Biomarkers of aging for the identification and evaluation of longevity interventions.

With the rapid expansion of aging biology research, the identification and evaluation of longevity interventions in humans have become key goals of this field. Biomarkers of aging are critically important tools in achieving these objectives over realistic time frames. However, the current lack of standards and consensus on the properties of a reliable aging biomarker hinders their further development and validation for clinical applications. Here, we advance a framework for the terminology and characterization of biomarkers of aging, including classification and potential clinical use cases. We discuss validation steps and highlight ongoing challenges as potential areas in need of future research. This framework sets the stage for the development of valid biomarkers of aging and their ultimate utilization in clinical trials and practice.

Cellular Senescence: Defining a Path Forward.

Cellular senescence is a cell state implicated in various physiological processes and a wide spectrum of age-related diseases. Recently, interest in therapeutically targeting senescence to improve healthy aging and age-related disease, otherwise known as senotherapy, has been growing rapidly. Thus, the accurate detection of senescent cells, especially in vivo, is essential. Here, we present a consensus from the International Cell Senescence Association (ICSA), defining and discussing key cellular and molecular features of senescence and offering recommendations on how to use them as biomarkers. We also present a resource tool to facilitate the identification of genes linked with senescence, SeneQuest (available at http://Senequest.net). Lastly, we propose an algorithm to accurately assess and quantify senescence, both in cultured cells and in vivo.

Enhancing cognitive performance prediction by white matter hyperintensity connectivity assessment.

White matter hyperintensities of presumed vascular origin (WMH) are associated with cognitive impairment and are a key imaging marker in evaluating brain health. However, WMH volume alone does not fully account for the extent of cognitive deficits and the mechanisms linking WMH to these deficits remain unclear. Lesion network mapping (LNM) enables to infer if brain networks are connected to lesions and could be a promising technique for enhancing our understanding of the role of WMH in cognitive disorders. Our study employed LNM to test the following hypotheses: (1) LNM-informed markers surpass WMH volumes in predicting cognitive performance, and (2) WMH contributing to cognitive impairment map to specific brain networks. We analyzed cross-sectional data of 3,485 patients from 10 memory clinic cohorts within the Meta VCI Map Consortium, using harmonized test results in 4 cognitive domains and WMH segmentations. WMH segmentations were registered to a standard space and mapped onto existing normative structural and functional brain connectome data. We employed LNM to quantify WMH connectivity to 480 atlas-based gray and white matter regions of interest (ROI), resulting in ROI-level structural and functional LNM scores. We compared the capacity of total and regional WMH volumes and LNM scores in predicting cognitive function using ridge regression models in a nested cross-validation. LNM scores predicted performance in three cognitive domains (attention/executive function, information processing speed, and verbal memory) significantly better than WMH volumes. LNM scores did not improve prediction for language functions. ROI-level analysis revealed that higher LNM scores, representing greater connectivity to WMH, in gray and white matter regions of the dorsal and ventral attention networks were associated with lower cognitive performance. Measures of WMH-related brain network connectivity significantly improve the prediction of current cognitive performance in memory clinic patients compared to WMH volume as a traditional imaging marker of cerebrovascular disease. This highlights the crucial role of network integrity, particularly in attention-related brain regions, improving our understanding of vascular contributions to cognitive impairment. Moving forward, refining WMH information with connectivity data could contribute to patient-tailored therapeutic interventions and facilitate the identification of subgroups at risk of cognitive disorders.

Diligent for better or worse: Conscientiousness is associated with higher likelihood of suicidal behavior and more severe suicidal intent in later life.

