RESUMO
INTRODUCTION: we examined the consequences of applying the new EWGSOP2 algorithm for sarcopenia screening instead of the former EWGSOP algorithm (EWGSOP1) in geriatric inpatients. METHODS: the dataset of our formerly published Sarcopenia in Geriatric Elderly (SAGE) study includes 144 geriatric inpatients (86 women, 58 men, mean age 80.7±5.6 years) with measurements of gait speed, handgrip strength and appendicular muscle mass by dual x-ray absorptiometry (DXA). We analysed the agreement between EWGSOP and EWGSOP2 algorithms in identifying patients as sarcopenic/non-sarcopenic. Differences in the distribution sarcopenic vs. non-sarcopenic were assessed by Chi²-test. RESULTS: sarcopenia prevalence according to EWGSOP1 (41 (27.7%)) was significantly higher than with EWGSOP2 (26(18.1%), p<0.05). The sex-specific sarcopenia prevalence was 22.1% (EWGSOP1) and 17.4% (EWGSOP2), respectively, for women (difference not significant) and 37.9% vs. 19.4% for men (p<0.05%). The overall agreement in classifying subjects as sarcopenic/non-sarcopenic was 81.25% (81.4% for women, 81.0% for men). However, among the 41 sarcopenia cases identified by EWGSOP1, only 20 (48.8%) were diagnosed with sarcopenia by EWGSOP2 (9/19 w (47.4%), 11/22 m (50.0%)). Ten of 19 women (52.6%) and 11 of 22 men (50.0%) diagnosed with sarcopenia by EWGSOP1 were missed by EWGSOP2, while 6 of 15 women (40.0%) and 0 of 11 men (0.0%) were newly diagnosed. DISCUSSION: there is a substantial mismatch in sarcopenia case finding according to EWGSOP1 and EWGSOP2. The overall prevalence and the number of men diagnosed with sarcopenia are significantly lower in EWGSOP2. While the absolute number of women identified as sarcopenic remains relatively constant, the overlap of individual cases between the two definitions is low.
Assuntos
Algoritmos , Marcha/fisiologia , Avaliação Geriátrica/métodos , Força da Mão/fisiologia , Pacientes Internados , Guias de Prática Clínica como Assunto , Sarcopenia/diagnóstico , Absorciometria de Fóton , Idoso , Idoso de 80 Anos ou mais , Áustria/epidemiologia , Diagnóstico Diferencial , Feminino , Humanos , Incidência , Masculino , Prevalência , Estudos Retrospectivos , Sarcopenia/epidemiologia , Sarcopenia/fisiopatologiaRESUMO
BACKGROUND: Sarcopenia and osteoporosis share an underlying pathology and reinforce each other in terms of negative outcomes. OBJECTIVE: To evaluate the extent of concomitance of sarcopenia as defined by the European Working Group on Sarcopenia in Older People (EWGSOP) and osteoporosis as defined by the World Health Organization (WHO) in geriatric inpatients and their relationship to nutritional and functional status. MATERIAL AND METHODS: A cross-sectional analysis of geriatric inpatients from the sarcopenia in geriatric elderly (SAGE) study. Measurements included dual Xray absorptiometry for bone mineral density and appendicular muscle mass; gait speed and hand grip strength, the Barthel index, body mass index (BMI) and the mini nutritional assessment short form (MNA-SF). RESULTS: Of the 148 patients recruited for SAGE, 141 (84 women, 57 men; mean age 80.6⯱ 5.5 years) had sufficient data to be included in this ancillary investigation: 22/141 (15.6%) were only osteoporotic, 19/141 (13.5%) were only sarcopenic and 20/141 (14.2%) osteosarcopenic (i.e. both sarcopenia and osteoporosis). The prevalence of osteoporosis was higher in sarcopenic than in non-sarcopenic individuals (51.3% vs. 21.6%, pâ¯< 0.001). Sarcopenic, osteoporotic and osteosarcopenic subjects had a lower BMI, MNA-SF, handgrip and gait speed (pâ¯< 0.05) than the reference group (those neither osteoporotic nor sarcopenic, nâ¯= 80). The Barthel index was lower for sarcopenic and osteosarcopenic (pâ¯< 0.05) but not for osteoporotic (pâ¯= 0.07) subjects. The BMI and MNA-SF were lower in osteosarcopenia compared to sarcopenia or osteoporosis alone (pâ¯< 0.05) while there were no differences in functional criteria. CONCLUSION: Osteoporosis and sarcopenia are linked to nutritional deficits and reduced function in geriatric inpatients. Co-occurrence (osteosarcopenia) is common and associated with a higher degree of malnutrition than osteoporosis or sarcopenia alone.
