Neutrophil-to-lymphocyte ratio and lymphocyte count as an alternative to body mass index for screening malnutrition in older adults living in the community.

PURPOSE: Accurate height and weight measurement can be challenging in older adults and complicates nutritional status assessment. Other parameters like the neutrophil-to-lymphocyte ratio (NLR) and the lymphocyte count (LC) could be an option to these measurements. We aimed to test these variables as subrogates of body mass index (BMI) or calf-circumference (CC) for malnutrition screening in community-dwelling older adults. METHODS: This is a secondary analysis from the Salud, Bienestar y Envejecimiento (SABE) survey from Ecuador (2009). Includes data on demographics, health-related factors, physical assessments, and complete blood count, allowing to calculate NLR and LC to be used as part of the Mini Nutritional Assessment (MNA), instead of the BMI. Consequently, 4 models were included: standard MNA, MNA-CC, MNA-NLR and MNA-LC. Finally, age, sex, and comorbidities were considered as confounding variables. RESULTS: In our analysis of 1,663 subjects, 50.81% were women. Positive correlations with standard MNA were found for MNA-NLR (Estimate = 0.654, p < 0.001) MNA-CC (Estimate = 0.875, p value < 0.001) and MNA-LC (Estimate = 0.679, p < 0.001). Bland-Altman plots showed the smallest bias in MNA-CC. Linear association models revealed varying associations between MNA variants and different parameters, being MNA-NLR strongly associated with all of them (e.g. Estimate = 0.014, p = 0.001 for albumin), except BMI. CONCLUSION: The newly proposed model classified a greater number of subjects at risk of malnutrition and fewer with normal nutrition compared to the standard MNA. Additionally, it demonstrated a strong correlation and concordance with the standard MNA. This suggests that hematological parameters may offer an accurate alternative and important insights into malnutrition.

Motoric cognitive risk syndrome and its association with falls: a secondary analysis of the Mexican Health and Aging Study.

OBJECTIVE: To reveal whether motoric cognitive risk syndrome (MCR) is associated with falls, recurrent falls, and complicated falls in older Mexican adults. MATERIALS AND METHODS: This is a secondary analysis of the Mexican Health and Aging Study. MCR was assessed in 2012 and included fall-related outcomes (recurrent [≥2], complicated [need for medical treatment] and number) in the 2018 follow-up. Competing risks analysis was performed, and subhazard ratios (sHRs) were estimated, adjusting for different variables. Negative binomial regression was used to estimate the incidence rate ratio (IRR) of the number of falls. RESULTS: A total of 1 929 participants were included, with a median age of 62 years and 58.3% female. The prevalence of MCR was 17.4% and was associated with falls sHR 1.11 (95%CI: 1.11, 1.12), recurrent falls sHR 1.16 (95%CI: 1.15, 1.16) and complicated falls sHR 1.25 (95%CI: 1.24, 1.25). The number of falls was also independently associated with baseline MCR (IRR 1.19; 95% CI 1.01, 1.40; p=0.039). CONCLUSION: MCR is independently associated with falls. Increasing the evidence on how MCR anticipates burdensome problems in older adults could lead to actions to halt them; therefore, including it in screening assessments could be clinically useful.

Association between the changes in socialsecurity continuity condition and mortality: MHAS 2001-2018 analysis.

OBJECTIVE: To analyze the association of changes in social security (SS) continuity and mortality, using the Mexican Health and Aging Study (MHAS) in people aged 60 years and more. MATERIALS AND METHODS: Retrospective cohort. We analyzed the SS continuity condition -classified as stable, unstable with SS, unstable without SS, and without SS- and its relation with mortality; a probit regression model was utilized to obtain marginal effects, taking into consideration covariates related to mortality. RESULTS: Unstable continuity with and without SS and multimorbidity (two or more diseases) increased the probability of dying by 52.9% (p = 0.000, 95%CI: 0.508,0.551), 50.3% (p = 0.000, 95%CI: 0.474,0.531) and 13.3% (p = 0.000, 95%CI: 0.108,0.159), respectively. Meanwhile, being woman, at least one year of formal education, and marriage reduced it in 8.8% (p = 0.000, 95%CI: -0.106,-0.071), 7% (p = 0.000, 95%CI: -0.091,-0.050) and 7.8% (p = 0.000, 95%CI: -0.096,-0.061), respectively. CONCLUSION: Belonging to SS was associated with higher mortality, compared to other social health determinants, like education.

