Effect of cholecalciferol supplementation on hand grip strength, walking speed, and expression of vitamin D receptor, interleukin-6, and insulin-like growth factor-1 in monocyte in pre-frail older adults: A randomized double-blind placebo-controlled trial.

AIM: To investigate the effect of cholecalciferol supplementation on hand grip strength, walking speed, and expression of vitamin D receptor (VDR), interleukine-6 (IL-6) and insulin-like growth factor-1 (IGF-1) in monocyte in pre-frail older adults. METHODS: We conducted a randomized double-blinded placebo-controlled clinical trial for 12 weeks, involving 120 pre-frail older adults who were randomized to the cholecalciferol group (cholecalciferol 4000 IU/day) or the placebo group. All subjects were given calcium lactate 500 mg/day. Hand grip strength and walking speed, as primary outcomes, were analyzed using intention-to-treat analysis. The expression of VDR, IGF-1 and IL-6 in monocytes, as secondary outcomes, were analyzed using per-protocol analysis. RESULTS: After a 12-week intervention, there was a significant increase in serum 25(OH)D levels in both groups, with the increase being higher in the cholecalciferol group than in the placebo group (49.05 vs. 24.01 ng/mL; P < 0.001). No statistically significant differences were observed in hand grip strength (P = 0.228) and walking speed (P = 0.734) between the groups. There were no differences in the expression of VDR (P = 0.513), IL-6 (P = 0.509), and IGF-1 (P = 0.503) monocytes between the groups. CONCLUSIONS: Cholecalciferol supplementation for 12 weeks increased serum 25(OH)D levels among pre-frail older adults. However, it did not improve hand grip strength and walking speed, and nor did it change the expression of VDR, IL-6, and IGF-1 in monocytes. Geriatr Gerontol Int 2024; 24: 554-562.

Physio-cognitive decline syndrome among middle-aged diabetes patients: Handgrip strength significantly correlates with glycaemic control and cognitive score.

Aims: To investigate the correlation between glycaemic control with component of Physio-Cognitive Decline Syndrome (PCDS) and among each component of PCDS itself. Methods: A cross sectional study was conducted (January 2021-November 2022) at Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia on consecutively recruited T2DM outpatients aged 40-59 years old. Data on the latest three months HbA1c, hand grip strength (HGS), usual gait speed (GS), and Indonesian Montreal Cognitive Assessment (MoCA-Ina) were evaluated. Pearson or Spearman's test was used to analyse the correlations. Results: There were 133 subjects with median age 53 (40-59) years. The PCDS was found in 48.1 % subjects, of which 64.1 % with uncontrolled glycaemia. Significant correlations were found between HGS and HbA1c (r = -0.24, R2 = 0.06, p < 0.01) and MoCA-Ina score (r = 0.21, R2 = 0.04, p < 0.05). Conclusion: The higher HbA1c and the lower MoCA-Ina score, the weaker handgrip strength was.

Vitamin D Levels in Pre-frail Older Adults and Its Correlation with Hand Grip Strength.

BACKGROUND: Vitamin D deficiency is frequent in older adults and associated with poor musculoskeletal function. The prevalence of pre-frailty is also high in older persons, who may proceed to a frail state. This study aimed to determine the vitamin D levels in pre-frail older adults and its correlation with hand grip strength. METHODS: A cross-sectional study was conducted on older adults (age > 60 years) with a pre-frail condition who were visiting the outpatient geriatric clinic at Cipto Mangunkusumo Hospital in Jakarta, Indonesia. Serum levels of vitamin D, measured as 25(OH)D, were determined by enzyme-linked immunosorbent assay (ELISA), and hand grip strength was measured using a Jamar hydraulic dynamometer. Correlations between vitamin D levels and hand grip strength were evaluated by Spearman's rank correlation coefficient. Multiple linear regression analysis was carried out to assess contribution of variables that influence hand grip strength. RESULTS: Of 95 pre-frail older adults (mean age 70.08 ± 5.35 years), 67.4% were female,  and the median vitamin D level was 17.91 (interquartile range/IQR 13.68-26.36) ng/mL. Overall, 11.6% of the participants had normal vitamin D levels, whereas 34.7% and 53.7% had insufficient and deficient levels, respectively. Females were more likely to have inadequacy of vitamin D than males.  Those with vitamin D deficiency tended to have a higher body mass index (BMI) and lower vitamin D intake than normal levels. A significant correlation between serum vitamin D levels and hand grip strength was observed (r = 0.283; P = 0.006). After adjusting for age, comorbidities, nutritional status, functional status, BMI, protein intake, and sun exposure score, regression analysis between hand grip strength and vitamin D levels gave standard coefficient beta = 0.255 (P = 0.013). CONCLUSION: In this study, pre-frail older adults had a high proportion of deficient and insufficient vitamin D levels, and a significant correlation was found between serum vitamin D levels and hand grip strength.