Assuntos
Osteoporose , Sarcopenia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Marcha , Força da Mão , Humanos , Masculino , Osteoporose/complicações , Osteoporose/epidemiologia , Prevalência , Sarcopenia/complicações , Sarcopenia/epidemiologiaRESUMO
The prognosis for patients with diastolic heart failure--heart failure with preserved ejection fraction--has not improved in the last few decades despite improvement of prognosis for all patients with heart failure. Diastolic dysfunction is a typical finding in elderly patients with heart failure. The diagnostic process is a challenge for clinicians who are often faced with comorbidities like COPD, osteoarthritis, sarcopenia, and diabetes. Classical treatment options fail to improve patients with diastolic heart failure; thus, a comprehensive and specific treatment plan is necessary.
Assuntos
Insuficiência Cardíaca Diastólica/diagnóstico , Insuficiência Cardíaca Diastólica/terapia , Volume Sistólico , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/terapia , Diagnóstico Diferencial , Insuficiência Cardíaca Diastólica/complicações , Humanos , Disfunção Ventricular Esquerda/complicaçõesRESUMO
Digitalis and theophylline are some of the oldest drugs used to treat cardiopulmonary diseases. Despite a long history, the evidence for both drugs is still inconsistent, in parts negative. In this context, geriatric medicine represents a special area of conflict. On the one hand, both drugs may play a role in the treatment of advanced heart failure and chronic obstructive pulmonary disease, particularly in the treatment of symptoms. On the other hand, both drugs are often listed as potentially inappropriate medications for the elderly. This paper discusses the evidence for both drugs based on the current literature.
Assuntos
Glicosídeos Digitálicos/uso terapêutico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/mortalidade , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/mortalidade , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/mortalidade , Teofilina/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Medicina Baseada em Evidências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição de Risco , Taxa de Sobrevida , Resultado do TratamentoRESUMO
Increasing evidence in managing polypharmacy in the growing elderly population with a higher prevalence of multiple chronic disease is the basis for this paper. Poor adherence, drug-drug interactions, drug-disease interactions, and inappropriate medication challenge the prescriptions of health care providers in this group of patients. Risk factors, the prevalence of polypharmacy, and the impact on health issues will be shown by analyzing the recent literature. Based on intervention trials, several tools in polypharmacy have emerged as practical guides for clinical practice or for the geriatric ward to solve this problem. The Medication Appropriateness Index (MAI) and national lists of potentially inappropriate medication used in clinical practice are presented, including Screening Tool to Alert Doctors to the Right Treatment (START), Screening Tool of Older Persons' Potentially Inappropriate Prescriptions (STOPP), and Assess, Comprehensive Geriatric Assessment, Adherence, Development, Emergence, Minimization, Interdisciplinarity, Alertness (ACADEMIA).
Assuntos
Algoritmos , Interações Medicamentosas , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Medicina Baseada em Evidências , Prescrição Inadequada/prevenção & controle , Prescrição Inadequada/estatística & dados numéricos , Polimedicação , Idoso , Idoso de 80 Anos ou mais , Ensaios Clínicos Controlados como Assunto , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Feminino , Humanos , Incidência , Masculino , Medição de Risco , Fatores de RiscoRESUMO
Among geriatric patients, atrial fibrillation is the most common cardiac arrhythmia. In patients over 80 years of age, the prevalence rises to approximately 10%. Atrial fibrillation is associated with serious health implications, including a 2-fold increase in mortality risk and a 5-fold increase in stroke risk. In contrast to these facts, the current guidelines on the management of atrial fibrillation of the European Society of Cardiology (ESC) contain only a short paragraph on these patients. Many relevant clinical aspects go without any comment. Thus, the purpose of our paper is to discuss those special needs of geriatric patients and their physicians which are not mentioned in the guidelines of the ESC. In our review, we discuss rhythm versus rate control, oral anticoagulation, outcome, prevention, falls, adherence, polypharmacy, dementia, nursing home patients, frailty, and geriatric assessment in consideration of geriatric patients. An extended search of the literature on Pubmed served as the basis for this review. Individual aspects of each geriatric patient should be considered when managing these complex patients; however, the complexity of each case must not lead to an individualized therapy that is not in accordance with current guidelines and the literature. A large number of papers which help us to answer most of the clinical questions regarding the management of trial fibrillation in geriatric patients have already been published.
