Study

Abstract Background Following a hip fracture up to 60% of patients are unable to regain their pre-fracture level of mobility. For hospitalized older adults, the deconditioning effect of bedrest and functional decline has been identified as the most preventable cause of ambulation loss. Recent studies demonstrate that this older adult population spends greater than 80% of their time in bed during hospitalization, despite being ambulatory before their fracture. We do not fully understand why there continues to be such high rates of sedentary times, given that evidence demonstrates functional decline is preventable and early mobility recommendations have been available for over a decade. Methods A descriptive mixed method embedded case study was selected to understand the phenomenon of early mobility after fragility hip fracture surgery. In this study, the main case was one post-operative unit with a history of recommendation implementation, and the embedded units were patients recovering from hip fracture repair. Data from multiple sources provided an understanding of mobility activity initiation and patient participation. Results Activity monitor data from eighteen participants demonstrated a mean sedentary time of 23.18 h. Median upright time was 24 min, and median number of steps taken was 30. Qualitative interviews from healthcare providers and patients identified two main categories of themes; themes external to the person and themes unique to the person. We identified four factors that can influence mobility; a patient’s pre-fracture functional status, cognitive status, medical unpredictability, and preconceived notions held by healthcare providers and patients. Conclusions There are multi-level factors that require consideration with implementation of best practice interventions, namely, systemic, healthcare provider related, and patient related. An increased risk of poor outcomes occurs with compounding multiple factors, such as a patient with low pre-fracture functional mobility, cognitive impairment, and a mismatch of expectations. The study reports several variables to be important considerations for facilitating early mobility. Communicating mobility expectations and addressing physical and psychological readiness are essential. Our findings can be used to develop meaningful healthcare provider and patient-centred interventions to address the risks of poor outcomes.

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Polypharmacy related with increased risk of hip fracture in the older patients

European Journal of Hospital Pharmacy ◽

10.1136/ejhpharm-2012-000074.59 ◽

2012 ◽

Vol 19 (2) ◽

pp. 107.2-107

Author(s):

O. Garcia ◽

R. Jimenez ◽

J. Velasco ◽

V. Arocas ◽

M.A. De la Rubia ◽

...

Keyword(s):

Hip Fracture ◽

Older Patients ◽

Increased Risk

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Impact of Low Muscle Mass and Low Muscle Strength According to EWGSOP2 and EWGSOP1 in Community-Dwelling Older People

The Journals of Gerontology Series A ◽

10.1093/gerona/glaa063 ◽

2020 ◽

Vol 75 (7) ◽

pp. 1324-1330 ◽

Cited By ~ 1

Author(s):

Luisa Costanzo ◽

Antonio De Vincentis ◽

Angelo Di Iorio ◽

Stefania Bandinelli ◽

Luigi Ferrucci ◽

...

Keyword(s):

Muscle Strength ◽

Older People ◽

Muscle Mass ◽

Community Dwelling ◽

Mobility Disability ◽

European Working ◽

Normal Mass ◽

Community Dwelling Older People ◽

Universal Definition ◽

Definition Of

Abstract Background A universal definition of sarcopenia is still lacking. Since the European criteria have been recently revised, we aimed at studying prevalence of low muscle strength (LMS) and low muscle mass (LMM), as defined according to the European Working Group of Sarcopenia in Older People (EWGSOP) 2 and 1 definitions, and their individual contribution toward mortality and incident mobility disability in a cohort of community-dwelling older people. Methods Longitudinal analysis of 535 participants of the InCHIANTI study. LMS and LMM were defined according to the criteria indicated in the EWGSOP2 and 1. Cox and log-binomial regressions were used to examine association with mortality and 3-year mobility disability (inability to walk 400 m). Results We observed a lower prevalence of the combination LMM/LMS according to EWGSOP2 compared to EWGSOP1 (3.2% vs 6.2%). Using the new criteria, all sarcopenia components were associated with mortality, although the hazard ratio [HR] for the group LMM/LMS was no longer significant after adjustment for confounders (LMM: HR 2.69, 95% confidence interval [CI] 1.04–6.94; LMS: HR 3.18, 95% CI 1.44–7.01; LMM/LMS: HR 2.95, 95% CI 0.86–10.16). Using EWGSOP1, LMS alone was independently associated with mortality (HR 4.43, 95% CI 1.85–10.57). None of the sarcopenia components conferred a higher risk of mobility disability. Conclusions The EWGSOP2 algorithm leads to a reduction in the estimated prevalence of sarcopenia defined as combination of LMM/LMS. The finding that, independent of the adopted criteria, people with LMS and normal mass have a higher mortality risk compared to robust individuals, confirms that evaluation of muscle strength has a central role for prognosis evaluation.

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