The impact of an exercise intervention on frailty levels in hospitalised older adults: secondary analysis of a randomised controlled trial.

BACKGROUND: physical activity reduces frailty in community-dwelling older adults. How exercise influences frailty in hospitalised older adults requires additional investigation. OBJECTIVES: (i) to examine the impact of an exercise intervention on frailty in older adults admitted to an acute care ward, and (ii) to determine the impact of baseline frailty on the effectiveness of this intervention. SETTING/PARTICIPANTS: this is a secondary analysis of a randomised controlled clinical trial that tested an intensive exercise intervention in ≥75-year-old adults admitted to an acute care ward. METHODS: the intervention included two daily sessions of moderate-intensity exercises (control received usual care). A 63-item Frailty Index (FI) was constructed, and three groups were formed: <0.2, 0.2-0.29 and ≥0.3. Other outcomes included Short Physical Performance Battery (SPPB) and Barthel Index (BI). RESULTS: a total of 323 individuals were included. The mean age was 87.1 years (± 4.8 standard deviation [SD]) and 56.3% were females. The intervention group improved FI from 0.26 (± 0.10 SD) to 0.20 (± 0.10 SD), whereas the control group FI worsened from 0.25 (± 0.1 SD) to 0.27 (± 0.10 SD). After stratifying by baseline FI, SPPB and depression improved in the intervention group across all levels of frailty; FI, BI and quality of life only improved in individuals with a baseline FI ≥ 0.2. CONCLUSIONS: frailty improves with an intensive individualised exercise intervention, especially in those with high baseline levels of frailty. In addition, frailty is a useful outcome when examining the impact of an intervention of hospitalised older adults.

Does the association between smoking and mortality differ due to frailty status? A secondary analysis from the Mexican Health and Aging Study.

BACKGROUND: despite the well-known adverse health effects of smoking, evidence of these effects on frail individuals is still scarce. AIMS: to assess whether frailty influences the association between smoking and mortality. METHODS: individuals ≥50 years from the Mexican Health and Aging Study were analysed. Mortality rates from a 17-year follow-up were compared between smoking status groups (never, previous and current) and other smoking behaviour-related characteristics (pack-years, age commenced and cessation). Baseline variables were included to adjust the Cox regression models. First, models were adjusted for the whole sample, including an interaction term between the frailty index (FI) and smoking variables. A second set of models were stratified by FI levels: 0.00-0.10, 0.11-0.20, 0.21-0.30 and ≥ 0.31. RESULTS: from a total 14,025 individuals, mean age was 62.4 (95% confidence interval [95% CI]: 62.1-62.8) and 53.9% were women (95% CI: 52.4-55.6). Main results from the survival analyses showed that when including FI interaction term with smoking status, comparing current to never smoking, the hazard ratio (HR) was 2.03 (95% CI: 1.07-3.85, P = 0.029), and comparing current to previous smoking, the HR was 2.13 (95% CI: 1.06-4.26, P = 0.032). Models stratified by FI levels showed a significant HR only for the two highest level groups. Similar results were found for the smoking behaviour-related characteristics. DISCUSSION: our results suggest that frailty could modify smoking mortality risk. Other smoking characteristics were impacted by frailty, in particular, cessation. It was noteworthy that having ≥10 years of tobacco cessation was beneficial for frail individuals. CONCLUSIONS: smoking has a higher toll on frail individuals, but ceasing is still beneficial for this group.

A classification tree to assist with routine scoring of the Clinical Frailty Scale.

BACKGROUND: the Clinical Frailty Scale (CFS) was originally developed to summarise a Comprehensive Geriatric Assessment and yield a care plan. Especially since COVID-19, the CFS is being used widely by health care professionals without training in frailty care as a resource allocation tool and for care rationing. CFS scoring by inexperienced raters might not always reflect expert judgement. For these raters, we developed a new classification tree to assist with routine CFS scoring. Here, we test that tree against clinical scoring. OBJECTIVE/METHODS: we examined agreement between the CFS classification tree and CFS scoring by novice raters (clerks/residents), and the CFS classification tree and CFS scoring by experienced raters (geriatricians) in 115 older adults (mean age 78.0 ± 7.3; 47% females) from a single centre. RESULTS: the intraclass correlation coefficient (ICC) for the CFS classification tree was 0.833 (95% CI: 0.768-0.882) when compared with the geriatricians' CFS scoring. In 93%, the classification tree rating was the same or differed by at most one level with the expert geriatrician ratings. The ICC was 0.805 (0.685-0.883) when CFS scores from the classification tree were compared with the clerk/resident scores; 88.5% of the ratings were the same or ±1 level. CONCLUSIONS: a classification tree for scoring the CFS can help with reliable scoring by relatively inexperienced raters. Though an incomplete remedy, a classification tree is a useful support to decision-making and could be used to aid routine scoring of the CFS.

