Validation of a proxy-reported SARC-F questionnaire for current and retrospective screening of sarcopenia-related functional impairments.

BACKGROUND: The strength, assistance walking, rise from a chair, climb stairs, and falls (SARC-F) questionnaire is a well-established instrument for screening of sarcopenia and sarcopenia-related functional impairments. As it is based on self-reporting, its use precludes patients who are unable to answer the questionnaire as a consequence of severe acute diseases or cognitive impairment. Therefore, we aimed to validate a proxy-reported version of the SARC-F for both ad-hoc as well as retrospective screening for severe sarcopenia-related functional impairments. METHODS: Patients aged ≥60 years completed the SARC-F and performed the short physical performance battery (SPPB) at baseline (T1). Proxies in Cohort A gave a simultaneous assessment of the patients' functional status with the proxy-reported SARC-F at T1 and again, retrospectively, after 3 months (T2). Proxies in Cohort B only completed the SARC-F retrospectively at T2. The questionnaires' performances were assessed through sensitivity/specificity analyses and receiver operating characteristic (ROC) curves. For non-inferiority analyses, results of both the patient-reported and proxy-reported SARC-F were correlated with the SPPB total score as well as the results of the chair-rise test subcategory; the respective correlation coefficients were tested against each other. RESULTS: One hundred and four patients and 135 proxies participated. Using a SPPB score < 9 points as the reference standard, the proxy-reported SARC-F identified patients at high risk for sarcopenia-related functional impairment with a sensitivity of 0.81 (ad-hoc), 0.88 (retrospective Cohort A), and 0.87 (retrospective Cohort B) as well as a specificity of 0.89 (ad-hoc), 0.78 (retrospective Cohort A), and 0.64 (retrospective Cohort B). Areas under the ROC curves were ≥ 0.9 for the ad-hoc proxy-reported SARC-F and the retrospective proxy-reported SARC-F in both cohorts. The proxy-reported SARC-F showed a non-inferior correlation with the SPPB compared with the patient-reported SARC-F for ad-hoc (P = <0.001) as well as retrospective screening for severe sarcopenia-related functional impairment in both Cohorts A (P = 0.007) and B (P = 0.026). CONCLUSIONS: Proxy-reported SARC-F is a valid instrument for both ad-hoc as well as retrospective screening for sarcopenia-related functional impairment and could become the standard tool for evaluating this risk in older adults with severe acute disease, for example, in patients with quickly evolving haematological conditions.

User-Oriented Evaluation of a Robotic Rollator That Provides Navigation Assistance in Frail Older Adults with and without Cognitive Impairment.

BACKGROUND: Navigational skills decline with age, and this decline is even more pronounced in cognitively impaired (CI) older adults. Navigation assistance is an emerging functionality of robotic rollators (RRs). The evidence on the effectiveness of RR-integrated navigation systems in potential end-users is, however, scarce. OBJECTIVE: To determine whether RR-provided navigation assistance improves navigation within a real-life environment in the intended user group of frail older adults with and without cognitive impairment currently using a rollator in daily life. METHODS: A randomized, between-subject, 2 × 2 factorial design was conducted to test the effects of navigation assistance and cognitive status on participants' navigation performance. Twenty CI (Mini-Mental State Examination [MMSE] 17-26) and 22 not cognitively impaired (NCI; MMSE >26) older rollator users (age 82.5 ± 8.7 years) were included. Participants were matched for cognitive status (CI vs. NCI) and randomized to one of two conditions: RR (1) with or (2) without activated navigation system. All participants had to complete a two-section navigation path with the RR in an unfamiliar, real-life environment. Participants with RR-assisted navigation were supported in wayfinding by directional audio cues of the RR-integrated navigation system. Participants without RR-assisted navigation had to complete the sections by orienting themselves along conventional signposts. Outcomes were success rate, completion and stopping time, number of stops, walking distance, and gait speed. RESULTS: The navigation assistance condition had no significant effect on the success rate in the CI, NCI, or total group. We found significant interactions between navigation assistance and cognitive status for both sections (p = 0.002-0.040), such that RR-assisted navigation reduced the completion time (both sections), stopping time (section 1), and number of stops (section 2) in the CI (p ≤ 0.001-0.014) but not in the NCI group. On the more complex section 2, RR-assisted navigation led to a reduced stopping time and walking distance in the total group (p = 0.014-0.016). CONCLUSION: The RR-integrated navigation system was effective for improving navigation within a real-life environment in potential end-users, especially in those with cognitive impairment. This is the first study to provide statistical evidence on the effectiveness of an RR-integrated navigation system in the intended user group.

