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5. Sarcopenia

Author

Sayer, Avan A., Cooper, Rachel, Arai, Hidenori, Cawthon, Peggy M., Ntsama Essomba, Marie-Josiane, Fielding, Roger A., Grounds, Miranda D., Witham, Miles D., and Cruz-Jentoft, Alfonso J.

Published
2024
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16. Prevalence of physical frailty, including risk factors, up to 1 year after hospitalisation for COVID-19 in the UK: a multicentre, longitudinal cohort study

Author

Abel, K., Adamali, H., Adeloye, D., Adeyemi, O., Adrego, R., Aguilar Jimenez, L.A., Ahmad, S., Ahmad Haider, N., Ahmed, R., Ahwireng, N., Ainsworth, M., Al-Sheklly, B., Alamoudi, A., Ali, M., Aljaroof, M., All, A.M., Allan, L., Allen, R.J., Allerton, L., Allsop, L., Almeida, P., Altmann, D., Alvarez Corral, M., Amoils, S., Anderson, D., Antoniades, C., Arbane, G., Arias, A., Armour, C., Armstrong, L., Armstrong, N., Arnold, D., Arnold, H., Ashish, A., Ashworth, A., Ashworth, M., Aslani, S., Assefa-Kebede, H., Atkin, C., Atkin, P., Aul, R., Aung, H., Austin, L., Avram, C., Ayoub, A., Babores, M., Baggott, R., Bagshaw, J., Baguley, D., Bailey, L., Baillie, J.K., Bain, S., Bakali, M., Bakau, M., Baldry, E., Baldwin, D., Baldwin, M., Ballard, C., Banerjee, A., Bang, B., Barker, R.E., Barman, L., Barratt, S., Barrett, F., Basire, D., Basu, N., Bates, M., Bates, A., Batterham, R., Baxendale, H., Bayes, H., Beadsworth, M., Beckett, P., Beggs, M., Begum, M., Beirne, P., Bell, D., Bell, R., Bennett, K., Beranova, E., Bermperi, A., Berridge, A., Berry, C., Betts, S., Bevan, E., Bhui, K., Bingham, M., Birchall, K., Bishop, L., Bisnauthsing, K., Blaikely, J., Bloss, A., Bolger, A., Bolton, C.E., Bonnington, J., Botkai, A., Bourne, C., Bourne, M., Bramham, K., Brear, L., Breen, G., Breeze, J., Briggs, A., Bright, E., Brightling, C.E., Brill, S., Brindle, K., Broad, L., Broadley, A., Brookes, C., Broome, M., Brown, A., Brown, J., Brown, J.S., Brown, M., Brown, V., Brugha, T., Brunskill, N., Buch, M., Buckley, P., Bularga, A., Bullmore, E., Burden, L., Burdett, T., Burn, D., Burns, G., Burns, A., Busby, J., Butcher, R., Butt, A., Byrne, S., Cairns, P., Calder, P.C., Calvelo, E., Carborn, H., Card, B., Carr, C., Carr, L., Carson, G., Carter, P., Casey, A., Cassar, M., Cavanagh, J., Chablani, M., Chalder, T., Chalmers, J.D., Chambers, R.C., Chan, F., Channon, K.M., Chapman, K., Charalambou, A., Chaudhuri, N., Checkley, A., Chen, J., Cheng, Y., Chetham, L., Childs, C., Chilvers, E.R., Chinoy, H., Chiribiri, A., Chong-James, K., Choudhury, G., Choudhury, N., Chowienczyk, P., Christie, C., Chrystal, M., Clark, D., Clark, C., Clarke, J., Clohisey, S., Coakley, G., Coburn, Z., Coetzee, S., Cole, J., Coleman, C., Conneh, F., Connell, D., Connolly, B., Connor, L., Cook, A., Cooper, B., Cooper, J., Cooper, S., Copeland, D., Cosier, T., Coulding, M., Coupland, C., Cox, E., Craig, T., Crisp, P., Cristiano, D., Crooks, M.G., Cross, A., Cruz, I., Cullinan, P., Cuthbertson, D., Daines, L., Dalton, M., Daly, P., Daniels, A., Dark, P., Dasgin, J., David, A., David, C., Davies, E., Davies, F., Davies, G., Davies, G.A., Davies, K., Davies, M.J., Dawson, J., Daynes, E., De