Relationship between hemoglobin and grip strength in older adults: the ActiFE study.

INTRODUCTION: Although anemia is associated with low muscle strength, hemoglobin has been rarely studied considering ferritin. AIM: To analyze the association between hemoglobin and grip strength in community-dwelling older adults. METHODS: We used data from a German cohort of adults ≥ 65 years, excluding those with CRP > 10 mg/L or taking iron supplements. Grip strength (kg) was measured using a Jamar dynamometer. Analysis was performed using multiple linear regression, adjusted for established confounders. Due to interaction, age-stratified (< 80, 80 +), further sex-stratified analysis in those < 80 years old and ferritin-stratified in men < 80 years were performed. RESULTS: In total, 1294 participants were included in this analysis (mean age 75.5 years, 549 (42.3%) women, 910 (70.3%) < 80 years). On average, hemoglobin and grip strength were 14.9 g/dL and 41.3 kg for men, 13.9 g/dL and 25.1 kg for women. Hemoglobin was significantly positively associated with grip strength only among women < 80 years (ß 0.923 [95% CI 0.196, 1.650]). For men < 80 years, the association was significant when ferritin was ≥ 300 µg/L (ß 2.028 [95% CI 0.910, 3.146]). No association was detected among those participants 80 + . DISCUSSION AND CONCLUSIONS: Our data show an association between hemoglobin and grip strength only in women < 80 years old. For men < 80 years, the association was only significant with ferritin levels ≥ 300 µg/L. Considering the decreasing levels of hemoglobin and grip strength and the high prevalence of iron deficiency in older adults further analyses investigating this relationship with more iron specific parameters such as transferrin saturation are warranted.

Cognitive behavioural therapy (CBT) with and without exercise to reduce fear of falling in older people living in the community.

BACKGROUND: Fear of falling (FoF) is a lasting concern about falling that leads to an individual avoiding activities that he/she remains capable of performing. It is a common condition amongst older adults and may occur independently of previous falls. Cognitive behavioural therapy (CBT), a talking therapy that helps change dysfunctional thoughts and behaviour, with and without exercise, may reduce FoF, for example, by reducing catastrophic thoughts related to falls, and modifying dysfunctional behaviour. OBJECTIVES: To assess the benefits and harms of CBT for reducing FoF in older people living in the community, and to assess the effects of interventions where CBT is used in combination with exercise. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 1, 2023), MEDLINE Ovid (from 1946 to 11 January 2023), Embase Ovid (from 1980 to 11 January 2023), CINAHL Plus (Cumulative Index to Nursing and Allied Health Literature) (from 1982 to 11 January 2023), PsycINFO (from 1967 to 11 January 2023), and AMED (Allied and Complementary Medicine from 1985 to 11 January 2023). We handsearched reference lists and consulted experts for identifying additional studies. SELECTION CRITERIA: This review included randomised controlled trials (RCTs), quasi-RCTs, and cluster-RCTs assessing CBT with and without exercise interventions compared to control groups with sham-treatment, or treatment as usual. We defined CBT as a collaborative, time-limited, goal-oriented, and structured form of speaking therapy. Included studies recruited community-dwelling older adults, with a mean population age of at least 60 years minus one standard deviation, and not defined by a specific medical condition. DATA COLLECTION AND ANALYSIS: Two review authors used standard methodological procedures expected by Cochrane. For continuous data, as assessed by single- or multiple-item questionnaires, we report the mean difference (MD) with 95% confidence interval (CI) when studies used the same outcome measures, and standardised mean difference (SMD) when studies used different measures for the same clinical outcome. For dichotomous outcomes, we reported the treatment effects as risk ratios (RR) with 95% CIs. We measured the primary outcome, FoF, immediately, up to, and more than six months after the intervention. We analysed secondary outcomes of activity avoidance, occurrence of falls, depression, and quality of life when measured immediately after the intervention. We assessed risk of bias for each included study, using the GRADE approach to assess the certainty of evidence. MAIN RESULTS: We selected 12 studies for this review, with 11 studies included for quantitative synthesis. One study could not be included due to missing information. Of the 11 individual studies, two studies provided two comparisons, which resulted in 13 comparisons. Eight studies were RCTs, and four studies were cluster-RCTs. Two studies had multiple arms (CBT only and CBT with exercise) that fulfilled the inclusion criteria. The primary aim of 10 studies was to reduce FoF. The 11 included studies for quantitative synthesis involved 2357 participants, with mean ages between 73 and 83 years. Study total sample sizes varied from 42 to 540 participants. Of the 13 comparisons, three investigated CBT-only interventions while 10 investigated CBT with exercise. Intervention duration varied between six and 156 hours, at a frequency between three times a week and monthly over an eight- to 48-week period. Most interventions were delivered in groups of between five and 10 participants, and, in one study, up to 25 participants. Included studies had considerable heterogeneity, used different questionnaires, and had high risks of bias. CBT interventions with and without exercise probably improve FoF immediately after the intervention (SMD -0.23, 95% CI -0.36 to -0.11; 11 studies, 2357 participants; moderate-certainty evidence). The sensitivity analyses did not change the intervention effect significantly. Effects of CBT with or without exercise on FoF may be sustained up to six months after the intervention (SMD -0.24, 95% CI -0.41 to -0.07; 8 studies, 1784 participants; very low-certainty evidence). CBT with or without exercise interventions for FoF probably sustains improvements beyond six months (SMD -0.28, 95% CI -0.40 to -0.15; 5 studies, 1185 participants; moderate-certainty of evidence). CBT interventions for reducing FoF may reduce activity avoidance (MD -2.57, 95% CI -4.67 to -0.47; 1 study, 312 participants; low-certainty evidence), and level of depression (SMD -0.41, 95% CI -0.60 to -0.21; 2 studies, 404 participants; low-certainty evidence). We are uncertain whether CBT interventions reduce the occurrence of falls (RR 0.96, 95% CI 0.66 to 1.39; 5 studies, 1119 participants; very low-certainty evidence). All studies had a serious risk of bias, due to performance bias, and at least an unclear risk of detection bias, as participants and assessors could not be blinded due to the nature of the intervention. Downgrading of certainty of evidence also occurred due to heterogeneity between studies, and imprecision, owing to limited sample size of some studies. There was no reporting bias suspected for any article. No studies reported adverse effects due to their interventions. AUTHORS' CONCLUSIONS: CBT with and without exercise interventions probably reduces FoF in older people living in the community immediately after the intervention (moderate-certainty evidence). The improvements may be sustained during the period up to six months after intervention (low-certainty evidence), and probably are sustained beyond six months (moderate-certainty evidence). Further studies are needed to improve the certainty of evidence for sustainability of FoF effects up to six months. Of the secondary outcomes, we are uncertain whether CBT interventions for FoF reduce the occurrence of falls (very low-certainty evidence). However, CBT interventions for reducing FoF may reduce the level of activity avoidance, and may reduce depression (low-certainty evidence). No studies reported adverse effects. Future studies could investigate different populations (e.g. nursing home residents or people with comorbidities), intervention characteristics (e.g. duration), or comparisons (e.g. CBT versus exercise), investigate adverse effects of the interventions, and add outcomes (e.g. gait analysis). Future systematic reviews could search specifically for secondary outcomes.