A Case Report of Profuse Bleeding in the Lower Gastrointestinal Tract due to Dieulafoy Lesion in the Rectum.

Dieulafoy lesion is a rare condition that usually occurs in cases of gastric bleeding in the upper gastrointestinal tract. However, this condition can also occur in the lower gastrointestinal tract but less frequently. The lesion is an arteriolar malformation that extends to the submucosa, causing erosion and bleeding. Meanwhile, this is a case of a 67-year-old woman presenting with a bright red bloody stool prior to admission, as well as a history of constipation which was relieved by digital stool evacuation two weeks earlier. The medical history of the patient reveals episodes of  repeated ischaemic stroke for over seven years and three months, which has led to other conditions such as right-sided paralysis, transcortical motor aphasia, and neurogenic dysphagia. The patient was routinely on antithrombotic medications, which was stopped during hospitalisation where repeated packed cell transfusion was done in order to avoid hematochezia. The patient needed the support of her caregiver most of the time since she was bedridden. Furthermore, the haemostasis and platelet function of the patient were normal. On colonoscopy, there was the discovery of a small lesion of about 3mm in her rectum, protruding into the lumen and pulsated, which was discovered to be Dieulafoy's lesion. Subsequently, this lesion was closed using rubber band ligation, and after a month, there was no recurrence of the lower gastrointestinal bleeding.

Indonesian Geriatrics Society Consensus on COVID-19 Management in Older Adults.

More than 80% of death cases and 95% of severe COVID-19 occur in patients aged over 60 years. Atypical clinical manifestations with high morbidity and mortality further emphasize the importance of COVID-19 management in older adults. Some older patients may appear asymptomatic while other may present with acute respiratory distress syndrome and multi organ failure. Fever, higher respiratory rate and crackles may present. The most common chest x-ray finding is ground glass opacity. Other imaging modalities that are often used are pulmonary computed tomography scan and lung ultrasonography. COVID-19 management in older adults should be comprehensive, starting from oxygen, fluid, nutritional, physical rehabilitation, pharmacology and psychosocial therapy. In this consensus, we also discuss about management of older adults with special condition such as diabetes mellitus, kidney disease, malignancy, frailty, delirium, immobilization and dementia. In post COVID-19 phase, we believe that physical rehabilitation is important as it is done to improve fitness.

Sedentary Lifestyle of Older Adults and Its Associated Factors: A Multicentre Cross-Sectional Study During COVID-19 Pandemic in Indonesia.

BACKGROUND: COVID-19 is here to stay, and humans ought to decide how to adapt. We aimed to describe lifestyle changes during COVID-19 pandemic, and to determine the prevalence and factors associated with sedentary lifestyle among older adults. METHODS: We obtained data from community-dwelling older adults aged ≥60 years. We presented the data descriptively and used multivariate analysis to assess the association between Physical Activity Scale for the Elderly (PASE) -based sedentary lifestyle and other variables in several tertiary geriatric centres. RESULTS: Among 601 participants, 21.1% had sedentary lifestyle. Ethnic groups with the highest prevalence of sedentary lifestyle were Minang, Balinese, and Sundanese. Changes related to food intake, body weight, and physical activity were seen in a small proportion of older adults. Sun exposure habit was described. Sedentary lifestyle was associated with less consumption of food (OR 2.59, 95% CI 1.07-6.30), weight loss (OR 3.00, 95% CI 1.64-5.48), and higher intensity of snacking (OR 0.45, 95% CI 0.20-0.99). CONCLUSION: During COVID-19 pandemic, one out of five older adults had sedentary lifestyle, which was positively associated with less consumption of food and weight loss, and negatively associated with higher intensity of snacking. The prevalence of sedentary lifestyle varied across ethnic groups. Adequate and appropriate food intake may be crucial to keep older adults active, preventing them from entering vicious cycle of malnutrition, sarcopenia, and frailty.

