[Frailty in nursing home : contribution of the SENIOR study]. / Apports de la cohorte liégeoise SENIOR dans l'étude de la fragilité en maison de repos.

Over the past 20 years, clinicians and researchers have shown increasing interest in frailty. However, there is still no consensus regarding its operational definition. An interesting definition in this context could be the one that best predicts functional decline and the occurrence of negative health outcomes. Moreover, frailty could be avoided, delayed and sometimes cured by the implementation of targeted interventions. The SENIOR cohort, a longitudinal study of nursing home residents, initiated in 2013, aims to contribute to the understanding of risk factors, consequences and dynamic of frailty. It also contributes to its management. This cohort is of great interest among scientists. Because of the large number of demographic, clinical and anamnestic data collected each year, the SENIOR study could fill the gap in the literature related to the frailty.

Au cours des deux dernières décennies, la documentation traitant de la fragilité s'est faite de plus en plus abondante. Toutefois, il n'existe toujours pas de définition opérationnelle et de critères universellement reconnus pour décrire la fragilité. Les critères cliniques de fragilité doivent être prédictifs du risque de déclin fonctionnel et d'événements péjoratifs de santé. Dans cette optique, identifier précocement les sujets fragiles permet d'agir sur les facteurs de risque et d'éviter les évolutions défavorables. La cohorte SENIOR, une étude longitudinale de personnes âgées résidant en maison de repos initiée en 2013, a pour objectif de contribuer à la compréhension des facteurs de risque, des conséquences et de la trajectoire de la fragilité. Elle a aussi pour but d'apporter des pistes de prise en charge. Cette cohorte suscite beaucoup d'intérêt dans le monde de la recherche scientifique. En effet, grâce aux nombreuses données démographiques, cliniques et anamnestiques récoltées annuellement, elle permet d'apporter des éléments de réponses aux problématiques liées à la fragilité des personnes âgées.

Impact of frailty status on the cost of drugs and dietary supplements prescribed to nursing home residents: the SENIOR cohort.

BACKGROUND: The financial impact associated with drug consumption has been poorly investigated among frail subjects and, specifically, in nursing home settings. AIMS: To determine the association of the average monthly cost of the drugs and dietary supplements consumed by nursing home residents with their frailty status. METHODS: This is an analysis of the first follow-up year of the SENIOR cohort. All participants were classified into "frail" or "non-frail" categories according to Fried's criteria at baseline. Monthly bills from the pharmacy were analysed to determine the association between the average monthly cost of the drugs and dietary supplements consumed and frailty status. RESULTS: A sample of 87 residents (83.8 ± 9.33 years and 75.9% women) from the SENIOR cohort was included. The prevalence of frailty was 28%. The median number of medications consumed each day was 9 (6-12) (no difference between frail and non-frail subjects; p = 0.15). The overall median monthly cost was € 109.6, of which 49% was covered by Belgian social security and the remaining balance was paid by the patient. When comparing the drug expenses of the frail subjects and the non-frail subjects, the overall average monthly cost did not differ between the 2 groups (p = 0.057). Nevertheless, the expenditure remaining to be paid by the residents, after the Belgian social security intervention, was significantly higher among the frail residents (€ 65.7) than among the non-frail residents (€ 47.6; p = 0.017). CONCLUSIONS: Frailty status has an impact on the expenditures related to the consumption of drugs.

Assessing gait parameters with accelerometer-based methods to identify older adults at risk of falls: a systematic review.

