A new possible marker: can pennation angle defined by ultrasound predict the frailty?

BACKGROUND: Frailty indicates older people who are vulnerable to stressors. The relation between ultrasonographic parameters of muscle and frailty among older people has yet to be investigated. AIMS: The aim of the study is to investigate the relationship between frailty and the ultrasonographic measurements of the rectus femoris muscle (RFM). METHODS: This cross-sectional study included 301 participants who were ≥65 years. The FRAIL questionnaire assessed frailty. The thickness, cross-sectional area (CSA), fascicle length, pennation angle (PA), stiffness, and echogenicity of RFM were assessed by ultrasound. The accuracy of parameters in predicting the frailty was evaluated by ROC analysis. RESULTS: Of all 301 participants, 24.6% were frail. Pre-frail and frail participants had significantly lower thickness (p = 0.002), CSA (p = 0.009), and fascicle length (p = 0.043) of RFM compared to robust. PA was significantly lowest in frails (p < 0.001). The multivariate logistic regression analysis showed that PA values lower than 10.65 degrees were an independent predictor of frailty (OR = 0.83, 95% Cl: 0.70-0.97, p = 0.019). Results of ROC analysis demonstrated a satisfactory result between the PA and frailty (AUC = 0.692, p < 0.001). DISCUSSION: Thickness, CSA, and PA of RFM were found to be lower in frail subjects, which may indicate the changes in muscle structure in frailty. Among all parameters, lower PA values were independent predictors of frailty. These findings may indicate a novel ultrasound-based method in frailty, that is more objective and unrelated to the cross-sectional evaluation. CONCLUSIONS: Ultrasonographic measurements of RFM, especially the lower PA may predict frailty in older people. As an objective and quantitative method, PA may be used to define frailty with acceptable sensitivity.

The relationship between sarcopenia, sarcopenia related quality of life and ultrasound findings of the rectus femoris muscle in older outpatients.

PURPOSE: Skeletal muscle ultrasonography stands out as a promising method for detecting sarcopenia. We aimed to evaluate the relationship between sarcopenia, sarcopenia related quality of life and US findings of the Rectus Femoris muscle. METHODS: A total of 300 older individuals were included in this cross-sectional study. Sarcopenia was diagnosed according to the European Working Group on Sarcopenia in Older People 2 criteria. Rectus F muscle thickness, cross-sectional area, fascicle length, pennation angle, stiffness and echogenicity were measured by an experienced radiologist using a B-mode US device. Quality of life was determined with the Sarcopenia- Quality of life questionnaire. Correlation analysis, receiver operating analysis, sensitivity and specificity analysis were performed. RESULTS: The median age of participants was 72. 191 (63.9%) and 109 (36.1%) of the participants were male and female, respectively. The prevalence of sarcopenia was 15.6%. Fascicle length, cross-sectional area and thickness showed the highest sensitivity (81%) and specificity (87%) for men. Fascicle length and pennation angle showed the highest sensitivity (87%) and specificity (66%) for women. Rectus Femoris ultrasound parameters differed across SarQoL quartiles, and higher Sarcopenia- Quality of life scores were associated with better ultrasound parameters. All ultrasound parameters had positive correlations with Sarcopenia- Quality of life. CONCLUSION: Different Rectus Femoris ultrasound parameters are useful for detecting sarcopenia according to gender. A combination of these parameters can increase diagnosis accuracy. Ultrasound parameters are associated with sarcopenia related quality of life.

Malnutrition-sarcopenia syndrome and all-cause mortality in hospitalized older people.

PURPOSE: Malnutrition-sarcopenia syndrome (MSS) describes the presence of sarcopenia and malnutrition together. This study aims to evaluate the relationship between MSS and all-cause mortality at two years in hospitalised older Turkish people. METHODS: This is a bi-centered prospective cohort study conducted in older individuals in hospital settings (University hospital and research, research and training hospital). Sarcopenia was diagnosed according to the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria. Muscle mass was measured by bioelectrical impedance analysis. Malnutrition (MN) was assessed by the Mini Nutritional Assessment. Six study groups were formed according to sarcopenia and MN status; MSS, sarcopenia with malnutrition risk (MNR), sarcopenia, MN, MNR, and normal nutrition. The relationship between MSS and other study groups with mortality was assessed by Cox regression model. Survival curves were estimated using the Kaplan-Meier method. RESULTS: 350 hospitalised older people participated (mean age: 77.2 ± 7.6, 56% female). During the 2-year follow-up, 98 (28%) of the participants died. MSS, sarcopenia, sarcopenia with MNR and MN groups were independently associated with all-cause mortality at two years. MSS group had the highest hazard ratio (HR:19.8). Survival curves of MSS sarcopenia, sarcopenia with MNR, and MN groups were significantly different from MNR and normal nutrition groups. MSS had the worst survival curve. CONCLUSIONS: Hospitalised older people should be evaluated for the presence of both sarcopenia and MN because of increased mortality. Preventive measures are needed for both conditions to decrease adverse health outcomes such as mortality.

Attitudes of a geriatric population towards risks about COVID-19 pandemic: in the context of anxiety and depression.

BACKGROUND: A curfew for elderly people was announced in Turkey to protect the geriatric population during the COVID-19 pandemic. Although this may have the beneficial effect of preventing infection, psychological distress may also increase with prolongation of the pandemic. METHODS: Geriatric patients were interviewed by telephone due to the ongoing curfew. Demographical characteristics, comorbidities, personal risk perception of COVID-19, common concerns related to COVID-19, and experiences of delayed hospital admission due to the pandemic were recorded. The Hospital Anxiety and Depression Scale (HADS) was used to assess psychological distress, anxiety, and depression. RESULTS: Participants (n = 136; 82 females, 60.3%) had a mean age of 73.4 ± 5.9 years. The most common comorbidity was hypertension (75%). Approximately 80% of the participants reported a decrease in physical activity during the curfew period. The HADS scores indicated rates of anxiety as 25.7% and depression as 16.9%. Anxiety was significantly more common in females than males (P = 0.002). Sleep problems (P = 0.000), fatigue (P = 0.000), and hopelessness (P = 0.000) were more common in participants with depression and anxiety. Logistic regression analyses showed an association between a delay in hospital admission and the presence of depression (P = 0.0029, R2  = 0.146). Personal risk perception of COVID-19 was statistically significantly higher among patients with anxiety (P = 0.0027, R2  = 0.157). CONCLUSION: Decreased adaptation to external and internal factors among older individuals may facilitate unfavourable outcomes of the pandemic. These results indicate that the geriatric population was mentally and physically affected by the restrictions and isolation.