What works to prevent falls in older adults dwelling in long term care facilities and hospitals? An umbrella review of meta-analyses of randomised controlled trials.

Preventing falls in long term care facilities (LTCF) and hospitals is an international priority. Many interventions have been investigated and summarised in meta-analyses (MA) and there is a need to synthesise the top of the hierarchy of evidence in one place. Therefore we conducted an umbrella review of MA of randomised controlled trials (RCTs) of falls prevention interventions LTCF and hospitals. Two independent reviewers searched major electronic databases from inception till October 2014 for MA containing ≥3 RCTs investigating any intervention to prevent falls in LTCF or hospitals in older adults aged ≥60 years. Methodological quality was assessed by the AMSTAR tool and data were narratively synthesised. The methodological quality of the MA was moderate to high across the 10 included MA. Nine MA provided data for LTCF and only two considered hospital settings. Only one MA defined a fall and two reported adverse events (although minor). Consistent evidence suggests that multifactorial interventions reduce falls (including the rate, risk and odds of falling) in LTCF and hospitals. Inconsistent evidence exists for exercise and vitamin D as single interventions in LTCF, whilst no MA has investigated this in hospitals. No evidence exists for hip protectors and medication review on falls in LTCF. In conclusion, multifactorial interventions appear to be the most effective interventions to prevent falls in LTCF and hospital settings. This is not without limitations and more high quality RCTs are needed in hospital settings in particular. Future RCTs and MA should clearly report adverse events.

What Works to Prevent Falls in Community-Dwelling Older Adults? Umbrella Review of Meta-analyses of Randomized Controlled Trials.