Frailty among middle-aged and older Canadians: population norms for the frailty index using the Canadian Longitudinal Study on Aging.

BACKGROUND: frailty is a public health priority now that the global population is ageing at a rapid rate. A scientifically sound tool to measure frailty and generate population-based reference values is a starting point. OBJECTIVE: in this report, our objectives were to operationalize frailty as deficit accumulation using a standard frailty index (FI), describe levels of frailty in Canadians ≥45 years old and provide national normative data. DESIGN: this is a secondary analysis of the Canadian Longitudinal Study on Aging (CLSA) baseline data. SETTING/PARTICIPANTS: about 51,338 individuals (weighted to represent 13,232,651 Canadians), aged 45-85 years, from the tracking and comprehensive cohorts of CLSA. METHODS: after screening all available variables in the pooled dataset, 52 items were selected to construct an FI. Descriptive statistics for the FI and normative data derived from quantile regressions were developed. RESULTS: the average age of the participants was 60.3 years (95% confidence interval [CI]: 60.2-60.5), and 51.5% were female (95% CI: 50.8-52.2). The mean FI score was 0.07 (95% CI: 0.07-0.08) with a standard deviation of 0.06. Frailty was higher among females and with increasing age, and scores >0.2 were present in 4.2% of the sample. National normative data were identified for each year of age for males and females. CONCLUSIONS: the standardized frailty tool and the population-based normative frailty values can help inform discussions about frailty, setting a new bar in the field. Such information can be used by clinicians, researchers, stakeholders and the general public to understand frailty, especially its relationship with age and sex.

COVID-19 related mortality in older adults: analysis of the first wave in Colombia and Mexico.

OBJECTIVE: The aim of this study is to describe the mortality among older adults in the first wave of COVID-19 in Colombia and Mexico. METHODS: This is an observational, prospective study on data obtained from open data sets that are publicly available on the websites of the health ministries of the respective countries. COVID-19 cases, age, sex, date to mortality, and mortality itself were analyzed with Kaplan-Meier curves and Cox regressions. RESULTS: Data on 1 779 877 individuals were analyzed, 58.2% from Mexico, with a higher frequency of men for both countries, and 11.7% were older adults. Survival curves show a continuous increase in mortality for Mexico, with higher rates for older adults, while for Colombia the mortality was observed up to 50 days of the follow-up. Finally, hazard ratios were higher for older adults in both countries. Colombia implemented a rigid curfew for older adults, and the effect on mortality is clear from the survival curves. CONCLUSIONS: This finding shows the potential benefit that public policies could have on older adults.

Screening intrinsic capacity and its epidemiological characterization: a secondary analysis of the Mexican Health and Aging Study.

OBJECTIVE: To describe the levels of intrinsic capacity and those factors related to its decline in Mexican older adults, using the Mexican Health and Aging Study. METHODS: This is a cross-sectional secondary analysis of the 2015 data of the Mexican Health and Aging Study, including adults aged 50 years and above. Selected questions were included to represent each domain of intrinsic capacity screening: cognition, depression, hearing, vision, anorexia, weight loss, and mobility. Sociodemographic characteristics, psychosocial factors, and health conditions were included to assess their association with intrinsic capacity. Further categories were established to assess not only individual characteristics but also different groupings. Along with descriptive statistics, multinomial regression models were performed. RESULTS: From a total of 12 459 adults aged 50 years and above, 54.7% were women and the average age was 71.2 years; 87.8% of the individuals had at least one intrinsic capacity domain affected, and mobility had the highest frequency (47.6%). All domains showed a trend of increasing with age and were higher among women. Self-rated health, chronic diseases, number of visits to a physician in the last year, and ≥2 affected activities of daily living were consistently associated with more intrinsic capacity domains affected. CONCLUSIONS: Decreased levels of intrinsic capacity in Mexican older people are associated with less schooling, self-rated health, chronic diseases, visits to a physician, and activities of daily living.