PURPOSE: The purpose of this study was to perform a systematic review to assess the utility of accelerometric methods to identify older adults at risk of falls. METHODS: The Preferred Reporting Item for Systematic review and Meta-Analysis (PRISMA) guidelines were followed during all steps of this systematic review. Cross sectional and longitudinal studies assessing gait parameters in older adults using accelerometric devices, and comparing groups based on the risk of falls or fall history were identified from studies published in the MEDLINE, SCOPUS and Cochrane Database of Systematic Reviews databases between January 1996 and January 2017. Study selection and data extraction were performed independently by two reviewers. The quality of the methodology used in the studies included was assessed using the Newcastle-Ottawa Scale. RESULTS: In total, 354 references were identified through the database search. After selection, ten studies were included in this systematic review. According to the cross sectional studies, people who fall or are at risk of fall are slower, and walk with shorter steps, lower step frequency, worse stride and step regularity in terms of time, position and acceleration profiles. One longitudinal study suggests considering harmonic ratio of upper trunk acceleration in the vertical plane. Two other longitudinal studies highlight the importance of considering more than one gait parameter, and sophisticated statistical tools to discern older adults at risk for future fall(s). CONCLUSION: This systematic review essentially highlights the lack of available literature providing strong evidence that gait parameters obtained using acceleration-based methods could be useful to discern older people at risk of fall. Available literature is encouraging, but further high quality studies are needed to highlight the cross-sectional and longitudinal relationships between gait parameters and falls in older adults.

Prevalence of sarcopenia in a population of nursing home residents according to their frailty status: results of the SENIOR cohort.

OBJECTIVE: To investigate the relationship between frailty and sarcopenia, by evaluating the prevalence of sarcopenia among frail, pre-frail and robust elderly nursing home residents in Belgium. METHODS: This is an analysis of baseline data collected from the SENIOR (Sample of Elderly Nursing home Individuals: an Observational Research) cohort. All subjects received a sarcopenia evaluation, based on the definition proposed by the European Working Group on Sarcopenia in Older People (EWGSOP). The frailty evaluation was primarily based on FRIED's definition but also on 9 other operational definitions. RESULTS: A total of 662 subjects (73.1% of women) were included in this analysis (mean age: 83.2±8.99 years). The prevalence of sarcopenia was 38.1% whereas the prevalence of frail and pre-frail persons was respectively 24.7% and 61.4%. Among frail, pre-frail and robust subjects, respectively 47%, 38.9% and 16.3% were diagnosed sarcopenic. The prevalence of sarcopenia according to ten different operational definitions of frailty ranged between 32.8 % (i.e. Frail scale Status and Frailty Index) and 47% (i.e. Fried definition). CONCLUSION: This research highlights that over a third of nursing home residents are sarcopenic and the percentage is almost 50% among frail subjects; those latter constitute about 1 in 4 of the population of nursing home residents studied here.

Prevalence of Frailty in Nursing Home Residents According to Various Diagnostic Tools.

BACKGROUND: Although the theoretical foundations of frailty are well established in the literature, it remains an evolving concept lacking any unique definition or diagnostic criteria for use in clinical practice and epidemiological research. No consensus exists about the accurate prevalence rates of frailty. The various operational definitions of frailty can at least partly explain such discrepancies. OBJECTIVE: To compare the prevalence of frailty, measured with different diagnostic tools, among elderly nursing home residents. DESIGN: This is an analysis of baseline data collected among the SENIOR (Sample of Nursing home Elderly Individuals: an Observational Research) cohort. SETTING: Nursing homes. POPULATION: A total of 662 volunteer subjects from 28 nursing homes were included in this analysis. Among them, the mean age was 83.2 ± 8.99 years and 484 (72.5%) of them were women. MEASUREMENT: The percentages of frail and non-frail subjects were calculated according to 10 different definitions. RESULTS: Prevalence of frailty varies from 1.70% (Frailty Index) to 76.3% (Groningen Frailty Indicator) depending on the tool used. CONCLUSIONS: The prevalence of frailty is highly dependent on the diagnostic tool used. It would be necessary to reach a consensus on which diagnostic tools to use if one wishes to have comparable data obtained in epidemiological studies.

Energy and Nutrient Content of Food Served and Consumed by Nursing Home Residents.