BACKGROUND: Contradictory findings link trait conscientiousness in mid- and late life to increased healthspan and lifespan, as well as to death by suicide. It remains unclear whether conscientiousness is associated with higher odds of attempting suicide or with more severe suicidal behavior among attempters, and whether its relationship to suicide risk varies with aging-related stressors, such as declining health. METHODS: In this cross-sectional study comprising 313 depressed adults aged ≥40 years and participating in the Longitudinal Research Program in Late-Life Suicide (Pittsburgh, USA), we employed logistic and linear regression to test whether conscientiousness was associated with the presence of recent suicidal behavior (≤2 years) and with intent severity in recent attempters (n = 84). We further tested whether the above relationships varied based on mental, cognitive, and physical health status, measured as depression severity, cognitive functioning, and the presence/absence of severe physical illness. RESULTS: Participants were 62.1 years old on average (SD = 7.6), 85% White, and 53% female. Recent attempters had a mean age of 61.8 years at their most recent attempt (SD = 8.5), had lower cognitive functioning and were more likely severely physically ill than comparisons. Conscientiousness was positively associated with a higher likelihood of recent suicidal behavior overall (adjusted OR = 1.44, 95% CI = 1.09, 1.90, p = .010), but not in case of co-occurring severe physical illness (interaction OR = 0.54, 95% CI = 0.30, 0.97, p = .039). Conscientiousness was also positively associated with suicidal intent at the most recent attempt (adjusted ß = 1.60, SE = 0.62, p = .012), explaining 7% of its variance, although this association lost significance after adjusting for other personality dimensions. CONCLUSIONS: Highly conscientious middle-aged and older adults may be at increased risk of resolute suicidal behavior, although conscientiousness may not confer additional suicide risk among those severely physically ill.

Foot Problems in Older Adults Presenting to a Falls and Balance Clinic.

INTRODUCTION: Foot problems, including musculoskeletal problems, peripheral neuropathy, peripheral arterial disease and dermatologic pathology are common in older adults and are associated with an increased risk of falling. Multicomponent podiatry interventions have been shown to reduce the incidence of falls. This paper aimed to identify older adults requiring podiatry input in a Falls and Balance clinic; to describe the model of foot health care they receive; to explore cross-sectional associations between foot problems and function and ultimately demonstrate the role of podiatry input in the multidisciplinary management of falls risk. METHODS: Cohort study of patients attending a Falls and Balance Clinic for Comprehensive Geriatric Assessment. Demographic information was collected and functional independence, mobility, foot problems, and footwear were assessed in the clinic. RESULTS: One-hundred and two patients were included; median age 79.3 (73-84.3) years, 68.6% female, 93.1% residing independently, 62.7% used a gait aid. Podiatry referrals were made in 80.4% of cases, with muscle weakness being the most common problem identified (90.2%); 74.8% were found to be wearing inappropriate footwear. Most patients received footwear education and half were prescribed foot and ankle strengthening exercises. Hallux and lesser toe weakness were associated with lower Short Physical Performance Battery scores (p < 0.001). CONCLUSION: The majority of older adults in the Falls and Balance Clinic required podiatry input, with foot weakness and inappropriate footwear being common reasons for referral. Those with weakness of the hallux and lesser toes had poorer balance and mobility, which is known to be associated with greater falls risk. This highlights the need for podiatry assessment and interventions as part of the multidisciplinary approach to the management of falls risk in older adults.

Towards senior-friendly hospitals: an overview of programs, their elements and effectiveness in improving care.

Comprehensive "senior-friendly hospital" (SFH)-programs have been developed to counteract negative health outcomes in hospitalized older adults. The aim of this narrative review was to provide an overview of published SFH-programs and their elements, and to summarize evidence of their effect on quality of care and patient satisfaction. A search of the databases Pubmed/Medline from inception to July 2023, and of governmental, regional and hospital websites was performed. Programs were earmarked as SFH-programs if they primarily focused on the hospital setting, and comprised a hospital-wide, multi-level approach and consisted of multiple elements. Articles and reports were included if participants were hospitalized and aged 60 years and older, and described the effect on quality of care or patient satisfaction. Articles focusing on specific patient groups or wards, or on a health system or network were excluded. Ten SFH-programs were identified, with mutual elements like 'organizational support', 'social climate and services', 'processes of care', and 'physical environment'. Only for the "Acute Care for Elders" program (USA), evidence was found showing positive effects on functional abilities, falls, delirium, length of stay, and patient satisfaction; effectiveness of other SFH-programs could not be found. Elements of SFH-programs may improve care for hospitalized older adults, but the evidence of their effectiveness is scarce.

Characteristics of geriatric rehabilitation inpatients with nocturia: RESORT.

