Using Sensor Graphs for Monitoring the Effect on the Performance of the OTAGO Exercise Program in Older Adults.

The OTAGO exercise program is effective in decreasing the risk for falls of older adults. This research investigated if there is an indication that the OTAGO exercise program has a positive effect on the capacity and as well as on the performance in mobility. We used the data of the 10-months observational OTAGO pilot study with 15 (m = 1, f = 14) (pre-)frail participants aged 84.60 y (SD: 5.57 y). Motion sensors were installed in the flats of the participants and used to monitor their activity as a surrogate variable for performance. We derived a weighted directed multigraph from the physical sensor network, subtracted the weights of one day from a baseline, and used the difference in percent to quantify the change in performance. Least squares was used to compute the overall progress of the intervention (n = 9) and the control group (n = 6). In accordance with previous studies, we found indication for a positive effect of the OTAGO program on the capacity in both groups. Moreover, we found indication that the OTAGO program reduces the decline in performance of older adults in daily living. However, it is too early to conclude causalities from our findings because the data was collected during a pilot study.

Development and Pilot Testing of an Algorithm-Based Approach to Anticholinergic Deprescribing in Older Patients.

BACKGROUND: Adverse anticholinergic drug reactions are common, yet evidence on how to reduce exposure to anticholinergic activity and reliably measure successful deprescribing is still scant. This study proposes an algorithm-based approach to evaluate and reduce anticholinergic load, and reports the results of its pilot testing. METHODS: Based on published evidence and expert opinion, a list of 85 anticholinergic drugs and 21 algorithms for reducing anticholinergic load, e.g., by recommending alternative drugs with lower risk, were developed. An accompanying test battery was assembled by focusing on instruments that sensitively reflect anticholinergic load and may be sensitive to depict changes (Neuropsychological Assessment Battery to measure memory and attention, validated assessments for constipation, urinary symptoms, and xerostomia, as well as blood biomarkers). The approach was pilot-tested in a geriatric rehabilitation unit, with clinician feedback as the primary outcome and characterization of anticholinergic symptoms as the secondary outcome. The intervention was delivered by a pharmacist and a clinical pharmacologist who used the algorithms to generate personalized recommendation letters. RESULTS: We included a total of 20 patients, 13 with anticholinergic drugs and 7 without. Recommendations were made for 22 drugs in nine patients from the intervention group, of which seven letters (78%) were considered helpful and 8/22 (36%) anticholinergic drugs were discontinued, reducing anticholinergic load in seven patients. In contrast to patients without drug change, memory assessment in patients with reduced anticholinergic load improved significantly after 2 weeks (6 ± 3 vs. -1 ± 6 points). CONCLUSIONS: The approach was well received by the participating physicians and might support standardized anticholinergic deprescribing.

A system for monitoring the functional status of older adults in daily life.

Functional decline in older adults can lead to an increased need of assistance or even moving to a nursing home. Utilising home automation, power and wearable sensors, our system continuously keeps track of the functional status of older adults through monitoring their daily life and allows health care professionals to create individualised rehabilitation programmes based on the changes in the older adult's functional capacity and performance in daily life. The system uses the taxonomy of the International Classification of Functioning, Disability and Health (ICF) by the World Health Organization (WHO). It links sensor data to five ICF items from three ICF categories and measures their change over time. We collected data from 20 (pre-)frail older adults (aged [Formula: see text] 75 years) during a 10-month observational randomised pilot intervention study. The system successfully passed the first pre-clinical validation step on the real-world data of the OTAGO study. Furthermore, an initial test with a medical professional showed that the system is intuitive and can be used to design personalised rehabilitation measures. Since this research is in an early stage further clinical studies are needed to fully validate the system.

Treatment of sarcopenia in nursing home residents: a scoping review protocol.

INTRODUCTION: Sarcopenia has been recognised as a disease that is consistently associated with a range of geriatric syndromes and negative health consequences. The prevalence of sarcopenia is high among nursing home residents. Several systematic reviews have assessed the efficacy of a range of treatment strategies against sarcopenia. However, no systematic review discussing specifically the treatment options for sarcopenic nursing home residents has been conducted so far. The objective of this scoping review, therefore, is to identify and map existing studies that assessed the feasibility and effectiveness of interventions that were conducted with the aim to treat sarcopenic nursing home residents. METHODS AND ANALYSIS: The protocol was developed using an established scoping review methodological framework. A systematic search of relevant literature databases will be conducted. We will also conduct a search of ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform Search Portal for ongoing and recently completed trials, and will search for grey literature. Two reviewers will independently screen titles and abstracts for inclusion, followed by screening of the full text of potentially relevant articles to determine final inclusion. A data extraction sheet will be developed including key study characteristics that will be relevant for collating, summarising and reporting the results of the scoping review. ETHICS AND DISSEMINATION: The proposed scoping review will undertake a secondary analysis of publicly available data, and therefore does not require ethical approval. The results will be disseminated to researchers in the field by submitting the review to a peer-reviewed international journal and by presenting our findings at relevant conferences. We expect that the results of the final review will help to guide future research in the field of sarcopenia treatment for nursing home residents.

[Significance and diagnosis of malnutrition in the elderly]. / Bedeutung und Diagnostik der Mangelernährung im Alter.

In certain high-risk groups like geriatric hospital patients and nursing home inhabitants malnutrition has a high prevalence and is highly relevant for morbidity and mortality in these populations. The diagnosis of malnutrition in the elderly can be achieved by simple parameters like loss of weight, BMI and oral intake. The available screening and assessment instruments like Mini Nutritional Assessment (MNA) and Nutritional Risk Screening (NRS 2002) aim at the standardization of the diagnosis and early recognition of malnutrition. While the MNA seems to be more appropriate for the community-dwelling elderly, the NRS 2002 offers advantages for the hospital setting. The dissimilarity of the two instruments makes the comparison of study populations difficult. Both the results of the MNA and those of the NRS 2002 are unsuitable as follow-up parameters and inappropriate for the evaluation of nutritional intervention. There is still a strong need for studies on the diagnosis and therapy of malnutrition in the elderly, especially in the nursing home setting. For scientific purposes a standardization of the instruments used for the diagnosis of malnutrition and for the evaluation of the study results is essential. The Minimum Data Set may be a first step in the right direction.