scholarly journals Lower Skeletal Muscle Mass at Admission Independently Predicts Falls and Mortality 3 Months Post-discharge in Hospitalized Older Patients

2018 ◽  
Vol 74 (10) ◽  
pp. 1650-1656 ◽  
Author(s):  
Esmee M Reijnierse ◽  
Sjors Verlaan ◽  
Vivien K Pham ◽  
Wen Kwang Lim ◽  
Carel G M Meskers ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Muscle Mass ◽  
Older Patients ◽  
Test Score ◽  
Handgrip Strength ◽  
Bed Rest ◽  
Post Discharge ◽  
Male Sex ◽  
Prospective Longitudinal

Abstract Background Approximately 10% of older adults are annually admitted to a hospital. Hospitalization is associated with a higher risk of falls and mortality after discharge. This study aimed to identify predictors at admission for falls and mortality 3 months post-discharge in hospitalized older patients. Methods The Evaluation of Muscle parameters in a Prospective cohort of Older patients at clinical Wards Exploring Relations with bed rest and malnutrition (EMPOWER) study is an observational, prospective longitudinal inception cohort of 378 patients aged 70 years and older who were subsequently admitted to a tertiary hospital (the Netherlands). Potential predictors for falls and mortality 3 months post-discharge were tested using univariate and multivariate logistic regression analyses and included the following domains: demographic (age, sex, living independently), lifestyle (alcohol, smoking), nutrition (SNAQ score), muscle mass (absolute, relative), physical function (handgrip strength, Katz ADL score), cognition (six-item cognitive impairment test score), and disease (medications, diseases). Results The mean age was 79.6 years (standard deviation 6.23) and 50% were male. Within 3 months post-discharge, 19% reported a fall and 13% deceased. Univariate predictors for falls were higher age, lower absolute muscle mass and higher six-item cognitive impairment test score. Lower absolute muscle mass independently predicted falls post-discharge (multivariate). Univariate predictors for mortality were higher age, male sex, no current alcohol use, higher SNAQ score, lower absolute and higher relative muscle mass, higher Katz ADL score and higher number of diseases. Male sex, higher SNAQ score, and lower absolute muscle mass independently predicted mortality post-discharge (multivariate). Conclusions In hospitalized older adults, muscle mass should be measured to predict future outcome. Future intervention studies should investigate if increasing muscle mass prevent short-term falls and mortality.

scholarly journals Decreased Appetite is Associated with Sarcopenia-Related Outcomes in Acute Hospitalized Older Adults

Nutrients ◽  
2019 ◽  
Vol 11 (4) ◽  
pp. 932 ◽  
Author(s):  
Carliene van Dronkelaar ◽  
Michael Tieland ◽  
Jesse Aarden ◽  
Lucienne Reichardt ◽  
Rosanne van Seben ◽  
...  
Keyword(s):  
Older Adults ◽  
Muscle Mass ◽  
Physical Performance ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Handgrip Strength ◽  
Post Discharge ◽  
Hospitalized Older Adults ◽  
Multicenter Prospective Cohort Study ◽  
Mobility Skills

Decreased appetite is one of the main risk factors of malnutrition. Little is known on how appetite changes during hospitalization and after discharge and how it relates with sarcopenia-related outcomes. We analyzed data of the Hospital-ADL study, a multicenter prospective cohort study that followed 400 acutely hospitalized older adults (≥70 year). Appetite (SNAQ), handgrip strength (Jamar), muscle mass (BIA), mobility (DEMMI), and physical performance (SPPB) were assessed within 48 h of admission, at discharge, and at one and three months post-discharge. The course of decreased appetite was analysed by Generalised Estimating Equations. Linear Mixed Model was used to analyse the associations between decreased appetite and the sarcopenia-related outcomes. Decreased appetite was reported by 51% at hospital admission, 34% at discharge, 28% one month post-discharge, and 17% three months post-discharge. Overall, decreased appetite was associated with lower muscle strength (β = −1.089, p = 0.001), lower mobility skills (β = −3.893, p < 0.001), and lower physical performance (β = −0.706, p < 0.001) but not with muscle mass (β = −0.023, p = 0.920). In conclusion, decreased appetite was highly prevalent among acute hospitalized older adults and remained prevalent, although less, after discharge. Decreased appetite was significantly associated with negative sarcopenia-related outcomes, which underlines the need for assessment and monitoring of decreased appetite during and post hospitalization.

scholarly journals Long-Term Survival of Older Patients Hospitalized for COVID-19. Do Clinical Characteristics upon Admission Matter?

