Development and validation of the electronic screening index of frailty.

BACKGROUND: primary care screening for frailty status is recommended in clinical guidelines, but is impeded by doctor and nurse workloads and the lack of valid, easy-to-use and time-saving screening tools. AIM: to develop and validate a new electronic tool (the electronic screening index of frailty, e-SIF) using routinely available electronic health data to automatically and massively identify frailty status in the population aged ≥65 years. METHODS: the e-SIF was developed in three steps: selection of clinical conditions; establishment of ICD-10 codes, criteria and algorithms for their definition; and electronic tool design and data extraction, transformation and load processes. The validation phase included an observational cohort study with retrospective data collection from computerised primary care medical records. The study population included inhabitants aged ≥65 years corresponding to three primary care centres (n = 9,315). Evaluated was the relationship between baseline e-SIF categories and mortality, institutionalisation, hospitalisation and health resource consumption after 2 years. RESULTS: according to the e-SIF, which includes 42 clinical conditions, frailty prevalence increases with age and is slightly greater in women. The 2-year adjusted hazard ratios for pre-frail, frail and very frail subjects, respectively, were as follows: 2.23 (95% CI: 1.74-2.85), 3.34 (2.44-4.56) and 6.49 (4.30-9.78) for mortality; 2.80 (2.39-3.27), 5.53 (4.59-6.65) and 9.14 (7.06-11.8) for hospitalisation; and 1.02 (0.70-1.49), 1.93 (1.21-3.08) and 2.69 (1.34-5.40) for institutionalisation. CONCLUSIONS: the e-SIF shows good agreement with mortality, institutionalisation, hospitalisation and health resource consumption, indicating satisfactory validity. More studies in larger populations are needed to corroborate our findings.

Intracellular Water Content in Lean Mass as an Indicator of Muscle Quality in an Older Obese Population.

BACKGROUND: In aged populations, muscle strength depends more on muscle quality than on muscle quantity, while all three are criteria for the diagnosis of sarcopenia. Intracellular water content (ICW) in lean mass (LM) has been proposed as an indicator of muscle quality related to muscle strength in older people. OBJECTIVES: To evaluate the relationship between the ICW/LM ratio, muscle strength and indicators of functional performance in obese older adults, and to assess the value of the ICW/LM ratio as an indicator of muscle quality. METHODOLOGY: Design: cross-sectional study. POPULATION: persons aged 65-75 years with a body mass index of 30-39 kg/m2. ICW and LM were estimated by bioelectrical impedance. Hand grip, gait speed, unipedal stance test, timed up-and-go (TUG) test, Barthel score and frailty (Fried criteria) were assessed. Sarcopenia was established according to EWGSOP2 criteria. RESULTS: Recruited were 305 subjects (66% women), mean age 68 years. The ICW/LM ratio correlated with the TUG test, gait speed and grip strength, and was also associated with sex, the unipedal stance test and frailty. Independently of age, sex and muscle mass, the ICW/LM ratio was related with gait speed, the TUG test and unipedal stance capacity. One person (0.3%) had sarcopenia defined as low muscle strength and low muscle mass, while 25 people (8.2%) had sarcopenia defined as low muscle strength and poor muscle quality (ICW/LM). With this last definition, sarcopenia was related to frailty, gait speed and the TUG test. CONCLUSIONS: ICW content in LM could be a useful muscle quality indicator for defining sarcopenia. However, more studies are required to confirm our findings for other populations.

Muscle strength in the Mataró aging study participants and its relationship to successful aging.

