Search

Summary We examined changes in the nutritional status of elderly patients with chest infection for a period of 3 months after discharge from hospital, including the effets of nutritional supplementation [...]

Importance: Sarcopenia, the age-related loss of muscle mass and strength/function, is an important clinical condition. However, no international consensus on the definition exists., Objective: The Global Leadership Initiative in Sarcopenia (GLIS) aimed to address this by establishing the global conceptual definition of sarcopenia., Design: The GLIS steering committee was formed in 2019-21 with representatives from all relevant scientific societies worldwide. During this time, the steering committee developed a set of statements on the topic and invited members from these societies to participate in a two-phase International Delphi Study. Between 2022 and 2023, participants ranked their agreement with a set of statements using an online survey tool (SurveyMonkey). Statements were categorised based on predefined thresholds: strong agreement (>80%), moderate agreement (70-80%) and low agreement (<70%). Statements with strong agreement were accepted, statements with low agreement were rejected and those with moderate agreement were reintroduced until consensus was reached., Results: 107 participants (mean age: 54 ± 12 years [1 missing age], 64% men) from 29 countries across 7 continents/regions completed the Delphi survey. Twenty statements were found to have a strong agreement. These included; 6 statements on 'general aspects of sarcopenia' (strongest agreement: the prevalence of sarcopenia increases with age (98.3%)), 3 statements on 'components of sarcopenia' (muscle mass (89.4%), muscle strength (93.1%) and muscle-specific strength (80.8%) should all be a part of the conceptual definition of sarcopenia)) and 11 statements on 'outcomes of sarcopenia' (strongest agreement: sarcopenia increases the risk of impaired physical performance (97.9%)). A key finding of the Delphi survey was that muscle mass, muscle strength and muscle-specific strength were all accepted as 'components of sarcopenia', whereas impaired physical performance was accepted as an 'outcome' rather than a 'component' of sarcopenia., Conclusion and Relevance: The GLIS has created the first global conceptual definition of sarcopenia, which will now serve to develop an operational definition for clinical and research settings., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Geriatrics Society.)