2021 ◽  
Vol 18 (20) ◽  
pp. 10671
Author(s):  
Michał Chojnicki ◽  
Agnieszka Neumann-Podczaska ◽  
Mikołaj Seostianin ◽  
Zofia Tomczak ◽  
Hamza Tariq ◽  
...  
Keyword(s):  
Older Adults ◽  
Hospital Admission ◽  
Functional Capacity ◽  
Functional Impairment ◽  
Older Patients ◽  
Post Discharge ◽  
Term Survival ◽  
Care Plans ◽  
Risk Of Death ◽  
Male Sex

Older adults are particularly susceptible to COVID-19 in terms of both disease severity and risk of death. To compare clinical differences between older COVID-19 hospitalized survivors and non-survivors, we investigated variables influencing mortality in all older adults with COVID-19 hospitalized in Poznań, Poland, through the end of June 2020 (n = 322). In-hospital, post-discharge, and overall 180-day mortality were analyzed. Functional capacity prior to COVID-19 diagnosis was also documented. The mean age of subjects was 77.5 ± 10.0 years; among them, 191 were females. Ninety-five (29.5%) died during their hospitalization and an additional 30 (9.3%) during the post-discharge period (up to 180 days from the hospital admission). In our study, male sex, severe cognitive impairment, underlying heart disease, anemia, and elevated plasma levels of IL-6 were independently associated with greater mortality during hospitalization. During the overall 180-day observation period (from the hospital admission), similar characteristics, excluding male sex and additionally functional impairment, were associated with increased mortality. During the post-discharge period, severe functional impairment remained the only determinant. Therefore, functional capacity prior to diagnosis should be considered when formulating comprehensive prognoses as well as care plans for older patients infected with SARS-CoV-2.

scholarly journals Muscular Function: An alternative way to identify cognitive impairment, Secondary Analysis From SABE-Colombia

2020 ◽  
Author(s):  
Elkin Garcia-Cifuentes ◽  
Felipe Botero-Rodríguez ◽  
Felipe Ramirez Velandia ◽  
Angela Iragorri ◽  
Isabel Marquez ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Cognitive Performance ◽  
Motor Function ◽  
Gait Speed ◽  
Handgrip Strength ◽  
Secondary Analysis ◽  
Screening Tools ◽  
Cognitively Impaired ◽  
Recall Memory

Abstract Background Traditionally, the identification of cognitive impairment is based on neuropsychological tests and supported with not widely available biomarkers. This study aimed to establish the association between motor function (Gait Speed and Handgrip Strength) and the performance in a global cognitive performance and various cognitive domains. Our secondary objective was to determine a cut-off point for Gait Speed and Handgrip Strength to classify older adults as cognitively impaired. Methods This is a secondary analysis from the SABE Colombia study (Health, Well-Being, and Aging) conducted in 2015. We performed linear regression models, to establish association with motor function, clinical, and sociodemographic variables, and predict the scores of the Mini-mental State Examination and its domains (i.e. orientation, recall, counting, and language). The evaluation of the motor function variables as an instrument to separate cognitively impaired older adults was evaluated by developing a receiving operating characteristic curve (ROC). Results Gait speed was associated with orientation (r2 = 0.16), language (r2 = 0.15), recall memory (r2 = 0.14) and counting (r2 = 0.08). Similarly, handgrip strength was associated with orientation (r2 = 0.175), language (r2 = 0.164), recall memory (r2 = 0.137), and counting (r2 = 0.08). Slow gait had a cut-off point of 0,59 m/s, with an area under the curve (AUC) of 0.629 (0.613–0.646), whereas a weak handgrip strength had an AUC of 0.653 (0.645–0.661), with a cut-off point of 17.50 Kg for separating those older adults with cognitive impairment. Conclusions Gait Speed or Handgrip Strength are similarly associated with cognitive performance, exhibiting the larger associations with orientation and language domains. Gait Speed and Handgrip Strength can be easily performed by any clinician and seems to be useful screening tools to detect cognitive impairment.

scholarly journals Reliability and validity of a quick test of cognitive speed (AQT) in screening for mild cognitive impairment and dementia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Pouya Farokhnezhad Afshar ◽  
Elisabeth H. Wiig ◽  
Seyed Kazem Malakouti ◽  
Behnam Shariati ◽  
Sara Nejati
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Sensitivity And Specificity ◽  
Older Patients ◽  
Reliability And Validity ◽  
Quick Test ◽  
Significant Difference ◽  
Cognitive Speed ◽  
Color Form