OBJECTIVE: The aim of this study was to compare energy and protein content of the served food with the actual intake from the food consumed by nursing home residents. This study also aimed to compare food intake and dietary allowances. DESIGN: This is a cross sectional study. SETTING: This study was performed in nursing homes. PARTICIPANTS: Residents of these 2 nursing homes were eligible for the study if they agreed to participate and if they meet the selection criteria (to be older than 65 years and have a regular texture diet). MEASUREMENT: Nutrient content of the served food and real food consumption was calculated for all meals during a 5-day period by precise weighting method. Difference between consumed and served dietary content was evaluated by the Chi² test. RESULTS: Seventy-four Belgian nursing home residents (75% of women, 85.8 ± 7.04 years on average) were included in this study. These subjects had a mean body mass index of 24.9 ± 4.83 kg/m². The mean energy content of the served food was 1783.3 ± 125.7 kcal per day. However, residents did not eat the whole of the meals and the actual energy content of the consumed food was significantly less (1552.4 ± 342.1 kcal per day; p<.001). The average protein content of the food served was equal to 0.96 ± 0.20 g/kg/day and the average consumption of protein by the residents was 0.88 ± 0.25 g/kg/day. The difference between protein served and consumed was also significant (p=.04). Moreover, people considered as well nourished, eating significantly more energy than the others (p=.04). CONCLUSION: Meals served in nursing homes are not entirely consumed by their residents. As expected, the energy consumed are lower in subjects considered as malnourished or at risk of malnutrition.

Prevalence of Concomitant Bone and Muscle Wasting in Elderly Women from the SarcoPhAge Cohort: Preliminary Results.

BACKGROUND: Recent studies suggest that bone and muscle wasting are closely interconnected. OBJECTIVE: The aim was of this study is to assess the prevalence of osteoporosis in a population of women diagnosed with sarcopenia. Participants, setting and design: We analyzed cross-sectional data of women, aged 65 years and above, for whom bone mineral density was available at the time of inclusion in the SarcoPhAge (Sarcopenia and Physical impairment with advancing Age) cohort, an ongoing prospective study with the aim to assess consequences of sarcopenia. MEASUREMENTS: Muscle strength was evaluated with a hydraulic hand-dynamometer, appendicular lean mass and bone mineral density by Dual-Energy X-Ray Absorptiometry and physical performance by the Short Physical Performance Battery test (SPPB). Sarcopenia was diagnosed according to the European Working Group on Sarcopenia in Older People definition, i.e. a low muscle mass plus either low muscle strength or low physical performance. A bone mineral density T-score equal to or below -2.5SD at the lumbar spine, at the total hip or at the femoral neck was used to define osteoporosis (World Health Organization definition). RESULTS: A total of 126 women aged 74.38±6.32 years were included. Among them, 26 were assessed with sarcopenia (20.6%) and 34 (27.0%) with osteoporosis. There were more osteoporotic women among sarcopenic subjects (46.1%) than among non-sarcopenic subjects (22.0%) (p-value=0.011). A significant lower appendicular lean mass index was observed in osteoporotic women (p-value=0.025). We also observed, in osteoporotic subjects, a lower muscle strength (p-value=0.023). Numerical values of bone mineral density were lower in the sarcopenic population but the differences did not reach the level of statistical significance. CONCLUSION: Our study demonstrated that muscle mass and strength are lower in patients with osteoporosis. Prospective changes in bone and muscle mass will be investigated during the follow-up of our cohort.

Data set of healthy old people assessed for three walking conditions using accelerometric and opto-electronic methods.

BACKGROUND: Gait patterns of healthy aging are needed to allow a comparison with pathological situations. However, little data is available. OBJECTIVE: To present gait pattern of healthy older specially selected to be "healthy walkers". METHOD: Fifty-seven older people benefited from a geriatric assessment including clinical and functional evaluations to include only those without gait disorders. Gait data were simultaneously recorded using a tri-axial accelerometer placed on the waist and four 3D position markers placed on the feet at the level of the heel and the toe. Volunteers walked at comfortable self-selected speed (CW), fast self-selected speed (FW), and finally in dual task walking condition (DTW). The extracted gait parameters were: gait speed, stride length, stride frequency, regularity and symmetry, swing, stance and double support time and ratio and minimum toe clearance. Gait speed and stride length were normalized to the right leg length. RESULTS: Fifty-seven older people with a mean age of 69.7 ± 4.2 years old (range from 65 to 82 years) were included. Data were analyzed according to the gender and according to the age (<70 or ≥70 years old). After normalization to leg length, the main significant differences were shown for stride length and minimum toe clearance in CW, FW and in DTW that were shorter in women. The regularity in FW was significantly lower among older volunteers. CONCLUSIONS: This work provides a data set considering 14 gait parameters obtained from 57 healthy old people strictly selected and assessed for three walking conditions and shows that GS, SL and MTC have to be related to the gender. The age-related impact on gait performances appears reduced in this cohort.