Introduction: Frailty is associated with adverse outcomes among patients attending emergency departments (EDs). While multiple frailty screens are available, little is known about which variables are important to incorporate and how best to facilitate accurate, yet prompt ED screening. To understand the core requirements of frailty screening in ED, we conducted an international, modified, electronic two-round Delphi consensus study., Methods: A two-round electronic Delphi involving 37 participants from 10 countries was undertaken. Statements were generated from a prior systematic review examining frailty screening instruments in ED (logistic, psychometric and clinimetric properties). Reflexive thematic analysis generated a list of 56 statements for Round 1 (August-September 2021). Four main themes identified were: (i) principles of frailty screening, (ii) practicalities and logistics, (iii) frailty domains and (iv) frailty risk factors., Results: In Round 1, 13/56 statements (23%) were accepted. Following feedback, 22 new statements were created and 35 were re-circulated in Round 2 (October 2021). Of these, 19 (54%) were finally accepted. It was agreed that ideal frailty screens should be short (<5 min), multidimensional and well-calibrated across the spectrum of frailty, reflecting baseline status 2-4 weeks before presentation. Screening should ideally be routine, prompt (<4 h after arrival) and completed at first contact in ED. Functional ability, mobility, cognition, medication use and social factors were identified as the most important variables to include., Conclusions: Although a clear consensus was reached on important requirements of frailty screening in ED, and variables to include in an ideal screen, more research is required to operationalise screening in clinical practice., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Populations in Asian developed economies are rapidly ageing, such that, currently, Hong Kong and Japan have the longest life expectancy at birth for both men and women. However, extended lifespan is not necessarily accompanied by prolongation of health span, such that there is increasing prevalence of frailty and dependency, which translates into increase in complex health and social needs as well as increase in absolute numbers of older adults that require such needs. Consideration of social determinants of healthy ageing would be important in the design of equitable health and social care systems. There is a trend towards development of integrated medical social care in the community in Asian countries. Long-term care insurance and also philanthropic support play a role in the financing of such care models., (© The Author(s) 2021. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: Social gradients of self-rated health (SRH) of older people are evident in various settings. However, it is not clear whether improving older people's sense of community (SoC) could mitigate the social gradient., Methods: People aged above 60 in five residential districts of Hong Kong were sampled using multistage sampling (n = 1,793). SoC was measured using the validated eight-item Brief Sense of Community Scale, with each item on a five-point Likert scale, forming a score from 8 to 40. SRH was considered as dichotomous (poor/not poor). Socioeconomic status (SES) was operationalised as monthly income, highest education attainment and self-rated disposable income (defined as whether the older person feel he/she has sufficient income). Causal mediation analysis using four-way decomposition was used to assess whether SoC mediates/moderates the association of SES and poor SRH., Results: A social gradient of poor SRH by all measures of SES was observed [adjusted relative risk (RR) per standard deviation income increase = 0.92; 95% confidence interval (95% CI) 0.88-0.97; RR comparing lowest to highest education= 1.77; 95% CI: 1.48-2.11; RR comparing very insufficient to very sufficient disposable income = 1.74; 95% CI: 1.48-2.05]. Causal mediation analysis showed that SoC interacts with the association of education and SRH, with higher the SoC, stronger the education gradient., Conclusions: Our findings showed a social gradient of SRH in the older population in Hong Kong. This relationship was moderated by SoC, for which higher SoC is related to stronger SES-SRH gradient., (© The Author(s) 2021. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Older people are disproportionately affected by the COVID-19 pandemic, which has had a profound impact on research as well as clinical service delivery. This commentary identifies key challenges and opportunities in continuing to conduct research with and for older people, both during and after the current pandemic. It shares opinions from responders to an international survey, a range of academic authors and opinions from specialist societies. Priorities in COVID-19 research include its specific presentation in older people, consequences for physical, cognitive and psychological health, treatments and vaccines, rehabilitation, supporting care homes more effectively, the impact of social distancing, lockdown policies and system reconfiguration to provide best health and social care for older people. COVID-19 research needs to be inclusive, particularly involving older people living with frailty, cognitive impairment or multimorbidity, and those living in care homes. Non-COVID-19 related research for older people remains of critical importance and must not be neglected in the rush to study the pandemic. Profound changes are required in the way that we design and deliver research for older people in a world where movement and face-to-face contact are restricted, but we also highlight new opportunities such as the ability to collaborate more widely and to design and deliver research efficiently at scale and speed., (© The Author(s) 2020. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Objectives: to evaluate the effect of an integrated care model for pre-frail and frail community-dwelling older people., Design: a quasi-experimental design., Setting and Participants: we enrolled people aged ≥60 years from a community care project. An inclusion criterion was pre-frailty/frailty, as measured by a simple frailty questionnaire (FRAIL) with a score of ≥1., Methods: we assigned participants to an intervention group (n = 183) in which they received an integrated intervention (in-depth assessment, personalised care plans and coordinated care) or a control group (n = 270) in which they received a group education session on frailty prevention. The outcomes were changes in frailty, individual domains of frailty ('fatigue', 'resistance', 'ambulation', 'illnesses' and 'loss of weight') and health services utilisation over 12 months. Assessments were conducted at baseline and at the 12-month follow-up., Results: the mean age of the participants (n = 453) at baseline was 76.1 ± 7.5 years, and 363 (80.1%) were women. At follow-up, the intervention group showed significantly greater reductions in FRAIL scores than the control group (P < 0.033). In addition, 22.4% of the intervention and 13.7% of the control participants had reverted from pre-frail/frail to robust status, with the difference reaching significance when the intervention was compared with the control group (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.0-2.4) after adjustments for age, sex, living arrangement/marital status and hypercholesterolemia. For individual domains of frailty, the adjusted OR for improved 'resistance' was 1.7 (95% CI 1.0-2.8). However, no effects were found on reducing use of health services., Conclusion: the integrated health and social care model reduced FRAIL scores in a combined population of pre-frail/frail community-dwelling older people attending older people's centres., (© The Author(s) 2020. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: Limited trials examining the effect of exercise and nutrition supplementation in older people with sarcopenia are available., Objectives: to assess the impact of resistance exercise program targeting muscle strength and power with and without nutrition supplementation on gait speed, body composition, physical function and quality of life., Methods: this trial randomized 113 community-dwelling older Chinese adults aged ≥65 and with sarcopenia defined using the Asian Criteria into one of the three groups: exercise program alone, combined-exercise program and nutrition supplement or waitlist control. The exercise program consisted of 90-min group training twice weekly and one-home session weekly for 12 weeks. Participants in the combined group were additionally asked to consume nutrition supplement twice daily for 12 weeks. Both groups were encouraged to keep home exercise after intervention period for another 12 weeks to detect sustained effect. The primary outcome was gait speed., Results: at 12 and 24 weeks, gait speed did not differ significantly between groups. Significant improvement in leg extension, and five-chair stand test occurred in both intervention groups that persisted to 24 weeks. Physical Activity Scale for the Elderly improved in both intervention groups that persisted until 24 weeks only in the combined group. Lower limb muscle and appendicular skeletal muscle mass increased significantly in the combined group but the increase was not sustained to 24 weeks., Conclusion: the exercise program with and without nutrition supplementation had no significant effect on the primary outcome of gait speed but improved the secondary outcomes of strength and the five-chair stand test in community-dwelling Chinese sarcopenic older adults., Clinicaltrials.gov Identifier: NCT02374268., (© The Author(s) 2018. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: there is little evidence to suggest that older people today are living in better health than their predecessors did at the same age. Only a few studies have evaluated whether there are birth cohort effects on frailty, an indicator of health in older people, encompassing physical, functional and mental health dimensions., Objectives: this study examined longitudinal trajectories of frailty among Chinese older people in Hong Kong., Methods: this study utilised data from the 18 Elderly Health Centres of the Department of Health comprising a total of 417,949 observations from 94,550 community-dwelling Chinese people aged ≥65 years in one early birth cohort (1901-23) and four later birth cohorts (1924-29, 1930-35, 1936-41, 1942-47) collected between 2001 and 2012, to examine trajectories of the frailty index and how birth cohorts may have contributed to the trends using an age-period-cohort analysis., Results: more recent cohorts had higher levels of frailty than did earlier cohorts at the same age, controlling for period, gender, marital status, educational levels, socioeconomic status, lifestyle and social factors. Older age, being female, widowhood, lower education and smoking were associated with higher levels of frailty., Conclusion: more recent cohorts had higher levels of frailty than did earlier cohorts. Frailty interventions, coupled with early detection, should be developed to combat the increasing rates of frailty in Hong Kong Chinese., (© The Author 2017. Published by Oxford University Press on behalf of the British Geriatrics Society.All rights reserved. For permissions, please email: journals.permissions@oup.com)