Abstract Background Cognitive disorders are one of the important issues in old age. There are many cognitive tests, but some variables affect their results (e.g., age and education). This study aimed to evaluate the reliability and validity of A Quick Test of Cognitive Speed (AQT) in screening for mild cognitive impairment (MCI) and dementia. Methods This is a psychometric properties study. 115 older adults participated in the study and were divided into three groups (46 with MCI, 24 with dementia, and 45 control) based on the diagnosis of two geriatric psychiatrists. Participants were assessed by AQT and Mini-Mental State Examination (MMSE). Data were analyzed using Pearson correlation, independent t-test, and ROC curve by SPSS v.23. Results There was no significant correlation between AQT subscales and age and no significant difference between the AQT subscales in sex, educational levels. The test-retest correlations ranges were 0.84 from 097. Concurrent validity was significant between MMSE and AQT. Its correlation was with Color − 0.78, Form − 0.71, and Color-Form − 0.72. The cut-off point for Color was 43.50 s, Form 52 s, and Color-Form 89 s were based on sensitivity and specificity for differentiating older patients with MCI with controls. The cut-off point for Color was 62.50 s, for Form 111 s, and Color-Form 197.50 s based on sensitivity and specificity measures for differentiating older patients with dementia and MCI. Conclusion The findings showed that AQT is a suitable tool for screening cognitive function in older adults.

SENSITIVITY AND SPECIFICITY OF THE HANDGRIP STRENGTH IN THE PREDICTION OF LOW MUSCLE MASS IN HOSPITALIZED OLDER PATIENTS

2012 ◽  
pp. 1-4
Author(s):  
V. Zanandrea ◽  
A.P. Rossi ◽  
M. Bertocchi ◽  
M. Zamboni
Keyword(s):  
Muscle Strength ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Muscle Mass ◽  
Acute Care ◽  
Sensitivity And Specificity ◽  
Older Patients ◽  
Handgrip Strength ◽  
Hospitalized Patients ◽  
Acute Care Unit

To the Editor: In the article entitled “Potential prognosticvalue of handgrip strength in older hospitalized patients”published in the first issue of The Journal of Frailty & Aging(1), Savino and colleagues presented the handgrip strength as apredictor of hospitalization length of stay in older patientsadmitted to an acute care unit. Authors reported an inverseassociation between muscle strength at the admission andsubsequent duration of the hospital stay, even after adjustmentfor potential confounders.

scholarly journals Can in-hospital or post discharge caregiver involvement increase functional performance of older patients? A systematic review

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Margaretha van Dijk ◽  
Jasmien Vreven ◽  
Mieke Deschodt ◽  
Geert Verheyden ◽  
Jos Tournoy ◽  
...  
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Older Patients ◽  
Functional Performance ◽  
Care Pathway ◽  
Intervention Group ◽  
Post Discharge ◽  
Home Setting ◽  
Randomized Controlled ◽  
Caregiver Involvement

Abstract Background Regaining pre-hospitalization activity levels is only achieved in 30–50% of older patients. Extra physiotherapy time has been proven to improve functional outcome and shorten length of stay, but is costly. Considering their key role in caring for older people, involving informal caregivers in rehabilitation might further improve functional performance. Aim To determine if in-hospital or post discharge caregiver involvement can increase functional performance in older adults. The secondary aim was to determine if caregiver involvement can influence, quality of life of patient and caregiver, medical costs, readmission rate, discharge location, and mortality. Design Systematic review with narrative synthesis. Methods The electronic bibliographic databases MEDLINE, Embase, CINAHL, Cochrane and Web of Science were searched for (quasi) experimental and observational studies, with the following inclusion criteria; caregiver involvement regarding functional performance, mean age over 65 years, admitted to a hospital unit and subsequently discharged to their home setting. Risk of bias was assessed with the Rob 2 (randomized trials) and the ROBINS-1 tool (non-randomized studies). Results Eight studies of an initial 4683 were included: four randomized controlled trials, one prospective cohort study, one non-randomized controlled trial, one subgroup analysis of an RCT and one prospective pre-post study. All but one study included patients with stroke. Three types of caregiver interventions could be distinguished: a care pathway (inclusion of caregivers in the process of care), education on stroke and teaching of bed-side handling-skills, and caregiver-mediated exercises. The one study evaluating the care pathway reported 24.9% more returns home in the intervention group. Studies evaluating the effect of education and bed-side handling-skills reported higher effect sizes for several outcomes with increasing session frequency. All studies with caregiver-mediated exercises showed beneficial effects on functional performance, immediately after the intervention and within 3 months follow-up. Conclusion The findings of this review suggest that involvement of caregivers in the rehabilitation of older adults leads to better functional performance up to 3 months after initiation. However, evidence is low and mainly focusing on stroke.

scholarly journals The impact of disease-related immobilization on thigh muscle mass and strength in older hospitalized patients

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Nikola Rommersbach ◽  
Rainer Wirth ◽  
Gero Lueg ◽  
Christiane Klimek ◽  
Mirja Schnatmann ◽  
...  
Keyword(s):  
Muscle Mass ◽  
Handgrip Strength ◽  
Knee Extension ◽  
Hospitalized Patients ◽  
Thigh Muscle ◽  
Knee Extension Strength ◽  
Isometric Knee Extension ◽  
Intermuscular Fat ◽  
Prospective Longitudinal ◽  
The Impact