Relationship between frailty, physical performance and quality of life among nursing home residents: the SENIOR cohort.

BACKGROUND: The aim of this study was to assess the relationship between frailty and a large number of indicators related to physical and muscular performance as well as quality of life. METHODS: This is an analysis of data collected at baseline in the Sample of Elderly Nursing home Individuals: an Observational Research (SENIOR) cohort including nursing home residents. Subjects are volunteer, oriented and able to walk (walking assistance allowed) nursing home residents in Belgium. A large number of demographic and clinical characteristics, including physical and muscular performance, were collected from each patient. The prevalence of frailty in this population was assessed using Fried's definition. RESULTS: In total, 662 subjects are included in this analysis. The mean age of the sample is 83.2 ± 8.99 years, and 484 (73.1 %) are women. In this population of nursing home residents, the prevalence of frailty is 25.1 %, pre-frailty, 59.8 % and robustness, 15.1 %. Compared to non-frail subjects, frail subjects have lower physical and muscular performances and a lower quality of life. CONCLUSION: Frailty, according to Fried's definition, seems to be associated with several clinical indicators suggesting a higher level of disability and an increased propensity to develop major clinical consequences. Follow-up data of the SENIOR cohort will be helpful in confirming these findings, establishing cause-effect relationships and identifying the most predictive components of physical frailty for adverse outcomes in nursing homes.

Determinants of vitamin D supplementation prescription in nursing homes: a survey among general practitioners.

SUMMARY: A total of 119 GPs participated to a survey aimed to assess the profile and determinants of vitamin D supplementation prescription in nursing homes. Among the respondent GPs, 65 (54.6%) systematically prescribe vitamin D to their institutionalized patients and the 54 (45.4%) others prescribe only sometimes. INTRODUCTION: The aim of this study is to assess the profile and determinants of vitamin D supplementation prescription in nursing homes. METHODS: General practitioners (GPs) having at least one patient in a nursing home in Liège, Belgium, were asked to complete the survey. RESULTS: A total of 119 GPs participated in the survey. Among the respondent GPs, 65 (54.6 %) systematically prescribe vitamin D to their institutionalized patients and the 54 (45.4%) others prescribe only sometimes. The main reasons for prescribing vitamin D cited by GPs who do so systematically are as follows: because they believe nursing home residents are mostly deficient in vitamin D status (92.1%), because they believe that vitamin D supplementation prevents osteoporotic fractures (77.8%), and because vitamin D supplementation is recommended by various scientific societies (38.1%). GPs who only prescribe vitamin D supplementation in some patients mainly do so following a diagnosis of osteoporosis (82.4%), on the basis the 25(OH)D level (78.4%), in the case of history of fracture (54.9%) or after a recent fracture (43.4%). Surprisingly, 16 physicians (31.4%) only prescribe vitamin D when they think of it. Interestingly, while 40.7% of GPs always prescribe the same dose of vitamin D, the remaining 59.3% prescribe a dose that will mainly depend on the results of the 25(OH)D level (94.0%), the patient's bone health (49.3%), or history of fracture (43.3%). CONCLUSIONS: More than half of GPs systematically prescribe vitamin D to their patients living in nursing homes. The other GPs usually prescribe vitamin D following the result of the vitamin D status or after a diagnosis of osteoporosis.

Gait speed or gait variability, which one to use as a marker of risk to develop Alzheimer disease? A pilot study.