BACKGROUND AND AIMS: Successful aging is a worldwide aim, but its related factors and instruments of measurement are currently hotly debated. To investigate the relationship between muscle strength and functional capacity, and its association with successful aging. METHODS: A population-based cross-sectional study was performed in Mataró (Spain). Included in the study were 313 subjects (153 men, 160 women) aged 70 years and over. Physical and cognitive functions were assessed, as well as muscle strength, nutritional status, lifestyle factors, and associated morbidities. RESULTS: A state of successful aging (SA), defined as optimal functional and cognitive capacities with absence of cancer, stroke, cardiovascular or pulmonary chronic diseases, was found in 20% of women and 32% of men. SA was associated with higher muscle strength in comparison with the non-SA condition. Muscle strength measurements were higher in men, and decreased with age, poor balance, decreased functional capacity, and impaired cognitive status. It was also associated with higher academic level, regular exercise, and nutritional status in both genders. Multivariate analysis showed that independent variables related to SA were: hand grip, arthrosis, deafness and unipodal balance test, but not age or gender. CONCLUSIONS: Muscle strength is positively associated with the successful aging condition, and may be one of its functional links, reflecting the integrated health status of old men and women. The systematic inclusion of the measurement of muscle strength may be helpful in clinical evaluation of the elderly.

[Loss of appetite in elderly people in the community and its relationship with functional capacity]. / Pérdida de apetito en ancianos no institucionalizados y su relación con la capacidad funcional.

BACKGROUND AND OBJECTIVE: The reasons of anorexia of ageing are multiple and not well-known. One of them is loss of appetite. We aimed to know the prevalence of self-reported appetite-loss in the elderly and its relationship with nutritional status, muscle strength and functional capacity. SUBJECTS AND METHOD: A population based cross-sectional study in which 236 non-institutionalized subjects over 70 years were randomly selected. Hand grip, functional capacity and nutritional status were assessed and a specific questionnaire was administered to assess appetite. Anorexia or loss of appetite was considered when subjects declared none or low usual appetite both in breakfast and lunch time. RESULTS: A 30.0% global prevalence of anorexia was observed (37.1% in females and 17.9% in males; p = 0.001). Loss of appetite was related to higher risk of malnutrition (41% in anorexic vs 27% in non-anorexic; p = 0.039), lower muscular strength and poorer functional capacity. CONCLUSIONS: Loss of appetite in the elderly has a high prevalence and must alert about frailty.

Pérdida de apetito en ancianos no institucionalizados y su relación con la capacidad funcional / Loss of appetite in elderly people in the community and its relationship with functional capacity

Fundamento y objetivo: Las causas de la disminución de la ingesta en el anciano son múltiples y poco conocidas. Una de ellas es la pérdida de apetito. El objetivo de este estudio ha sido conocer la prevalencia de pérdida de apetito autodeclarada en población anciana, así como su relación con el estado nutricional, la fuerza muscular y la capacidad funcional. Población y método: Se ha realizado un estudio observacional y transversal, de base poblacional, con una muestra aleatoria de 236 personas de más de 70 años no institucionalizadas. Se valoraron la fuerza de agarre con dinamómetro, la capacidad funcional y el riesgo de desnutrición, y se administró un cuestionario específico de apetito. Se consideró anorexia o pérdida de apetito la manifestación de nada o poco apetito habitual tanto en el desayuno como en la comida. Resultados: La prevalencia global de anorexia fue del 30,0% (un 37,1% en mujeres y un 17,9% en varones; p = 0,001). La pérdida de apetito se relacionó con un mayor riesgo de desnutrición (un 41% en los sujetos con anorexia frente al 27% en aquéllos sin anorexia; p = 0,039), una menor fuerza muscular y una peor capacidad funcional. Conclusiones: La pérdida de apetito en los ancianos es muy prevalente y debe alertar sobre un estado de fragilidad

Background and objective: The reasons of anorexia of ageing are multiple and not well-known. One of them is loss of appetite. We aimed to know the prevalence of self-reported appetite-loss in the elderly and its relationship with nutritional status, muscle strength and functional capacity. Subjects and method: A population based cross-sectional study in which 236 non-institutionalized subjects over 70 years were randomly selected. Hand grip, functional capacity and nutritional status were assessed and a specific questionnaire was administered to assess appetite. Anorexia or loss of appetite was considered when subjects declared none or low usual appetite both in breakfast and lunch time. Results: A 30.0% global prevalence of anorexia was observed (37.1% in females and 17.9% in males; p = 0.001). Loss of appetite was related to higher risk of malnutrition (41% in anorexic vs 27% in non-anorexic; p = 0.039), lower muscular strength and poorer functional capacity. Conclusions: Loss of appetite in the elderly has a high prevalence and must alert about frailty