Soyza, A., Deakin, B., Deans, A., Deas, C., Deery, J., Defres, S., Dell, A., Dempsey, K., Denneny, E., Dennis, J., Dewar, A., Dharmagunawardena, R., Diar-Bakerly, N., Dickens, C., Dipper, A., Diver, S., Diwanji, S.N., Dixon, M., Djukanovic, R., Dobson, H., Dobson, S.L., Docherty, A.B., Donaldson, A., Dong, T., Dormand, N., Dougherty, A., Dowling, R., Drain, S., Draxlbauer, K., Drury, K., Drury, H.J.C., Dulawan, P., Dunleavy, A., Dunn, S., Dupont, C., Earley, J., Easom, N., Echevarria, C., Edwards, S., Edwardson, C., El-Taweel, H., Elliott, A., Elliott, K., Ellis, Y., Elmer, A., Elneima, O., Evans, D., Evans, H., Evans, J., Evans, R., Evans, R.A., Evans, R.I., Evans, T., Evenden, C., Evison, L., Fabbri, L., Fairbairn, S., Fairman, A., Fallon, K., Faluyi, D., Favager, C., Fayzan, T., Featherstone, J., Felton, T., Finch, J., Finney, S., Finnigan, J., Finnigan, L., Fisher, H., Fletcher, S., Flockton, R., Flynn, M., Foot, H., Foote, D., Ford, A., Forton, D., Fraile, E., Francis, C., Francis, R., Francis, S., Frankel, A., Fraser, E., Free, R., French, N., Fu, X., Fuld, J., Furniss, J., Garner, L., Gautam, N., Geddes, J.R., George, J., George, P., Gibbons, M., Gill, M., Gilmour, L., Gleeson, F., Glossop, J., Glover, S., Goodman, N., Goodwin, C., Gooptu, B., Gordon, H., Gorsuch, T., Greatorex, M., Greenhaff, P.L., Greenhalf, W., Greenhalgh, A., Greening, N.J., Greenwood, J., Gregory, H., Gregory, R., Grieve, D., Griffin, D., Griffiths, L., Guerdette, A.-M., Guillen Guio, B., Gummadi, M., Gupta, A., Gurram, S., Guthrie, E., Guy, Z., Henson, H.H., Hadley, K., Haggar, A., Hainey, K., Hairsine, B., Haldar, P., Hall, I., Hall, L., Halling-Brown, M., Hamil, R., Hancock, A., Hancock, K., Hanley, N.A., Haq, S., Hardwick, H.E., Hardy, E., Hardy, T., Hargadon, B., Harrington, K., Harris, E., Harris, V.C., Harrison, E.M., Harrison, P., Hart, N., Harvey, A., Harvey, M., Harvie, M., Haslam, L., Havinden-Williams, M., Hawkes, J., Hawkings, N., Haworth, J., Hayday, A., Haynes, M., Hazeldine, J., Hazelton, T., Heaney, L.G., Heeley, C., Heeney, J.L., Heightman, M., Heller, S., Henderson, M., Hesselden, L., Hewitt, M., Highett, V., Hillman, T., Hiwot, T., Ho, L.P., Hoare, A., Hoare, M., Hockridge, J., Hogarth, P., Holbourn, A., Holden, S., Holdsworth, L., Holgate, D., Holland, M., Holloway, L., Holmes, K., Holmes, M., Holroyd-Hind, B., Holt, L., Hormis, A., Horsley, A., Hosseini, A., Hotopf, M., Houchen-Wolloff, L., Howard, K., Howard, L.S., Howell, A., Hufton, E., Hughes, A.D., Hughes, J., Hughes, R., Humphries, A., Huneke, N., Hurditch, E., Hurst, J., Husain, M., Hussell, T., Hutchinson, J., Ibrahim, W., Ilyas, F., Ingham, J., Ingram, L., Ionita, D., Isaacs, K., Ismail, K., Jackson, T., Jacob, J., James, W.Y., Jang, W., Jarman, C., Jarrold, I., Jarvis, H., Jastrub, R., Jayaraman, B., Jenkins, R.G., Jezzard, P., Jiwa, K., Johnson, C., Johnson, S., Johnston, D., Jolley, C.J., Jones, D., Jones, G., Jones, H., Jones, I., Jones, L., Jones, M.G., Jones, S., Jose, S., Kabir, T., Kaltsakas, G., Kamwa, V., Kanellakis, N., Kaprowska, S., Kausar, Z., Keenan, N., Kelly, S., Kemp, G., Kerr, S., Kerslake, H., Key, A.L., Khan, F., Khunti, K., Kilroy, S., King, B., King, C., Kingham, L., Kirk, J., Kitterick, P., Klenerman, P., Knibbs, L., Knight, S., Knighton, A., Kon, O., Kon, S., Kon, S.S., Koprowska, S., Korszun, A., Koychev, I., Kurasz, C., Kurupati, P., Laing, C., Lamlum, H., Landers, G., Langenberg, C., Lasserson, D., Lavelle-Langham, L., Lawrie, A., Lawson, C., Layton, A., Lea, A., Leavy, O.C., Lee, D., Lee, J.