Individual and cumulative association of commonly used biomarkers on frailty: a cross-sectional analysis of the Mexican Health and Aging Study.

Frailty has been recognized as a common condition in older adults, however, there is scarce information on the association between frailty and commonly used biomarkers. The aim of this study was to assess the individual and cumulative association of biomarkers with frailty status. This is a cross-sectional analysis of the 2012 wave of the Mexican Health and Aging Study. A sub-sample of 60-year or older adults with anthropometric measurements was analyzed. Frailty was defined with a 31-item frailty index and those considered frail had a score ≥ 0.21. Biomarkers were further categorized as normal/abnormal and tested both one by one and grouped (according to their usual cutoff values). Adjusted logistic models were performed. A total of 1128 older adults were analyzed and their mean age was 69.45 years and 51.24% of them were women. 26.7% (n = 301) were categorized as frail. Individual biomarkers associated with frailty after adjusting for confounding were: hemoglobin [odds ratio (OR) 1.67, 95% confidence interval (CI) 1.13-2.46, p = 0.009], glycated hemoglobin (OR 2.04, 95% CI 1.54-2.7, p < 0.001) and vitamin D (OR 1.53, 95% CI 1.13-2.07, p = 0.005). Those with ≥ 4 abnormal biomarkers had an independent association with frailty when compared to those without any abnormal biomarker (OR 2.64, 95% CI 1.3-5.25, p = 0.005). Aside from the individual associations of specific biomarkers, our findings show that an incremental association of abnormal biomarkers increases the probability of frailty, accounting for the multidimensional nature of frailty and the possible interplay between components of the system that potentiate to give rise to a negative condition such as frailty.

Educational level and its Association with the domains of the Montreal Cognitive Assessment Test.

Objective: To explore the association between educational level and the scores obtained in each of the domains of the Montreal Cognitive Assessment test. Methods: This is a secondary analysis of the SABE/2012 Bogotá survey; a cross-sectional study including 2000 subjects aged ≥60years. The MoCA test was the dependent variable and was stratified by cognitive domains, incorrect answers and scores were considered. Educational level was assessed through years of formal education. Age, sex and selected medical conditions were also included to adjust the multivariate models. Bivariate analyses, fitted logistic and linear regression models were employed for analyzing association between these variables. Results: The proportion of incorrect answers increased as schooling years decreased and as age increased. In the multivariate analysis, visuospatial and executive function were the most affected domains. Educational level displayed less influence than age on short memory-recall task (standardized beta 0.19 vs -0.24). Educational level showed a greater influence than age on no-memory tasks (the sum of all other domains; standardized beta 0.50 vs -0.29). Conclusions: It seems logical to consider that performance in most domains of the MoCA is influenced by years of education. Therefore, low scores on these tasks could lead to low total MoCA scores and thus to bias and over diagnosis of cognitive impairment in patients with lower educational levels. Memory-recall domain is not affected much by education and applying it separately could be useful in patients with low educational level in whom we suspect memory impairment.

[Out of pocket expenditure on health during the last year of life of Mexican elderly: analysis of the Enasem]. / Gasto de bolsillo en salud durante el último año de vida de adultos mayores mexicanos: análisis del Enasem.

OBJECTIVE: To estimate the out-of-pocket expenses (OOPE) during the last year of life in Mexican older adults (OA). MATERIALS AND METHODS: Estimation of the OOPE corresponding to the last year of life of OA, adjusting by type of management, affiliation and cause of death. Data from the National Health and Aging Study in Mexico (2012) were used. To calculate the total OOPE, the expenses in the last year were used in: medications, medical consultations and hospitalization. The OOPE was adjusted for inflation and is reported in US dollars 2018. RESULTS: The mean OOPE was $6 255.3±18 500. In the ambulatory care group, the OOPE was $4 134.9±13 631.3. The OOPE in hospitalization was $7 050.6±19 971.0. CONCLUSIONS: The probability of incurre in OOPE is lower when hospitalization is not required. With hospitalization, affiliation to social security and attending to public hospitals plays a protective role.