Frailty among Older Adults Living in Nursing Homes in Indonesia: Prevalence and Associated Factors.

BACKGROUND: Frailty syndrome is a predictor of all-cause mortality among older adults living in nursing homes. However, data on the prevalence of frailty among individuals living in nursing homes, particularly in middle-income countries, are limited. Thus, this study aimed to determine the prevalence of frailty and identify its associated factors among older adults living in nursing homes in Indonesia. METHODS: This cross-sectional study of older adults living in six nursing homes in Indonesia was conducted between May and December 2019. Data on demographic characteristics, physical activity (Physical Activity Scale for the Elderly), cognitive status (Abbreviated Mental Test), nutritional status (Mini Nutritional Assessment Short-Form), depression (Geriatric Depression Scale), comorbidity, frailty state (Cardiovascular Health Study criteria), dietary pattern (24-hour food recall), handgrip strength, and gait speed were evaluated. Bivariate and multivariate analyses were performed to identify factors independently associated with frailty. RESULTS: This study recruited a total of 214 participants with a mean age of 73.68±4.30 years. The prevalence rates of frailty and malnutrition were 46.5% and 58%, respectively. The results showed that physical frailty was associated with malnutrition (odds ratio=4.23; 95% confidence interval, 1.730-10.380). CONCLUSION: Frailty was prevalent and strongly associated with malnutrition among older adults living in nursing homes in Indonesia.

Frailty and Its Associated Risk Factors: First Phase Analysis of Multicentre Indonesia Longitudinal Aging Study.

Background: National long-term care development requires updated epidemiological data related to frailty. We aimed to find the prevalence of frailty and its associated factors among Indonesian elderly. Methods: We conducted first-phase cross-sectional analysis of Indonesia Longitudinal Aging Study (INALAS) data collected from community-dwelling outpatients aged 60 years and older without acute illness in nine geriatric service care centres. Descriptive, bivariate and multivariate analyses were conducted. Results: Among 908 elderly in this study, 15.10% were robust, 66.20% were pre-frail, and 18.70% were frail. Functional dependence was associated with frailty among Indonesian elderly (OR 5.97, 95% CI 4.04-8.80). Being depressed and at risk for malnutrition were also associated with frailty with OR 2.54, 95% CI 1.56-4.12, and OR 2.56, 95% CI 1.68-3.90, respectively. Prior history of fall (OR 1.77, 95% CI 1.16-2.72) and hospitalization (OR 1.46, 95% CI 0.97-2.20) in the previous 12 months were associated with frailty. There is also significant association between poly pharmacy and frailty (OR 2.42, 95% CI 1.50-3.91). Conclusion: Approximately one in five Indonesian community-dwelling elderly was frail. Frailty is associated with functional dependence, being at risk for malnutrition or being malnourished, depression, history of fall, history of hospitalization, and poly pharmacy. There may be bidirectional relationships between the risk factors and frailty. The development of long-term care in Indonesia should be considered, without forcing the elderly who need it.

The Impact of Frailty on 30-day Post-Elective Surgery Complications in Elderly Patients: a Prospective Cohort Study.

BACKGROUND: late-life surgery poses a greater risk for complications and a higher mortality rate. Frailty has been noted to predict adverse outcomes after surgery in elderly patients. We aimed to investigate the impact of frailty on 30-day post-elective surgery complications in elderly patients. METHODS: this prospective cohort study was conducted based on data collected from patients undergoing elective surgery in Cipto Mangunkusumo Hospital, Indonesia. Frailty was assessed using the Frailty Index 40 items, and 30-day post-surgery complications were assessed using Clavien-Dindo classification. Multivariate logistic regression analysis was performed to determined adjusted relative risk (RR) of the development of 30-day post-surgery complications. RESULTS: a total of 180 subjects were enrolled in the study, with average age of 67.1 (SD 6.06) years old. More than half of the subjects fell into pre-frail category (55.6%), followed by frail (26.7%) and fit (17.7%) respectively. About 21.1% experienced complications within 30 days post-surgery. Frail subjects (41.7%) showed higher incidence of complications compared to the pre-frail (15%) and fit (9.4%) group. Multivariate analysis revealed that adjusted RR in the frail group accounted for 4.58 (95% CI 1.8-8.12), considering the surgical severity as a confounding factor. No significant difference in the incidence of complications was observed between the pre-frail and fit groups, despite the pre-frail group having a higher complication rate. CONCLUSION: being frail increases the risk of 30-day post-elective surgery complications in elderly patients.