-H., Lee, E., Leitch, K., Lenagh, R., Lewis, D., Lewis, J., Lewis, K.E., Lewis, V., Lewis-Burke, N., Li, X., Light, T., Lightstone, L., Lilaonitkul, W., Lim, L., Linford, S., Lingford-Hughes, A., Lipman, M., Liyanage, K., Lloyd, A., Logan, S., Lomas, D., Lone, N.I., Loosley, R., Lord, J.M., Lota, H., Lovegrove, W., Lucey, A., Lukaschuk, E., Lye, A., Lynch, C., MacDonald, S., MacGowan, G., Macharia, I., Mackie, J., Macliver, L., Madathil, S., Madzamba, G., Magee, N., Magtoto, M.M., Mairs, N., Majeed, N., Major, E., Malein, F., Malim, M., Mallison, G., D-C Man, W., Mandal, S., Mangion, K., Manisty, C., Manley, R., March, K., Marciniak, S., Marino, P., Mariveles, M., Marks, M., Marouzet, E., Marsh, S., Marshall, B., Marshall, M., Martin, J., Martineau, A., Martinez, L.M., Maskell, N., Matila, D., Matimba-Mupaya, W., Matthews, L., Mbuyisa, A., McAdoo, S., McAllister-Williams, H., McArdle, A., McArdle, P., McAulay, D., McCann, G.P., McCormick, J., McCormick, W., McCourt, P., McGarvey, L., McGee, C., Mcgee, K., McGinness, J., McGlynn, K., McGovern, A., McGuinness, H., McInnes, I.B., McIntosh, J., McIvor, E., McIvor, K., McLeavey, L., McMahon, A., McMahon, M.J., McMorrow, L., Mcnally, T., McNarry, M., McNeill, J., McQueen, A., McShane, H., Mears, C., Megson, C., Megson, S., Mehta, P., Meiring, J., Melling, L., Mencias, M., Menzies, D., Merida Morillas, M., Michael, A., Miller, C., Milligan, L., Mills, C., Mills, G., Mills, N.L., Milner, L., Misra, S., Mitchell, J., Mohamed, A., Mohamed, N., Mohammed, S., Molyneaux, P.L., Monteiro, W., Moriera, S., Morley, A., Morrison, L., Morriss, R., Morrow, A., Moss, A.J., Moss, P., Motohashi, K., Msimanga, N., Mukaetova-Ladinska, E., Munawar, U., Murira, J., Nanda, U., Nassa, H., Nasseri, M., Neal, A., Needham, R., Neill, P., Neubauer, S., Newby, D.E., Newell, H., Newman, T., Newman, J., Newton-Cox, A., Nicholson, T., Nicoll, D., Nikolaidis, A., Nolan, C.M., Noonan, M.J., Norman, C., Novotny, P., Nunag, J., Nwafor, L., Nwanguma, U., Nyaboko, J., O'Brien, C., O'Donnell, K., O'Regan, D., O’Brien, L., Odell, N., Ogg, G., Olaosebikan, O., Oliver, C., Omar, Z., Openshaw, P.J.M., Orriss-Dib, L., Osborne, L., Osbourne, R., Ostermann, M., Overton, C., Owen, J., Oxton, J., Pack, J., Pacpaco, E., Paddick, S., Painter, S., Pakzad, A., Palmer, S., Papineni, P., Paques, K., Paradowski, K., Pareek, M., Parekh, D., Parfrey, H., Pariante, C., Parker, S., Parkes, M., Parmar, J., Patale, S., Patel, B., Patel, M., Patel, S., Pattenadk, D., Pavlides, M., Payne, S., Pearce, L., Pearl, J.E., Peckham, D., Pendlebury, J., Peng, Y., Pennington, C., Peralta, I., Perkins, E., Peterkin, Z., Peto, T., Petousi, N., Petrie, J., Pfeffer, P., Phipps, J., Pimm, J., Piper Hanley, K., Pius, R., Plant, H., Plein, S., Plekhanova, T., Plowright, M., Poinasamy, K., Polgar, O., Poll, L., Porter, J.C., Porter, J., Portukhay, S., Powell, N., Prabhu, A., Pratt, J., Price, A., Price, C., Price, D., Price, L., Prickett, A., Propescu, J., Prosper, S., Pugmire, S., Quaid, S., Quigley, J., Quint, J., Qureshi, H., Qureshi, I.N., Radhakrishnan, K., Rahman, N.M., Ralser, M., Raman, B., Ramos, A., Ramos, H., Rangeley, J., Rangelov, B., Ratcliffe, L., Ravencroft, P., Reddington, A., Reddy, R., Reddy, A., Redfearn, H., Redwood, D., Reed, A., Rees, M., Rees, T., Regan, K., Reynolds, W., Ribeiro, C., Richards, A., Richardson, E., Richardson, M., Rivera-Ortega, P., Roberts, K., Robertson, E., Robinson, E., Robinson, L., Roche, L., Roddis, C., Rodger, J., Ross, A., Ross, G., Rossdale, J., Rostron, A., Rowe, A., Rowland, A., Rowland, J., Rowland, M.J., Rowland-Jones, S.L., Roy, K., Roy, M., Rudan, I., Russell, R., Russell, E., Saalmink, G., Sabit, R., Sage, E.K., Samakomva, T., Samani, N., Sampson, C., Samuel, K., Samuel, R., Sanderson, A., Sapey, E., Saralaya, D., Sargant, J., Sarginson, C., Sass, T