OBJECTIVE: Estimar el gasto de bolsillo (GB) durante el último año de vida en adultos mayores (AM) mexicanos. MATERIALS AND METHODS: Estimación del GB del último año de vida de AM, ajustando por tipo de manejo, afiliación y causa de muerte. Se emplearon datos del Estudio Nacional de Salud y Envejecimiento en México (2012). Los gastos en medicamentos, consultas médicas y hospitalización durante el año previo a la muerte conforman el GB. El GB se ajustó por inflación y se reporta en dólares americanos 2018. RESULTS: La media de GB fue $6 255.3±18 500. En el grupo de atención ambulatoria el GB fue $4 134.9±13 631.3. El GB en hospitalización fue $7 050.6±19 971.0. CONCLUSIONS: La probabilidad de incurrir en GB es menor cuando no se requiere hospitalización. Con hospitalización, la afiliación a la seguridad social y atenderse en hospitales públicos juega un papel protector.

Mortality and associated risk factors for older adults admitted to the emergency department: a hospital cohort.

BACKGROUND: Older emergency department patients are more vulnerable than younger patients, yet many risk factors that contribute to the mortality of older patients remain unclear and under investigation. This study endeavored to determine mortality and factors associated with mortality in patients over 60 years of age who were admitted to the emergency departments of two general hospitals in Mexico City. METHODS: This is a hospital cohort study involving adults over 60 years of age admitted to the emergency department and who are beneficiaries of the Mexican Institute of Social Security and residents of Mexico City. All causes of mortality from the time of emergency department admission until a follow-up home visit after discharge were measured. Included risk factors were: socio-demographic, health-care related, mental and physical variables, and in-hospital care-related. Survival functions were estimated using Kaplan-Meier curves. Hazard ratios (HR) were derived from Cox regression models in a multivariate analysis. RESULTS: From the 1406 older adults who participated in this study, 306 (21.8%) did not survive. Independent mortality risk factors found in the last Cox model were age (HR = 1.02, 95% CI, 1.005-1.04; p = 0.01), length of stay in the ED (HR = 1.003, 95% CI = 0.99, 1.04; p = 0.006), geriatric care trained residents model in Hospital A (protective factor) (HR = 0.66, 95% CI = 0.46, 0.96; p = 0.031), and the FRAIL scale (HR of 1.34 95% CI, 1.02-1.76; p = 0.033). CONCLUSIONS: Risk factors for mortality in patients treated at Mexican emergency departments are length of stay and variables related to frailty status.

Collective violence and the health of the elderly: a cross-sectional analysis of a population-based national survey in Mexico.

OBJECTIVE: To describe the association between collective violence and the health of older adults in Mexico. METHODS: The data analyzed were taken from a Mexican population-based national survey of health and nutrition that included a representative sample of adults over 60 years of age and from an index of violence for each of the states of Mexico that was compiled by a major research center. Five of the most common geriatric ailments (weight loss, depressive symptoms, falls, positive affectivity, and disability) were crossed with the violence index score assigned to each state. RESULTS: A total of 7 108 older adults were included in the analysis. Among the five geriatric health problems, weight loss had the strongest association with violence, even when an adjusted model was used. For weight loss, that association increased as the level of collective violence rose. With the adjusted model, there was also an association of severe collective violence with disability and with low positive affectivity. CONCLUSIONS: Our results show that there is an association of collective violence with weight loss and other geriatric problems. Collective violence could indirectly affect individuals' health, especially older persons and other vulnerable groups.

Frailty and food insecurity in older adults.

OBJECTIVE: The objective of the current work was to determine the association between food insecurity and frailty in older adults, within the context of a country with accelerated ageing and nutritional problems. DESIGN: Cross-sectional analysis of a representative nationwide survey on health and nutrition. SETTING: Mexican nationwide survey. SUBJECTS: A sample of 7108 adults aged 60 years or older living in communities, representative of Mexican older adults. RESULTS: Multivariate regression and descriptive analyses of food insecurity and frailty were performed. From a total of 7108 adults aged 60 years or older, with a mean age of 70·7 years, most (54·7 %) were women. Food security categories were: 26·3 % had food security, 40·3 % had mild food insecurity, 20·5 % had moderate food insecurity and 12·9 % had severe food insecurity. Food insecurity categories were associated with frailty, with the severe category having the highest odds ratio of 2·41 (95 % CI 2·03, 2·86; P<0·001) after adjustment for confounding factors. CONCLUSIONS: According to our results, food insecurity is associated to frailty, which in turn is a condition that renders the older adult at a higher risk of developing adverse outcomes. Targeted food programmes for older adults with a high risk of having food insecurity or of being frail may improve health in this population group.