INTRODUCTION: Nocturnal lower urinary tract symptoms (nLUTS) are common in geriatric rehabiliation inpatients but have not been well described. The aim of this study was to compare patient characteristics stratified by self-reported nocturia severity in geriatric rehabilitation inpatients. METHODS: The REStORing health of acutely unwell adulTs (RESORT) is an observational, longitudinal, prospective inception cohort of geriatric rehabilitation inpatients who underwent a Comprehensive Geriatric Assessment (CGA) at admission and discharge. Nocturia was captured by item 7 of the American Urology Association Symptom Score (AUASS) and dichotomised as ≤1 void and >1 void at night as per the International Continence Society definition. Differences in demographic, functional and medical characteristics of the inpatients with and without nocturia >1 were compared. RESULTS: Overall, 641 inpatients completed the nocturia item (mean age 82.6 (SD 7.7) years, 59.9% female). Nocturia occurred > once per night in 57.4%; mean number of episodes was 1.96 (SD 1.38), ranging from 0-5. There was no change in nocturia severity between admission and discharge. Daily urinary incontinence, urinary urgency and comorbid illness were independently associated with multiple nocturia episodes. A history of falls within the last year, difficulty climbing stairs pre-admission, higher faecal incontinence score, impaired quality of life domains, higher levels of anxiety and depression were significantly more common in inpatients with multiple episodes of nocturia compared to no or only one episode of nocturia Conclusion: Bladder symptoms, poor functional status and frailty markers were associated with repeated episodes of nocturia. Targeted intervention may reduce the severity of nocturia, with potential to improve sleep quality, impact therapeutic gains and influence discharge destination.

Geriatric Syndromes Frequently (Co)-Occur in Geriatric Rehabilitation Inpatients: Restoring Health of Acutely Unwell Adults (RESORT) and Enhancing Muscle Power in Geriatric Rehabilitation (EMPOWER-GR).

OBJECTIVE: To determine the prevalence and co-occurrence of common geriatric syndromes in geriatric rehabilitation inpatients. DESIGN: Restoring Health of Acutely Unwell Adults (RESORT) and Enhancing Muscle Power in Geriatric Rehabilitation (EMPOWER-GR) are observational, longitudinal cohorts. SETTING: Geriatric rehabilitation. PARTICIPANTS: Geriatric rehabilitation inpatients (N=1890 and N=200). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Geriatric syndromes included polypharmacy, multimorbidity (Cumulative Illness Rating Scale), cognitive impairment, depression (Hospital Anxiety and Depression Scale/Geriatric Depression Scale), malnutrition (Global Leadership Initiative on Malnutrition), functional limitation (Katz index), falls, physical frailty (Fried), and sarcopenia (European Working Group on Sarcopenia in Older People 2). RESULTS: Inpatients in RESORT (R) (N=1890, 56% females) had a median age of 83.4 years (interquartile range [IQR], 77.6-88.4) and in EMPOWER-GR (E) (N=200, 57% females) of 79.8 years (IQR, 75.0-85.9). Polypharmacy (R, 82.2%; E, 84.0%), multimorbidity (R, 90.4%; E, 85.5%), functional limitation (R, 96.0%; E, 76.5%), and frailty (R, 91.8%; E, 92.2%) were most prevalent. Most inpatients had ≥5 geriatric syndromes at admission in both cohorts (R, 70.0%; E, 72.4%); few inpatients had only 1 (R, 0.4%; E, 1.5%) or no geriatric syndrome (R, 0.2%; E, 0.0%). Geriatric syndromes did not occur in isolation (without other syndromes), except for multimorbidity (R, 1%; E, 5%), functional limitation (R, 3%; E, 2%), falls (R, 0%; E, 4%), and frailty (R, 2%; E, 5%), which occurred in isolation in some inpatients; sarcopenia did not. CONCLUSIONS: Geriatric syndromes are highly prevalent at admission to geriatric rehabilitation, with a median of 5 co-occurring syndromes. Implications for diagnosis and intervention potential should be further addressed.

Amyloid pathology and vascular risk are associated with distinct patterns of cerebral white matter hyperintensities: A multicenter study in 3132 memory clinic patients.