BACKGROUND: Previous literature demonstrates the interest of gait analysis to predict cognitive decline in old people. AIMS: This pilot study aims to determine if gait speed or gait variability is a marker able to early identify, among mild cognitive impairment (MCI) subjects, those at risk to develop Alzheimer's disease (AD) in the future. METHODS: 13 MCI subjects were included in 2007. Their gait parameters (walking speed, stride length and gait frequency, regularity and symmetry) were measured in 2007 and 2008 in simple task (ST) and in dual task (DT) using a triaxial accelerometer (Locometrix(®)). Among the 13 MCI subjects included in 2007, 10 were assessed in 2008. So, 23 (13 in 2007 + 10 in 2008) gait tests were collected. In 2011, MCI people were considered as "MCI+" when they developed AD (between baseline and 2011) and as "MCI-" if they did not. Among the 23 gait tests, 15 were from MCI+ (9 gait tests in 2007 and 6 in 2008) and 8 from MCI- (4 gait tests in 2007 and 4 gait tests in 2008). Mann-Whitney non-parametric U test was used to compare gait parameters of MCI+ and MCI-. RESULTS: Gait speed, symmetry and regularity were lower in MCI+ than in MCI-. DISCUSSION: Despite the small sample size, the results presented in this original pilot study are in line as the infrequent previous literature related to this topic. The authors discuss lacks and strengths of this work. CONCLUSIONS: These results suggest that both gait speed and gait variability could be markers to early identify MCI at risk to develop AD.

[How I treat... Delirium in the aged]. / COMMENT JE TRAITE le delirium chez le patient âgé.

Delirium is an acute psycho-organic disorder, most of the time reversible, that happens in various situations (acute disease, drugs ... ). It can also result from an acute or long term stress when the patient is already in an unstable homeostatic balance. Delirium is common in the geriatric population and can have serious consequences in terms of morbidity and mortality. Unfortunately, it is often not well known by hospital doctors. It is the consequence of predisposing factors (age, polypharmacy, multiple illnesses, neurodegenerative diseases, ... ) and precipitating factors (inadequate medications, dehydration, infections, ...). Diagnosis of delirium is simple with the Confusion Assessment Method (CAM). Rapid diagnosis and management are mandatory to limit functional decline. In people at risk, simple non-drug interventions can prevent the occurrence of delirium. Psychotropic drugs should be used with caution. The prevention of delirium is important and a standardized geriatric assessment to identify old patients at risk should be performed before any surgery or heavy treatment.

Le delirium, ou syndrome confusionnel aigu, est un trouble psycho-organique aigu et habituellement réversible qui peut survenir sous l'influence de conditions diverses (affection somatique, médicaments…), mais aussi être la conséquence d'un stress aigu ou de longue durée, lorsque le patient se trouve déjà dans un équilibre homéostatique très instable. Il est fréquent dans la population gériatrique, souvent peu connu des médecins hospitaliers, et influence considérablement la morbi-mortalité. Il est la conséquence de l'association de facteurs prédisposants (grand âge, polymédication, polypathologie, maladies neurodégénératives, …) et de facteurs précipitants (médications inadaptées, déshydratation, infections, contention, …). Son dépistage est rapide à l'aide de la Confusion Assessment Method (CAM). Son diagnostic et sa prise en charge sont importants afin de limiter le déclin fonctionnel du patient âgé qui en est atteint. Chez les personnes à risque, il existe des interventions non médicamenteuses simples pour limiter la survenue du delirium. Les psychotropes doivent être utilisés avec précaution. La prévention du delirium est importante et une évaluation gériatrique standardisée pour repérer les patients âgés à risque devrait être réalisée avant toute intervention chirurgicale ou traitement lourd.

Quality of life and physical components linked to sarcopenia: The SarcoPhAge study.