Predictive Value of Frailty Indices for Adverse Outcomes in Older Adults.

BACKGROUND: There are two widely used tools to classify frailty in older adults: the frailty phenotype and the frailty index. Both have been validated for prediction of adverse outcomes. OBJECTIVE: To assess the ability of different frailty indices to predict a number of adverse outcomes (falls, disability, and mortality) by adding deficits in a fixed sequence (with the first five deficits as in the frailty phenotype: weakness, weight loss, slowness, exhaustion and low physical activity) or randomly. METHODS: This is an analysis of the Costa-Rican Longevity and Healthy Aging Study in which ≥ 60-year-old adults were included and followed up for four years. Frailty indices were constructed, including the frailty phenotype components in the first five indices followed by the random addition of other deficits and estimating for each one the odds ratios for falls and disability and hazard ratios for mortality, adjusted for age and sex. RESULTS: We included 2,708 adults; mean age was 76.31 years, 54.28% were women. Indices with the highest number of deficits had the highest estimates for each adverse outcome, independent of the deficit. CONCLUSION: The higher the number of deficits in an index, the higher the estimates for adverse outcomes, independent of the type of deficit added.

Using magnetic resonance imaging to measure head muscles: An innovative method to opportunistically determine muscle mass and detect sarcopenia.

BACKGROUND: Sarcopenia is associated with multiple adverse outcomes. Traditional methods to determine low muscle mass for the diagnosis of sarcopenia are mainly based on dual-energy X-ray absorptiometry (DXA), whole-body magnetic resonance imaging (MRI) and bioelectrical impedance analysis. These tests are not always available and are rather time consuming and expensive. However, many brain and head diseases require a head MRI. In this study, we aim to provide a more accessible way to detect sarcopenia by comparing the traditional method of DXA lean mass estimation versus the tongue and masseter muscle mass assessed in a standard brain MRI. METHODS: The H70 study is a longitudinal study of older people living in Gothenburg, Sweden. In this cross-sectional analysis, from 1203 participants aged 70 years at baseline, we included 495 with clinical data and MRI images available. We used the appendicular lean soft tissue index (ALSTI) in DXA images as our reference measure of lean mass. Images from the masseter and tongue were analysed and segmented using 3D Slicer. For the statistical analysis, the Spearman correlation coefficient was used, and concordance was estimated with the Kappa coefficient. RESULTS: The final sample consisted of 495 participants, of which 52.3% were females. We found a significant correlation coefficient between both tongue (0.26) and masseter (0.33) with ALSTI (P < 0.001). The sarcopenia prevalence confirmed using the alternative muscle measure in MRI was calculated using the ALSTI (tongue = 2.0%, masseter = 2.2%, ALSTI = 2.4%). Concordance between sarcopenia with masseter and tongue versus sarcopenia with ALSTI as reference has a Kappa of 0.989 (P < 0.001) for masseter and a Kappa of 1 for the tongue muscle (P < 0.001). Comorbidities evaluated with the Cumulative Illness Rating Scale were significantly associated with all the muscle measurements: ALSTI (odds ratio [OR] 1.16, 95% confidence interval [CI] 1.07-1.26, P < 0.001), masseter (OR 1.16, 95% CI 1.07-1.26, P < 0.001) and tongue (OR 1.13, 95% CI 1.04-1.22, P = 0.002); the higher the comorbidities, the higher the probability of having abnormal muscle mass. CONCLUSIONS: ALSTI was significantly correlated with tongue and masseter muscle mass. When performing the sarcopenia diagnostic algorithm, the prevalence of sarcopenia calculated with head muscles did not differ from sarcopenia calculated using DXA, and almost all participants were correctly classified using both methods.

Temporal Muscle Thickness: A Practical Approximation for Assessing Muscle Mass in Older Adults.