Background: there is a suggestion that while the age-adjusted incidence of hip fracture in the West may be declining, the incidence may be rising in Asia., Objective: this study examines the incidence and post-fracture mortality from 2001 to 2009 among the population aged 65 years and over., Methods: hip fracture incidence rates and case-fatality rates among Hong Kong population aged 65 and over for the period 2001-09 were obtained from the Hong Kong Hospital Authority (HA) database. Rates were adjusted for age. Poisson and logistic regressions were used to examine trends in incidence and post-fracture mortality, respectively., Results: the age-adjusted incidence rate of hip fracture among the population aged 65 and over in Hong Kong (per 100,000 population) decreased from 381.6 for men and 853.3 for women in 2001 to 341.7 and 703.1, respectively, in 2009. There were no significant changes in post-fracture mortality trends., Conclusions: there is a downward trend in age-specific hip fracture incidence rates since 2001 among Hong Kong Chinese, but no change in post-fracture mortality trends.

Background: Previous studies have confirmed the contribution of various medications towards falls in the older population. Recently questions were raised as to whether the chronic illnesses or drug use was more important., Objective: We attempt to test the hypothesis that underlying medical illnesses are the cause of falls rather than medications., Design: Cross-sectional., Setting: Urban community in Hong Kong., Subjects: 4,000 Ambulatory community-dwelling men and women aged 65 years or over., Methods: Demographic data, fall history in the previous 12 months, medical diagnoses, current medications and self-rated health were recorded. Body measurements and neuromuscular function tests were performed. Medical diagnoses and their corresponding medications were tested simultaneously in a multivariate model., Results: 789 (19.7%) Subjects reported at least one fall and 235 (5.9%) experienced two or more falls. After adjustment for age and sex, medications associated with any falls were aspirin, diabetic drugs, nitrates, NSAIDs, and paracetamol, and those associated with recurrent falls were calcium channel blockers, diabetic drugs, nitrates, NSAIDs, aspirin and statins. Only anti-diabetics and nitrate showed moderate and borderline significance in multivariate analyses for recurrent and any falls respectively (OR 2.9, P = 0.01; OR 1.5, P = 0.027). Other medications failed to show significant relationship with falls, while eye diseases, heart diseases and musculoskeletal pain showed variable associations., Conclusion: The apparent association between many medications and falls was mediated through the underlying medical diagnoses and neuromuscular impairment. Anti-diabetics agents were associated with falls.