Abstract Background We assessed the quantitative changes in muscle mass and strength during 2 weeks of hospitalization in immobile and mobile acutely ill hospitalized older adults. Methods Forty-one patients (82.4 ± 6.6 years, 73.0% females) participated in this prospective longitudinal observational study. Mobility status was defined according to walking ability as described in the Barthel-Index. Functional status, including handgrip strength and isometric knee-extension strength, and mid-thigh magnetic resonance imaging (MRI) measurements of cross-sectional area (CSA) were conducted on admission and at discharge. Results Twenty-two participants (54%) were immobile and 19 (46%) mobile. In all, 54.0 and 12.0% were at risk of malnutrition and malnourished, respectively. The median time between baseline and follow-up for MRI scans were 13 days in mobile and immobile participants (P = 0.072). Mid-thigh muscle and subcutaneous fat CSA significantly decreased by 3.9cm2 (5.0%, P = 0.002) and 5.3cm2 (5.7%, P = 0.036) during hospitalization whereas intermuscular fat remained unchanged in immobile subjects. No significant changes were observed in mobile patients. In a regression analysis, mobility was the major independent risk factor for changes in mid-thigh muscle CSA as a percentage of initial muscle area (P = 0.022) whereas other variables such as age (P = 0.584), BMI (P = 0.879), nutritional status (P = 0.835) and inflammation (P = 0.291) were not associated with muscle mass changes. There was a significant decrease in isometric knee extension strength (P = 0.002) and no change in handgrip strength (P = 0.167) in immobile patients whereas both parameters increased significantly over time in mobile patients (P = 0.048 and P = 0.012, respectively). Conclusions Two weeks of disease-related immobilization result in a significant loss of thigh muscle mass and muscle strength in older patients with impaired mobility. Concomitantly, there was a significant reduction of subcutaneous adipose tissue in immobile older hospitalized patients whereas no changes were observed in intermuscular fat among these patients. These data highlight the importance of mobility support in maintaining muscle mass and function in older hospitalized patients.

Cancer-specific mortality and competing causes of death in older adults: A prospective, multicenter cohort study (ELCAPA-19).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 11547-11547 ◽  
Author(s):  
Deborah Assouan ◽  
Elena Paillaud ◽  
Philippe Caillet ◽  
Emmanuelle Kempf ◽  
Helene Vincent ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Cancer Mortality ◽  
Older Patients ◽  
Rating Scale ◽  
Mortality Rates ◽  
Test Time ◽  
Cancer Death ◽  
Multicenter Cohort Study ◽  
Patients With Cancer

11547 Background: Among older adults with cancer, comorbidities compete with cancer as the cause of death. The objectives were to quantify the proportion and rate of cancer-specific death in older patients with cancer, and to analyze the associations between geriatric factors and cancer death. Methods: Between January 2007 and December 2014, older patients with cancer were prospectively included by the ELCAPA cohort study’s eight investigating centers. Competing risk methods were used to estimate 6-month and 3-year cancer mortality rates and to probe associations between geriatric factors and cancer death. Results: A total of 1678 patients were included (mean ± standard deviation age: 81.3 ± 5.8; women: 49%). The most common cancers were colorectal (19%), breast (17%) and urinary (15%) cancers and 49% had metastasis. After a median follow-up period of 34 months, a total of 948 deaths were observed. Of the 282 deaths in non-metastatic patients, 203 (72%; 95% confidence interval (CI): [66%-77%]) were attributable to cancer. This proportion was 92% (89–94; N = 448/498) for metastatic patients. The 6-month and 3-year cancer mortality rates was respectively 12% (9–15) and 34% (29-38) for non-metastatic tumors and 45% (41–49) and 83% (80–87) for metastatic stage tumors. At 6 months, the geriatric factors independently associated with cancer death were a dependency in activities of daily living (ADL) score ≤ 5 (adjusted subhazard ratio: 2.11 (95%CI: [1.68–2.64]), mobility impairment (Timed Get Up and Go (TGUG) test time > 20 s (1.40 [1.05–1.87]) or inability to perform the TGUG (2.41 [1.67–3.48])) and comorbidities (total Cumulative Index Rating Scale-Geriatric score ≥13) (1.59 [1.23–2.06]). At 3 years, the independently associated factors were ADL ≤ 5 (1.60, [1.34–1.91]), TGUG > 20 s (1.28, [1.04–1.59]) or inability to perform TGUG (2.02 [1.47–2.79]), and cognitive impairment (1.23 [1.01–1.50]). Conclusions: Most older adults with cancer die from this disease and not from other comorbidities. However, geriatric parameters (dependency, impaired mobility, comorbidities, and cognitive impairment) are independently associated with cancer death. These geriatric impairments should be taken into account when assessing the cancer patient’s prognosis in clinical practice. Clinical trial information: NCT02884375.

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