OBJECTIVE: Ongoing research has evidenced the importance of muscle measurement in predicting adverse outcomes. Measurement of other muscles is promising in current research. This study aimed to determine the correlation between temporal muscle thickness (TMT) and appendicular lean soft tissue (ALSTI) in older adults. DESIGN: Cross-sectional study. SETTINGS AND PARTICIPANTS: Single cohort gathered in Gothenburg, Sweden, consisting of individuals born in 1944 (n = 1203). METHODS: We studied 657 magnetic resonance images to measure TMT. Comparisons of TMT with dual-energy X-ray absorptiometry ALSTI (kg/m2) as a reference standard were performed. Finally, TMT associations with cognition evaluated using the Mini-Mental State Examination (MMSE), gait speed, and handgrip strength were explored with linear regressions. RESULTS: The correlation between TMT and ALSTI was weak yet significant (r = 0.277, P < .001). TMT exhibited significant associations with MMSE (estimate = 0.168, P = .002), gait speed (estimate = 1.795, P < .001), and ALSTI (estimate = 0.508, P < .001). These associations varied when analyzed by sex. In women, TMT was significantly associated with gait speed (estimate = 1.857, P = .005) and MMSE (estimate = 0.223, P = .003). In men, TMT scores were significantly correlated with ALSTI scores (estimate = 0.571, P < .001). CONCLUSION AND IMPLICATIONS: Repurposing head images can be an accessible alternative to detect muscle mass and ultimately detect sarcopenia. These studies have the potential to trigger interventions or further evaluation to improve the muscle and overall health of individuals. However, additional research is warranted before translating these findings into clinical practice.

Nutrient Intake and Its Association with Appendicular Total Lean Mass and Muscle Function and Strength in Older Adults: A Population-Based Study.

Treatment options for sarcopenia are currently limited, and primarily rely on two main therapeutic approaches: resistance-based physical activity and dietary interventions. However, details about specific nutrients in the diet or supplementation are unclear. We aim to investigate the relationship between nutrient intake and lean mass, function, and strength. Data were derived from the Gothenburg H70 birth cohort study in Sweden, including 719,70-year-olds born in 1944 (54.1% females). For independent variables, the diet history method (face-to-face interviews) was used to estimate habitual food intake during the preceding three months. Dependent variables were gait speed (muscle performance), hand grip strength (muscle strength), and the appendicular lean soft tissue index (ALSTI). Linear regression analyses were performed to analyze the relationship between the dependent variables and each of the covariates. Several nutrients were positively associated with ALSTI, such as polyunsaturated fatty acids (DHA, EPA), selenium, zinc, riboflavin, niacin equivalent, vitamin B12, vitamin D, iron, and protein. After correction for multiple comparisons, there were no remaining correlations with handgrip and gait speed. Findings of positive correlations for some nutrients with lean mass suggest a role for these nutrients in maintaining muscle volume. These results can be used to inform clinical trials to expand the preventive strategies and treatment options for individuals at risk of muscle loss and sarcopenia.

Factors associated with help-seeking behaviors in Mexican older individuals with depressive symptoms: a cross-sectional study.

OBJECTIVE: Depression in the older individuals is associated with multiple adverse outcomes, such as high health service utilization rates, low pharmacological compliance, and synergistic interactions with other comorbidities. Moreover, the help-seeking process, which usually starts with the feeling "that something is wrong" and ends with appropriate medical care, is influenced by several factors. The aim of this study was to explore factors associated with the pathway of help seeking among older adults with depressive symptoms. METHODS: A cross-sectional study of 60-year or older community dwelling individuals belonging to the largest health and social security system in Mexico was carried out. A standardized interview explored the process of seeking health care in four dimensions: depressive symptoms, help seeking, help acquisition, and specialized mental health. RESULTS: A total of 2322 individuals were studied; from these, 67.14% (n = 1559) were women, and the mean age was 73.18 years (SD = 7.02); 57.9% had symptoms of depression; 337 (25.1%) participants sought help, and 271 (80.4%) received help; and 103 (38%) received specialized mental health care. In the stepwise model for not seeking help (χ(2) = 81.66, p < 0.0001), significant variables were female gender (odds ratio (OR) = 0.7, 95% confidence interval (CI) 0.511-0.958, p = 0.026), health-care use (OR 3.26, CI 95% 1.64-6.488, p = 0.001). Number of years in school, difficulty in activities, Short Anxiety Screening Test score, and indication that depression is not a disease belief were also significant. CONCLUSIONS: Appropriate mental health care is rather complex and is influenced by several factors. The main factors associated with help seeking were gender, education level, recent health service use, and the belief that depression is not a disease. Detection of subjects with these characteristics could improve care of the older individuals with depressive symptoms.