INTRODUCTION: The SarcoPhAge project is an ongoing longitudinal study following community-dwelling elderly subjects with the objective to assess some health and functional consequences of sarcopenia. The sarcopenia diagnosis algorithm developed by the European Working Group on Sarcopenia in Older People (EWGSOP) and used in the present study needs further validation through cross-sectional and longitudinal studies. The aim of the present study is to assess, using this algorithm, the prevalence of sarcopenia and the clinical components linked to this geriatric syndrome. METHODS: Participants were community dwelling subjects aged 65years or older. To diagnose sarcopenia, we applied the definition of the EWGSOP. Muscle mass was measured by dual-energy X-ray absorptiometry, muscle strength by a hydraulic dynamometer and physical performance by the SPPB test. Large amounts of socio-demographic, anamnestic and clinical data were collected in all subjects. RESULTS OVER ONE YEAR: 534 subjects were recruited for this study (60.5% of women, mean age of 73.5±6.16years), among whom 73 subjects were diagnosed sarcopenic, which represents a global prevalence of 13.7%. Prevalence was 11.8% in men and 14.9% in women. Sarcopenic subjects were older; had a lower Body Mass Index, lower calf, waist, wrist and arm circumferences; presented more cognitive impairments (Mini-Mental State Examination), more comorbidities; were more often malnourished; and consumed more drugs. After adjustment for age, BMI, cognitive status, nutritional status, number of comorbidities and number of drugs, sarcopenic subjects had a worse physical health-related quality of life (SF-36) for the domain of physical functioning, were at higher risk of falls (Timed Up and Go test), were more frail (Fried), presented more often tiredness for the achievement of activities of daily living (Mobility-test), presented less fat mass and obviously less lean mass. Sarcopenic women were also more dependent for housekeeping and handling finances (Lawton scale) than non-sarcopenic ones. CONCLUSION: Sarcopenia seems to be associated with many harmful clinical components making this geriatric syndrome a real public health burden. Follow-up data of the SarcoPhAge study will be helpful to assess the outcomes of sarcopenia based on the EWGSOP diagnosis algorithm and its different proposed cut-offs.

Relationship between Isometric Strength of Six Lower Limb Muscle Groups and Motor Skills among Nursing Home Residents.

This research aimed to assess the correlation between isometric muscle strength of the lower limb and motor skills. This is a cross sectional study performed among volunteer nursing home residents included in the SENIOR (Sample of Elderly Nursing home Individuals: an Observational Research) cohort. The present analysis focused on isometric muscle strength of 6 lower limb muscle groups (i.e. knee extensors, knee flexors, hip abductors, hip extensors, ankle flexors and ankle extensors), assessed using a validated hand-held dynamometer (i.e. the MicroFET2 device), and motor skills evaluated using the Tinetti test, the Timed Up and Go test, the Short Physical Performance Battery test (SPPB) and the walking speed. The relationship between all these parameters was tested by means of a multiple correlation, adjusted on age, sex and body mass index. 450 nursing home residents (69.8% of women) with a mean age of 83.1±9.4 years were included in this study. Our results showed a significant inverse correlation between lower limb muscle strength and the time required to perform the TUG test or gait speed, except for ankle flexors and ankle extensors. The relationship between the Tinetti test or the SPPB score, and lower limb muscle strength was significant, except for ankle flexors and ankle extensors. In conclusion, a positive association between lower limb muscle strength of the four main muscle groups and motor skills of the elderly nursing residents was found in this research. Therefore, special attention should be given to these muscle groups during rehabilitation programs.

Added value of a triaxial accelerometer assessing gait parameters to predict falls and mortality among nursing home residents: A two-year prospective study.

BACKGROUND: Gait impairment seems to be a risk factor for falls and mortality. Because gait change cannot be determined easily with classical clinical tests, some authors have suggested that it might be useful to use a gait-analysis system among elderly community-dwelling people. OBJECTIVE: The main objective of the present study was to determine the predictive value of a quantitative evaluation of the gait characteristics in nursing home residents for the occurrence of falls and death performed using a tri-axial accelerometer (Locométrix®). MATERIAL AND METHODS: One hundred elderly nursing home residents (80 women and 20 men, mean age 86.4 ± 6.04 years) were included in this study with the aim to follow them for 2 years. Deaths and falls were systematically recorded. A quantitative evaluation of a 10-second walk was performed with a tri-axial accelerometer (Locometrix®). Demographic data (i.e age, sex, body mass index) and clinical data (i.e. fall risk evaluated by the Tinetti test) were also recorded. RESULTS: During the two years of follow-up, 27 patients died. After adjustment on all potential confounding variables, only body mass index was significantly associated with the risk of mortality with an odds ratio of 0.86 (95% CI: 0.77-0.96, p=0.04). At the end of the study period, 440 falls had occurred (mean: 4.44 ± 6.79 falls per patient) but no single factors were independently associated with fall incidence. CONCLUSION: Our results show that a quantitative gait analysis performed using a tri-axial accelerometer is not predictive of long-term falls and mortality among nursing home residents.