Is Polypharmacy Associated with Frailty in Older People? Results From the ESTHER Cohort Study.

OBJECTIVES: To investigate the relationship between polypharmacy and frailty. DESIGN: Longitudinal, observational cohort study. SETTING: Saarland, Germany. PARTICIPANTS: 3,058 community-dwelling adults aged between 57 and 84 years. MEASUREMENTS: Frailty was assessed according to the frailty phenotype, described by Fried et al. Polypharmacy and hyperpolypharmacy were defined as the concomitant use of five or more and 10 or more drugs, respectively. We assessed associations between polypharmacy and prevalent and incident frailty within 3 years of follow-up by logistic regression models controlled for multiple potential confounders including comorbidity. Additionally, cubic splines were used to assess dose-response associations. RESULTS: Polypharmacy was reported in 39.1% (n = 1,194), and hyperpolypharmacy in 8.9% (n = 273) of participants. Prevalent frailty was present in 271 (8.9%) participants; 186 (9.3%) of 1,998 non-frail participants with follow-up data became frail within 3 years. After adjustment, polypharmacy and hyperpolypharmacy were associated with prevalent frailty with adjusted odds ratios (95% confidence interval) of 2.30 (1.60-3.31) and 4.97 (2.97-8.32), respectively. Polypharmacy (odds ratio (OR) 1.51 (1.05-2.16)) and hyperpolypharmacy (OR 1.90 (1.10-3.28)) were also independent predictors of incident frailty. Furthermore, there was a moderate exposure-response relationship between the number of medicines and prevalent as well as incident frailty. CONCLUSION: Our study showed that polypharmacy is associated with frailty. Further research should address the potential benefit of reducing of inappropriate polypharmacy and better pharmacotherapeutic management for preventing medication-associated frailty.

Development and evaluation of a modification of the Fried frailty criteria using population-independent cutpoints.

OBJECTIVES: To develop and evaluate a modification of the Fried frailty assessment using population-independent cutpoints and to determine frailty prevalence of community-dwelling elderly people in a German population. DESIGN: Cross-sectional analysis of 8-year follow-up data of a large German cohort study. SETTING: Saarland, Germany. PARTICIPANTS: Three thousand one hundred twelve community-dwelling adults aged 59 and older. MEASUREMENTS: Frailty was operationalized using modified Fried frailty criteria. Criteria were categorized according to quintiles (lowest-quintile approach) or using population-independent cutpoints derived from the literature (population-independent approach). Agreement and construct validity of frailty classification according to both approaches were evaluated according to weighted kappa (κ) and Spearman rank correlation (r(Sp) ). Associations between frailty and covariates were assessed using multiple logistic regression models. RESULTS: Although more participants were identified as frail according to the population-independent index (8.9%) than the lowest-quintile index (6.5%), agreement and correlation of frailty classification using both approaches was high (κ = 0.75 and r(Sp) = 0.84). Sex differences in frailty prevalence were more pronounced when the population-independent approach was used (women 11.4%; men 6.1%). Similarly strong significant associations with sociodemographic, lifestyle, and medical factors such as older age, female sex, smoking, and obesity were seen for both approaches. CONCLUSION: The modified Fried index using literature-derived cutpoints independent from the frailty criteria distributions in the underlying study population showed good correlation with the lowest-quintile approach and enables prevalence estimates that are directly comparable between different populations.

Maximum step length as a potential screening tool for falls in non-disabled older adults living in the community.