INTRODUCTION: White matter hyperintensities (WMH) are associated with key dementia etiologies, in particular arteriolosclerosis and amyloid pathology. We aimed to identify WMH locations associated with vascular risk or cerebral amyloid-ß1-42 (Aß42)-positive status. METHODS: Individual patient data (n = 3,132; mean age 71.5 ± 9 years; 49.3% female) from 11 memory clinic cohorts were harmonized. WMH volumes in 28 regions were related to a vascular risk compound score (VRCS) and Aß42 status (based on cerebrospinal fluid or amyloid positron emission tomography), correcting for age, sex, study site, and total WMH volume. RESULTS: VRCS was associated with WMH in anterior/superior corona radiata (B = 0.034/0.038, p < 0.001), external capsule (B = 0.052, p < 0.001), and middle cerebellar peduncle (B = 0.067, p < 0.001), and Aß42-positive status with WMH in posterior thalamic radiation (B = 0.097, p < 0.001) and splenium (B = 0.103, p < 0.001). DISCUSSION: Vascular risk factors and Aß42 pathology have distinct signature WMH patterns. This regional vulnerability may incite future studies into how arteriolosclerosis and Aß42 pathology affect the brain's white matter. HIGHLIGHTS: Key dementia etiologies may be associated with specific patterns of white matter hyperintensities (WMH). We related WMH locations to vascular risk and cerebral Aß42 status in 11 memory clinic cohorts. Aß42 positive status was associated with posterior WMH in splenium and posterior thalamic radiation. Vascular risk was associated with anterior and infratentorial WMH. Amyloid pathology and vascular risk have distinct signature WMH patterns.

Targeting the epigenetically older individuals for geroprotective trials: the use of DNA methylation clocks.

Chronological age is the most important risk factor for the incidence of age-related diseases. The pace of ageing determines the magnitude of that risk and can be expressed as biological age. Targeting fundamental pathways of human aging with geroprotectors has the potential to lower the biological age and therewith prolong the healthspan, the period of life one spends in good health. Target populations for geroprotective interventions should be chosen based on the ageing mechanisms being addressed and the expected effect of the geroprotector on the primary outcome. Biomarkers of ageing, such as DNA methylation age, can be used to select populations for geroprotective interventions and as a surrogate outcome. Here, the use of DNA methylation clocks for selecting target populations for geroprotective intervention is explored.

Associations between potentially inappropriate prescribing and increased number of medications with postdischarge health outcomes among geriatric rehabilitation inpatients: RESORT study.

AIMS: Older adults are vulnerable to medication-related harm mainly due to high use of medications and inappropriate prescribing. This study aimed to investigate the associations between inappropriate prescribing and number of medications identified at discharge from geriatric rehabilitation with subsequent postdischarge health outcomes. METHOD: RESORT (REStORing health of acutely unwell adulTs) is an observational, longitudinal cohort study of geriatric rehabilitation inpatients. Potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) were measured at acute admission, and at admission and discharge from geriatric rehabilitation, using Version 2 of the STOPP/START criteria. RESULTS: In total, 1890 (mean age 82.6 ± 8.1 years, 56.3% female) were included. The use of at least 1 PIM or PPO at geriatric rehabilitation discharge was not associated with 30-day and 90-day readmission and 3-month and 12-month mortality. Central nervous system/psychotropics and fall risk PIMs were significantly associated with 30-day hospital readmission (adjusted odds ratio [AOR] 1.53; 95% confidence interval [CI] 1.09-2.15), and cardiovascular PPOs with 12-month mortality (AOR 1.34; 95% CI 1.00-1.78). Increased number of discharge medications was significantly associated with 30-day (AOR 1.03; 95% CI 1.00-1.07) and 90-day (AOR 1.06; 95% CI 1.03-1.09) hospital readmissions. The use and number of PPOs (including vaccine omissions) were associated with reduced independence in instrumental activities of daily living scores at 90-days after geriatric rehabilitation discharge. CONCLUSION: The number of discharge medications, central nervous system/psychotropics and fall risk PIMs were significantly associated with readmission, and cardiovascular PPOs with mortality. Interventions are needed to improve appropriate prescribing in geriatric rehabilitation patients to prevent hospital readmission and mortality.

Why Is Rapamycin Not a Rapalog?

Rapamycin (sirolimus) is an immunosuppressive drug approved by the Food and Drug Administration (FDA). It is also a leading candidate for targeting aging. Rapamycin and its analogs (everolimus, temsirolimus, ridaforolimus) inhibit the mammalian target of rapamycin (mTOR) kinase by binding to FK506-binding proteins (FKBP) and have a similar chemical structure that only differs in the functional group present at carbon-40. Analogs of rapamycin were developed to improve its pharmacological properties, such as low oral bioavailability and a long half-life. The analogs of rapamycin are referred to as "rapalogs." Rapamycin is the parent compound and should therewith not be called a "rapalog."

Characteristics and perceptions of utilising telehealth for predominantly middle-aged to older, metropolitan-based general medical patients.