Estimation of sarcopenia prevalence using various assessment tools.

BACKGROUND: Sarcopenia is defined as a progressive and generalized loss of muscle mass with either a loss of muscle strength or a loss of physical performance but there is no recommendation regarding the diagnostic tools that have to be used. In this study, we compared the prevalence of sarcopenia assessed using different diagnostic tools. METHODS: To measure muscle mass, muscle strength and physical performance, we used for each outcome two different diagnostic tools. For muscle mass, we used Dual Energy X-Ray Absorptiometry (DXA) and bio-electrical impedance analysis (BIA); for muscle strength, we used a hydraulic dynamometer and a pneumatic dynamometer; for physical performance we used the Short Physical Performance Battery test (SPPB test) and the walk speed. Eight diagnostic groups were hereby established. RESULTS: A total of 250 consecutive subjects were recruited in an outpatient clinic in Liège, Belgium. Estimated prevalence of sarcopenia varied from 8.4% to 27.6% depending on the method of diagnosis used. Regarding muscle mass, BIA systematically overestimated muscle mass compared to DXA (mean estimated prevalence with BIA=12.8%; mean prevalence with DXA=21%). For muscle strength, the pneumatic dynamometer diagnosed twice more sarcopenic subjects than the hydraulic dynamometer (mean estimated prevalence with PD=22.4%; mean estimated prevalence with HD=11.4%). Finally, no difference in prevalence was observed when the walking speed or the SPPB test was used. A weak overall kappa coefficient was observed (0.53), suggesting that the 8 methods of diagnosis are moderately concordant. CONCLUSION: Within the same definition of sarcopenia, prevalence of sarcopenia is highly dependent on the diagnostic tools used.

[The role of the geriatrician in the organization of the health care system]. / Place du gériatre dans la filière de soins.

The purpose of this paper is to define the role of the geriatrician in the organization of the health care for the elderly. In Belgium, the healthcare program for the geriatric patient defines the various functions; at present, the classical geriatric hospitalization, the hospital day care, and the internal links within the hospital are well developed around the geriatrician. The standardized, comprehensive geriatric assessment of hospitalized patients has demonstrated its value for the prevention of functional decline. The efficiency of the day care services and of the link teams remains to be further appraised. Outside the hospital, the general practionner plays the major role in the treatment of the elderly living at home, or in nursing homes. The demographic evolution and the frailty of the elderly require a good coordination of all those involved in the care of the aged. A model of healthcare organization is proposed to better coordinate the in- and out of hospital activities.

[Screening for frailty: a benefit for both patients and physicians]. / Dépister la fragilité: un bénéfice pour le patient et pour le soignant.

Preventing the increasing number of depending persons is a novel priority in European Union health policy. One of the means to succeed relies on identifying, among elderly persons, those at risk of dependency, also named "the frail elderly". Screening for frailty is also useful to better assess the physiological reserves of the elderly before any therapeutic decision, as early as the first consultation. Researchers currently work on developing a new simple tool allowing a distinction between frail and robust persons. Since frailty is partly reversible, the global geriatric evaluation, in a one-day clinic, will lead to a personalized program to prevent or reverse frailty by a multidisciplinary approach.

[Sarcopenia: what's new in 2014]. / Sarcopénie. Quoi de neuf en 2014?

The term "sarcopenia" was first introduced in 1989 by Irwin Rosenberg to define a progressive and generalized loss of muscle mass and muscle strength with advancing age. Above certain thresholds, that loss of muscle mass and muscle strength is considered abnormal. Despite the progress of scientific knowledge, a universally accepted definition of sarcopenia is still lacking to date. Therefore, it is a real challenge to establish the prevalence of sarcopenia because the results highly depend on the definition used for its diagnosis. This geriatric syndrome represents a public health issue with multiple clinical consequences. Loss of autonomy and quality of life, altered functional status, increase of fatigue, falls and a higher mortality rate are well-known consequences of sarcopenia. Although many pharmacological and non-pharmacological therapeutical strategies seem to have a positive impact on muscle strength and muscle mass, very few studies have yet assessed the effects of those treatments on sarcopenia itself. Therefore, developing high-quality interventional studies, in this field, seem necessary.