BACKGROUND AND AIMS: Identification of the risk of falls in a cohort of interest is a prerequisite for a targeted fall prevention study. Motor tasks are widely used as baseline assessment in such studies, but there are only a few well-evaluated tests of motor performance to predict falls prospectively. This study was conducted to find out if the potential of the maximum step length (MSL) test can predict future falls in non-disabled older persons. METHODS: A modified version of the MSL test was used for baseline assessment in 56 community-dwelling, non-disabled elderly persons (mean age 67.7 yrs, SD 6 yrs; 57% women). During a follow-up of 1 year, falls were recorded in a daily calendar. RESULTS: During the follow-up, 30 persons (54%) fell, with no gender difference in reporting of falls between men and women. The adjusted mean valid step length and adjusted maximum valid step length were predictive of future falls with a sensitivity/specificity of 77%/62% and 70%/69%, respectively. Combining MSL test results with fall history increased sensitivity to 93% and 90%, respectively, but decreased specificity to 54% and 58%, respectively. CONCLUSIONS: The MSL test is a feasible tool, with low requirements in space, predicting future falls in community-dwelling older persons. In combination with history of falls, the sensitivity of the test increased considerably.

Improvement in muscular performance and decrease in tumor necrosis factor level in old age after antioxidant treatment.

Aging-related loss of muscle function is a predictor of mortality and a surrogate parameter of the aging process. Its consequences include a high risk for falls, hip fractures, and loss of autonomy. Aging is associated with changes in the oxidant/antioxidant balance including a decrease in plasma thiol (cysteine) concentration. To assess the importance of cysteine, we determined in a double-blind study the effects of N-acetylcysteine on the functional capacity of frail geriatric patients and their response to physical exercise. The subjects on placebo showed only a relatively weak response, and 31% showed even a decrease in more than one parameter during the observation period. Low plasma arginine levels were correlated with a weak overall performance before exercise and a poor response to exercise. N-Acetylcysteine strongly enhanced the increase in knee extensor strength and significantly increased the sum of all strength parameters if adjusted for baseline arginine level as a confounding parameter. N-acetylcysteine had no significant effect on growth hormone and IGF-1 levels but caused a significant decrease in plasma TNF-alpha. These findings may provide a basis for therapeutic intervention and suggest that the loss of function involves limitations in cysteine and one or more other amino acids which may compromise muscular protein synthesis.

Intensive physical training in geriatric patients after severe falls and hip surgery.

BACKGROUND: Intensive exercise training can lead to improvement in strength and functional performance in older people living at home and nursing home residents. There is little information whether intensive physical exercise may be applicable and effective in elderly patients suffering from the acute sequelae of injurious falls or hip surgery. OBJECTIVE: To assess the feasibility, safety and efficacy of intensive, progressive physical training in rehabilitation after hip surgery. DESIGN: Prospective, randomised, placebo-controlled intervention study of a 3-months training intervention and a 3-months' follow-up. SETTING: Physical training 6-8 weeks after hip surgery. SUBJECTS: Twenty-eight (15 intervention, 13 control) elderly patients with a history of injurious falls admitted to acute care or inpatient rehabilitation because of acute fall-related hip fracture or elective hip replacement. METHODS: Progressive resistance and functional training to improve strength and functional performance. RESULTS: No training-related medical problems occurred in the study group. Twenty-four patients (86%) completed all assessments during the intervention and follow-up period. Adherence was excellent in both groups (intervention: 93, 0+/-13, 5% versus control: 96, 7+/-6, 2%). Training significantly increased strength, functional motor performance and balance and reduced fall-related behavioural and emotional problems. Some improvements in strength persisted during 3-months follow-up while other strength variables and functional performances were lost after cessation of training. Patients in the control group showed no change in strength, functional performance and emotional state during intervention and follow-up. CONCLUSIONS: Progressive resistance training and progressive functional training are safe and effective methods to increase strength and functional performance during rehabilitation in patients after hip surgery and a history of injurious falls. Because part of the training improvements were lost after stopping the training, a continuing training regime should be established.