., Sattar, N., Saunders, K., Saunders, R.M., Saunders, P., Saunders, L.C., Savill, H., Saxon, W., Sayer, A., Schronce, J., Schwaeble, W., Scott, J.T., Scott, K., Selby, N., Semple, M.G., Sereno, M., Sewell, T.A., Shah, A., Shah, K., Shah, P., Shankar-Hari, M., Sharma, M., Sharpe, C., Sharpe, M., Shashaa, S., Shaw, A., Shaw, K., Shaw, V., Sheikh, A., Shelton, S., Shenton, L., Shevket, K., Shikotra, A., Short, J., Siddique, S., Siddiqui, S., Sidebottom, J., Sigfrid, L., Simons, G., Simpson, J., Simpson, N., Singapuri, A., Singh, C., Singh, S., Singh, S.J., Sissons, D., Skeemer, J., Slack, K., Smith, A., Smith, D., Smith, S., Smith, J., Smith, L., Soares, M., Solano, T.S., Solly, R., Solstice, A.R., Soulsby, T., Southern, D., Sowter, D., Spears, M., Spencer, L.G., Speranza, F., Stadon, L., Stanel, S., Steele, N., Steiner, M., Stensel, D., Stephens, G., Stephenson, L., Stern, M., Stewart, I., Stimpson, R., Stockdale, S., Stockley, J., Stoker, W., Stone, R., Storrar, W., Storrie, A., Storton, K., Stringer, E., Strong-Sheldrake, S., Stroud, N., Subbe, C., Sudlow, C.L., Suleiman, Z., Summers, C., Summersgill, C., Sutherland, D., Sykes, D.L., Sykes, R., Talbot, N., Tan, A.L., Tarusan, L., Tavoukjian, V., Taylor, A., Taylor, C., Taylor, J., Te, A., Tedd, H., Tee, C.J., Teixeira, J., Tench, H., Terry, S., Thackray-Nocera, S., Thaivalappil, F., Thamu, B., Thickett, D., Thomas, C., Thomas, D.C., Thomas, S., Thomas, A.K., Thomas-Woods, T., Thompson, T., Thompson, A.A.R., Thornton, T., Thorpe, M., Thwaites, R.S., Tilley, J., Tinker, N., Tiongson, G.F., Tobin, M., Tomlinson, J., Tong, C., Toshner, M., Touyz, R., Tripp, K.A., Tunnicliffe, E., Turnbull, A., Turner, E., Turner, S., Turner, V., Turner, K., Turney, S., Turtle, L., Turton, H., Ugoji, J., Ugwuoke, R., Upthegrove, R., Valabhji, J., Ventura, M., Vere, J., Vickers, C., Vinson, B., Wade, E., Wade, P., Wain, L.V., Wainwright, T., Wajero, L.O., Walder, S., Walker, S., Wall, E., Wallis, T., Walmsley, S., Walsh, J.A., Walsh, S., Warburton, L., Ward, T.J.C., Warwick, K., Wassall, H., Waterson, S., Watson, E., Watson, L., Watson, J., Weir McCall, J., Welch, C., Welch, H., Welsh, B., Wessely, S., West, S., Weston, H., Wheeler, H., White, S., Whitehead, V., Whitney, J., Whittaker, S., Whittam, B., Whitworth, V., Wight, A., Wild, J., Wilkins, M., Wilkinson, D., Williams, B., Williams, N., Williams, J., Williams-Howard, S.A., Willicombe, M., Willis, G., Willoughby, J., Wilson, A., Wilson, D., Wilson, I., Window, N., Witham, M., Wolf-Roberts, R., Wood, C., Woodhead, F., Woods, J., Wootton, D.G., Wormleighton, J., Worsley, J., Wraith, D., Wrey Brown, C., Wright, C., Wright, L., Wright, S., Wyles, J., Wynter, I., Xu, M., Yasmin, N., Yasmin, S., Yates, T., Yip, K.P., Young, B., Young, S., Young, A., Yousuf, A.J., Zawia, A., Zeidan, L., Zhao, B., Zheng, B., Zongo, O., McAuley, Hamish J.C., Evans, Rachael A., Bolton, Charlotte E., Brightling, Christopher E., Chalmers, James D., Docherty, Annemarie B., Elneima, Omer, Greenhaff, Paul L., Gupta, Ayushman, Harris, Victoria C., Harrison, Ewen M., Ho, Ling-Pei, Horsley, Alex, Houchen-Wolloff, Linzy, Jolley, Caroline J., Leavy, Olivia C., Lone, Nazir I., Man, William D-C, Marks, Michael, Parekh, Dhruv, Poinasamy, Krisnah, Quint, Jennifer K., Raman, Betty, Richardson, Matthew, Saunders, Ruth M., Sereno, Marco, Shikotra, Aarti, Singapuri, Amisha, Singh, Sally J., Steiner, Michael, Tan, Ai Lyn, Wain, Louise V., Welch, Carly, Whitney, Julie, Witham, Miles D., Lord, Janet, and Greening, Neil J.