BACKGROUND: Effective post-pandemic telehealth (TH) requires understanding patients' characteristics and perceptions, which have not been established in broader clinical services and are independent of TH appointments. AIMS: To understand medical patients' characteristics and perspectives on using TH. METHODS: General medical patients in a statewide tertiary hospital in Victoria, Australia received a de-identified survey independent of TH appointments during visits between July and November 2020. Patients' characteristics, access to devices enabling TH, knowledge of TH and willingness to use TH were analysed with descriptive statistics. RESULTS: Of 1600 patients, 754 (46.4% female, aged 72.0 years [59.0-83.0]) were able to complete the survey. The majority lived in metropolitan areas (74.4%), owned at least one TH device (98.1%) and had internet access at home (55.6%). About 52.7% of patients were comfortable with their devices, and 43.5% had successfully used TH. Although patients preferred face-to-face appointments (80.8%) and 41.4% agreed TH would be as good as in-person appointments, 63.9% were interested in future TH appointments. Patients preferring face-to-face appointments were older (P = 0.008) and had lower education levels (P = 0.010), whereas patients preferring TH had video TH devices (P < 0.05), were comfortable with their devices (P = 0.002) and were willing to use TH (P < 0.05). TH cost saving was parking AU$10.0 [0.0-15.0], driving AU$5.8 [4.5-19.9], public transport AU$8.00 [5.0-10.0], taxis AU$30.00 [15.0-50.0] and time AU$153.2 [76.6-153.2]. CONCLUSION: From predominantly middle-aged to older, metropolitan-based general medical patients completing the survey, most patienpreferred face-to-face appointments to TH. Health services should subsidise those in need of TH and target the patients' barriers to effective TH use.

Physical activity levels in cognitively normal and cognitively impaired oldest-old and the association with dementia risk factors: a pilot study.

BACKGROUND: Research assessing the relationship of physical activity and dementia is usually based on studies with individuals younger than 90 years of age. The primary aim of this study was to determine physical activity levels of cognitively normal and cognitively impaired adults older than 90 years of age (oldest-old). Our secondary aim was to assess if physical activity is associated with risk factors for dementia and brain pathology biomarkers. METHODS: Physical activity was assessed in cognitively normal (N = 49) and cognitively impaired (N = 12) oldest-old by trunk accelerometry for a 7-day period. We tested physical performance parameters and nutritional status as dementia risk factors, and brain pathology biomarkers. Linear regression models were used to examine the associations, correcting for age, sex and years of education. RESULTS: Cognitively normal oldest-old were on average active for a total duration of 45 (SD 27) minutes per day, while cognitively impaired oldest-old seemed less physically active with 33 (SD 21) minutes per day with a lower movement intensity. Higher active duration and lower sedentary duration were related to better nutritional status and better physical performance. Higher movement intensities were related to better nutritional status, better physical performance and less white matter hyperintensities. Longer maximum walking bout duration associated with more amyloid binding. CONCLUSION: We found that cognitively impaired oldest-old are active at a lower movement intensity than cognitively normal oldest-old individuals. In the oldest-old, physical activity is related to physical parameters, nutritional status, and moderately to brain pathology biomarkers.

Feasibility of bioelectrical impedance analysis in routine clinical care to assess body composition in geriatric rehabilitation inpatients: RESORT.

BACKGROUND: Sarcopenia is prevalent in 20-50% of geriatric rehabilitation inpatients, but it is often undiagnosed. AIMS: The aim of the study is to evaluate the feasibility of bioelectric impedance analysis (BIA) to measure muscle mass in routine clinical care in a cohort of geriatric rehabilitation inpatients. METHODS: REStORing Health of acutely unwell adulTs (RESORT) is an observational, longitudinal inception cohort of geriatric rehabilitation inpatients. BIA was implemented at admission and discharge as routine care performed by nursing staff. BIA feasibility was defined as completion rate (low ≤ 25%, moderate > 25- ≤ 50%, good > 50- ≤ 75%, excellent > 75%), reasons for non-completion and need for remeasurement. Clinical characteristics associated with BIA completion and remeasurements were assessed. RESULTS: Patients (n = 1890, 56% females) had a median age of 83.4 years (interquartile range: [77.6-88.4]). Of the total cohort, 5.7% had a contraindication (pacemaker/other electronic medical device) for BIA at admission and 4.5% at discharge. BIA was completed in 77.1% of patients eligible for BIA at admission and 63.2% at discharge indicating good feasibility; remeasurement was required in 7.4 and 6.9%, respectively; 5.9% had a medical reason preventing BIA completion at admission and 3.7% at discharge. Refusal and technical issues occurred in 1.6 and 0.7% at admission and 2.1 and 1.8% at discharge. Reason for non-completion was unknown/missing in 14.7% at admission and 28.6% at discharge. Worse functional and physical performance was associated with BIA non-completion and remeasurement. CONCLUSIONS: BIA in routine clinical care in geriatric rehabilitation inpatients is feasible; completion rates may be enhanced further by reviewing barriers and enablers.