BACKGROUND: Preventing falls is an international priority. There is a need to synthesize the highest-quality falls prevention evidence in one place for clinicians. PURPOSE: The aim of this study was to conduct an umbrella review of meta-analyses of randomized controlled trials (RCTs) of falls prevention interventions in community-dwelling older adults. DATA SOURCES: The MEDLINE, EMBASE, CINAHL, AMED, BNI, PsycINFO, Cochrane Library, PubMed, and PEDro databases were searched. STUDY SELECTION: Meta-analyses with one pooled analysis containing ≥3 RCTs that investigated any intervention to prevent falls in community-dwelling older adults aged ≥60 years were eligible. Sixteen meta-analyses, representing 47 pooled analyses, were included. DATA EXTRACTION: Two authors independently extracted data. DATA SYNTHESIS: Data were narratively synthesized. The methodological quality of the meta-analyses was moderate. Three meta-analyses defined a fall, and 3 reported adverse events (although minor). There is consistent evidence that exercise reduces falls (including the rate, risk, and odds of falling), with 13/14 pooled analyses (93%) from 7 meta-analyses demonstrating a significant reduction. The methodological quality of meta-analyses investigating exercise were medium/high, and effect sizes ranged from 0.87 (relative risk 95% confidence interval=0.81, 0.94; number of studies=18; number of participants=3,568) to 0.39 (rate ratio 95% confidence interval=0.23, 0.66; number of meta-analyses=6). There is consistent evidence that multifactorial interventions reduce falls (5/6, 83% reported significant reduction). There is conflicting evidence regarding the influence of vitamin D supplementation (7/12, 58.3% reported significant reduction). LIMITATIONS: Meta-analyses often used different methods of analysis, and reporting of key characteristics (eg, participants, heterogeneity, publication bias) was often lacking. There may be some overlap among included meta-analyses. CONCLUSIONS: There is consistent evidence that exercise and individually tailored multifactorial interventions are effective in reducing falls in community-dwelling older adults.

Objectively measured physical activity and vitamin D status in older people from Germany.

BACKGROUND: To analyse the seasonal relationship of objectively measured physical activity with vitamin D status in older persons from Southern Germany (latitude: 48.4°N). METHODS: Physical activity was assessed in 1193 community-dwelling individuals aged ≥65 years (58% men) over 1 week using a thigh-worn accelerometer. Furthermore, the 25-hydroxyvitamin D (25(OH)D) level was measured. Least-square means of 25(OH)D serum levels were calculated for quartiles of average daily walking duration stratified by season and adjusted for gender, age and body mass index. Participants with prescribed vitamin D supplements were excluded. RESULTS: Statistically significant linear associations between quartiles of walking duration with 25(OH)D serum levels were observed in all seasons but not in summer. Differences in 25(OH)D serum levels between the first and the last quartile were 3.42 ng/mL (p=0.002) in winter, 2.80 ng/mL (p=0.009) in spring, and 3.60 ng/mL (p<0.001) in the fall. The proportion of vitamin D insufficiency (<20 ng/mL) even in the highest quartile of walking duration was 45.3% in winter, 73.7% in spring, 17.4% in summer and 16.5% in the fall. CONCLUSIONS: Although a positive dose-response relationship was seen between walking duration and the 25(OH)D serum level for most seasons, vitamin D insufficiency was still very prevalent even in high-active persons during all seasons.

Seasonality of vitamin D status in older people in Southern Germany: implications for assessment.

BACKGROUND: from a clinical and public health perspective, it is important to understand the influence of seasonality on the serum vitamin D level to adequately assess and interpret an individual measurement. Therefore, the aim of this study was to analyse the effects of seasonal conditions on 25-hydroxyvitamin D (25(OH)D) serum levels in a population-based cohort of older people. METHODS: between March 2009 and April 2010 the 25(OH)D serum level was assessed in 1,418 community-dwelling individuals living in Germany aged ≥65 years (56.7% men) with no subscribed vitamin D supplementation. Least-square means of monthly 25(OH)D serum levels with 95% confidence intervals (CI) were estimated, adjusted for gender, age and body mass index. Additionally, the proportion of vitamin deficiency (<20 ng/ml), insufficiency (20-<30 ng/ml) and sufficiency (30 ng/ml or higher) were estimated for each month. Finally, mean values of daily total global solar radiation and daylight were calculated for each month. RESULTS: the minimum 25(OH)D serum level was observed in March with 15.4 ng/ml (SD = 6.56 ng/ml) and the maximum in August with 25.6 ng/ml (SD = 6.59 ng/ml). Compared with daylight and global solar radiation the progression over the year was similar but delayed by ∼2 months. The proportion of vitamin D deficiency, insufficiency and sufficiency were 78.8, 19.2 and 1.9% in March and 16.1, 63.4 and 20.5% in August, respectively. CONCLUSION: vitamin D insufficiency was very common in this cohort and showed a strong seasonal effect with lowest values in March.