Assuntos
Antiarrítmicos/uso terapêutico , Anticoagulantes/uso terapêutico , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/terapia , Estimulação Cardíaca Artificial/métodos , Avaliação Geriátrica/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , MasculinoAssuntos
Depressão/prevenção & controle , Fadiga/tratamento farmacológico , Terapia de Reposição Hormonal/métodos , Comportamento Sexual/efeitos dos fármacos , Testosterona/sangue , Testosterona/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Depressão/sangue , Método Duplo-Cego , Humanos , Masculino , Estudos Retrospectivos , Medição de Risco , Resultado do Tratamento , Estados UnidosAssuntos
Fibrilação Atrial/epidemiologia , Demência/epidemiologia , Insuficiência Cardíaca/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Escolaridade , Feminino , Humanos , Incidência , Estudos Longitudinais , Massachusetts/epidemiologia , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Fatores de RiscoAssuntos
Infecções Relacionadas a Cateter/prevenção & controle , Infecção Hospitalar/prevenção & controle , Telômero/efeitos dos fármacos , Cateterismo Urinário/estatística & dados numéricos , Infecções Urinárias/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Doenças da Medula Óssea/tratamento farmacológico , Doenças da Medula Óssea/genética , Infecções Relacionadas a Cateter/epidemiologia , Infecção Hospitalar/epidemiologia , Danazol/uso terapêutico , Humanos , Pessoa de Meia-Idade , Estados Unidos/epidemiologiaAssuntos
Acidentes por Quedas/prevenção & controle , Antagonistas Adrenérgicos beta/administração & dosagem , Calcifediol/administração & dosagem , Geriatria/organização & administração , Insuficiência Cardíaca/tratamento farmacológico , Fraturas do Quadril/terapia , Idoso , Idoso de 80 Anos ou mais , Método Duplo-Cego , Feminino , Humanos , Limitação da Mobilidade , Ortopedia/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Resultado do Tratamento , Vitamina D/análogos & derivados , Deficiência de Vitamina D/prevenção & controleRESUMO
BACKGROUND: Quantification of skeletal muscle mass is mandatory for diagnosing sarcopenia, a highly prevalent geriatric syndrome. While dual energy X-ray absorptiometry (DXA) is the reference method in a clinical context, bioimpedance analysis (BIA) is more readily applicable on a broad scale. Recently BIA equations for the prediction of appendicular skeletal muscle mass in higher age groups have been published, but data on their performance in geriatric inpatients are lacking. METHODS: In 144 geriatric inpatients (86 women and 58 men, mean age 80.7 ± 5.6 years) appendicular skeletal muscle mass was predicted by 4 different BIA equations and measured by DXA. Results were compared by linear regression analysis and Bland Altmann plots. The agreement with DXA in classifying subjects to have normal or reduced muscle mass was calculated for the BIA based approaches. RESULTS: The 4 BIA equations showed only minor differences in regression analysis, but major differences in mean error (range -0.98 kg to + 0.19 kg in women and -2.47 kg to -0.58 kg in men). Considering regression parameters and mean error, the equation of Scafoglieri et al. performed best, resulting in an agreement with DXA of more than 83%. Sensitivity to detect subjects with reduced muscle mass was <70% in the whole group for all BIA equations. CONCLUSION: The BIA equation of Scafoglieri et al. performs best in geriatric inpatients, with more than 83% of subjects classified correctly as having normal or reduced muscle mass compared to DXA. Low sensitivity to detect subjects with reduced muscle mass in geriatric inpatients remains a limitation of BIA.