Outcome measures for Alzheimer's disease: A global inter-societal Delphi consensus.

INTRODUCTION: We aim to provide guidance on outcomes and measures for use in patients with Alzheimer's clinical syndrome. METHODS: A consensus group of 20 voting members nominated by 10 professional societies, and a non-voting chair, used a Delphi approach and modified GRADE criteria. RESULTS: Consensus was reached on priority outcomes (n = 66), measures (n = 49) and statements (n = 37) across nine domains. A number of outcomes and measurement instruments were ranked for: Cognitive abilities; Functional abilities/dependency; Behavioural and neuropsychiatric symptoms; Patient quality of life (QoL); Caregiver QoL; Healthcare and treatment-related outcomes; Medical investigations; Disease-related life events; and Global outcomes. DISCUSSION: This work provides indications on the domains and ideal pertinent measurement instruments that clinicians may wish to use to follow patients with cognitive impairment. More work is needed to develop instruments that are more feasible in the context of the constraints of clinical routine.

Strategic white matter hyperintensity locations for cognitive impairment: A multicenter lesion-symptom mapping study in 3525 memory clinic patients.

INTRODUCTION: Impact of white matter hyperintensities (WMH) on cognition likely depends on lesion location, but a comprehensive map of strategic locations is lacking. We aimed to identify these locations in a large multicenter study. METHODS: Individual patient data (n = 3525) from 11 memory clinic cohorts were harmonized. We determined the association of WMH location with attention and executive functioning, information processing speed, language, and verbal memory performance using voxel-based and region of interest tract-based analyses. RESULTS: WMH in the left and right anterior thalamic radiation, forceps major, and left inferior fronto-occipital fasciculus were significantly related to domain-specific impairment, independent of total WMH volume and atrophy. A strategic WMH score based on these tracts inversely correlated with performance in all domains. DISCUSSION: The data show that the impact of WMH on cognition is location-dependent, primarily involving four strategic white matter tracts. Evaluation of WMH location may support diagnosing vascular cognitive impairment. HIGHLIGHTS: We analyzed white matter hyperintensities (WMH) in 3525 memory clinic patients from 11 cohorts The impact of WMH on cognition depends on location We identified four strategic white matter tracts A single strategic WMH score was derived from these four strategic tracts The strategic WMH score was an independent determinant of four cognitive domains.

Handgrip strength rather than chair stand test should be used to diagnose sarcopenia in geriatric rehabilitation inpatients: REStORing health of acutely unwell adulTs (RESORT).

BACKGROUND: according to the revised sarcopenia definition proposed by the European Working Group on Sarcopenia in Older People (EWGSOP2) and revised definition of the Asian Working Group for Sarcopenia (AWGS2019), handgrip strength (HGS) and chair stand test (CST) can be used interchangeably as initial diagnostic measures. OBJECTIVE: to assess the agreement between sarcopenia prevalence, using either HGS or CST, and their association with adverse outcomes in geriatric rehabilitation inpatients. METHODS: REStORing health of acutely unwell adulTs is an observational, longitudinal cohort of geriatric rehabilitation inpatients. Cohen's kappa (κ) was used to assess the agreement between sarcopenia prevalence (no, probable and confirmed and severe sarcopenia) according to EWGSOP2 and AWGS2019 using either HGS or CST. Associations between HGS and CST and readmission, institutionalisation and mortality were assessed by binomial regression. RESULTS: patients (n = 1,250, 57% females) had a median age of 83.1 years (interquartile range: [77.5-88.3]). There was no agreement between probable sarcopenia prevalence using HGS or CST for EWGSOP2 and AWGS2019, respectively (HGS: 70.9% and 76.2%; CST: 95.5% and 98.4%; κ = 0.08 and 0.02). Agreement between confirmed and severe sarcopenia prevalence using either HGS or CST was strong to almost perfect. HGS was associated with 3-month institutionalisation and 3-month and 1-year mortality, whereas CST was not associated. CONCLUSIONS: HGS and CST cannot be used interchangeably as diagnostic measures for probable sarcopenia in geriatric rehabilitation inpatients. CST is not useful to predict adverse outcomes in geriatric rehabilitation inpatients.