The Effect of Ophiocephalus striatus Extract on the Levels of IGF-1 and Albumin in Elderly Patients with Hypoalbuminemia.

BACKGROUND: a freshwater fish Ophiocephalus striatus or known locally to Indonesian as haruan,can potentially increases IGF-1 and albumin levels in elderly patients with hypoalbuminemia due to the contents of amino acids, fatty acids, vitamins, and minerals. This study was conducted to investigate the effect of Ophiocephalus striatus extract on the level of IGF-1 and albumin in elderly patients with hypoalbuminemia. METHODS: the study is a double-blind randomized controlled trial involving malnourished elderly inpatients (≥60 years old) recovering from acute condition before hospital discharge, with Mini Nutritional Assessment score ≤23.5 and albumin level <3.5 g/dL. A total of 109 subjects were randomly divided into two groups: one group received 10 g Ophiocephalus striatus extract per day for 14 days and another group received placebo. Albumin and IGF-1 levels were obtained before and after intervention. RESULTS: ninety subjects completed the study (extract group=45 subjects; placebo group =45 subjects) for 14 days. The median of age were 69 (64;75) years and the male to female ratio were 2 : 3. The changes of IGF-1 and albumin levels from before to after intervention between extract group compared to placebo group were 14.7 (0.30;31.5) ng/mL vs 1.0 (-6;13.15) ng/mL (p=0.002) and 0.5 (0.15;0.70) g/dL vs 0.10 (0.0;0.50) g/dL (p=0.003), respectively. There were significant differences in the improvement of IGF-1 and albumin levels between extract and placebo group. CONCLUSION: supplementation of Ophiocephalus striatus extract was associated with a significant increase in IGF-1 and albumin levels in elderly patients with hypoalbuminemia.

The correlation between body fat distribution and insulin resistance in elderly.

AIM: to find the correlation between total body fat, truncal subcutaneous fat, peripheral subcutaneous fat, waist circumference and insulin resistance in elderly METHODS: a cross sectional study was conducted in patients aged 60 years or more who visited the Geriatric Outpatient Clinic at Department of Internal Medicine, Cipto Mangunkusumo National Central General Hospital, Jakarta. Subcutaneous fat thickness was measured by using caliper at 5 different sites. Truncal subcutaneous fat was measured at subscapular, suprailiaca and abdomen; whereas peripheral subcutaneous fat was measured at tricep and thigh region. Total body fat was assessed by using Bioelectrical Impedance Analysis. Index of insulin resistance was measured by using HOMA-IR. RESULTS: from November 2008 to January 2009, there were 55 elderly subjects who fulfilled criteria. There were significant correlations between HOMA-IR and percentage of total body fat (r=0.318; p=0.018), truncal subcutaneous fat (r=0.347; p=0.01), peripheral subcutaneous fat (r=0.296; p=0.028), and waist circumference as index of visceral fat (r=0.361; p=0.007). Other results included our finding on the correlation between BMI and percentage of total body fat (r=0.8; p=0.000), truncal subcutaneous fat (r=0.844; p=0.000), peripheral subcutaneous fat (r=0.706; p=0.000), and waist circumference (r=0.874; p=0.000). There were tendencies of decreasing body fat distribution, BMI and HOMA-IR along with increasing age. Moreover, there was also a tendency of increasing HOMA-IR with increasing BMI. CONCLUSION: this study showed a positive correlation between percentage of total body fat, truncal subcutaneous fat, peripheral subcutaneous fat, waist circumference and insulin resistance in elderly.