Sarcopenia Is Associated with Mortality in Adults: A Systematic Review and Meta-Analysis.

BACKGROUND: Sarcopenia can predispose individuals to falls, fractures, hospitalization, and mortality. The prevalence of sarcopenia depends on the population studied and the definition used for the diagnosis. OBJECTIVE: This systematic review and meta-analysis aimed to investigate the association between sarcopenia and mortality and if it is dependent on the population and sarcopenia definition. METHODS: A systematic search was conducted in MEDLINE, EMBASE, and Cochrane from 1 January 2010 to 6 April 2020 for articles relating to sarcopenia and mortality. Articles were included if they met the following criteria - cohorts with a mean or median age ≥18 years and either of the following sarcopenia definitions: Asian Working Group for Sarcopenia (AWGS and AWGS2019), European Working Group on Sarcopenia in Older People (EWGSOP and EWGSOP2), Foundation for the National Institutes of Health (FNIH), International Working Group for Sarcopenia (IWGS), or Sarcopenia Definition and Outcomes Consortium (SDOC). Hazard ratios (HR) and odds ratios (OR) were pooled separately in meta-analyses using a random-effects model, stratified by population (community-dwelling adults, outpatients, inpatients, and nursing home residents). Subgroup analyses were performed for sarcopenia definition and follow-up period. RESULTS: Out of 3,025 articles, 57 articles were included in the systematic review and 56 in the meta-analysis (42,108 participants, mean age of 49.4 ± 11.7 to 86.6 ± 1.0 years, 40.3% females). Overall, sarcopenia was associated with a significantly higher risk of mortality (HR: 2.00 [95% CI: 1.71, 2.34]; OR: 2.35 [95% CI: 1.64, 3.37]), which was independent of population, sarcopenia definition, and follow-up period in subgroup analyses. CONCLUSIONS: Sarcopenia is associated with a significantly higher risk of mortality, independent of population and sarcopenia definition, which highlights the need for screening and early diagnosis in all populations.

The Association between Sarcopenia as a Comorbid Disease and Incidence of Institutionalisation and Mortality in Geriatric Rehabilitation Inpatients: REStORing health of acutely unwell adulTs (RESORT).

INTRODUCTION: Sarcopenia is associated with poor health outcomes and highly prevalent in individuals with age-related diseases. This study aimed to determine whether sarcopenia as a comorbid disease is associated with the incidence of institutionalisation and mortality in geriatric rehabilitation inpatients. METHODS: REStORing health of acutely unwell adulTs (RESORT) includes geriatric rehabilitation patients assessed for sarcopenia (the European Working Group on Sarcopenia in Older People [EWGSOP, 2010], EWGSOP2 [2018], and the Asian Working Group for Sarcopenia [AWGS 2019]), multimorbidity, disease severity, and specific diseases (Charlson Comorbidity Index and Cumulative Illness Rating Scale) at admission. The incidence of institutionalisation and mortality was recorded 3 months after discharge. Logistic regressions were adjusted for age and sex with "low morbidity and no sarcopenia" as the reference group. RESULTS: In 549 included patients (median age was 82.2 [77.4-87.7] years, 58.3% female), sarcopenia prevalence was 37.9, 18.6, and 26.1% according to EWGSOP, EWGSOP2, and AWGS 2019, respectively. Sarcopenia as a comorbid disease with high multimorbidity, dementia, diabetes mellitus, and renal impairment had higher odds of institutionalisation incidence. Sarcopenia as a comorbid disease with high multimorbidity, high disease severity, chronic obstructive pulmonary disease, osteoporosis, and renal impairment had higher odds of mortality. CONCLUSION: Sarcopenia as a comorbid disease is associated with a higher incidence of institutionalisation and mortality in geriatric rehabilitation inpatients. This highlights the need for in-hospital sarcopenia diagnostics and interventions.