Published
2023
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18. Impact of Exercise Rehabilitation on Exercise Capacity and Quality-of-Life in Heart Failure Individual Participant Meta-Analysis

Author

Taylor, Rod S, Walker, Sarah, Smart, Neil A, Piepoli, Massimo F, Warren, Fiona C, Ciani, Oriana, Whellan, David, O’Connor, Christopher, Keteyian, Steven J, Coats, Andrew, Davos, Constantinos H, Dalal, Hasnain M, Dracup, Kathleen, Evangelista, Lorraine S, Jolly, Kate, Myers, Jonathan, Nilsson, Birgitta B, Passino, Claudio, Witham, Miles D, Yeh, Gloria Y, and Collaboration, ExTraMATCH II

Subjects
Rehabilitation, Heart Disease, Cardiovascular, Clinical Research, Clinical Trials and Supportive Activities, 7.1 Individual care needs, Management of diseases and conditions, Cardiac Rehabilitation, Exercise Therapy, Exercise Tolerance, Heart Failure, Humans, Quality of Life, Randomized Controlled Trials as Topic, exercise capacity, heart failure, MLHFQ, QoL, quality-of-life, rehabilitation, ExTraMATCH II Collaboration, Cardiorespiratory Medicine and Haematology, Public Health and Health Services, Cardiovascular System & Hematology
Abstract

BackgroundPrevious systematic reviews have indicated that exercise-based cardiac rehabilitation (ExCR) for patients with heart failure (HF) has a beneficial effect on health-related quality-of-life (HRQoL) and exercise capacity. However, there is uncertainty regarding potential differential effects of ExCR across HF patient subgroups.ObjectivesThe authors sought to undertake an individual participant data (IPD) meta-analysis to: 1) assess the impact of ExCR on HRQoL and exercise capacity in patients with HF; and 2) investigate differential effects of ExCR according to a range of patient characteristics: age, sex, ethnicity, New York Heart Association functional class, ischemic etiology, ejection fraction, and exercise capacity.MethodsA single dataset was produced, comprising randomized trials where ExCR (delivered for 3 weeks or more) was compared with a no exercise control group. Each trial provided IPD on HRQoL or exercise capacity (or both), with follow-up of 6 months or more. One- and 2-stage meta-analysis models were used to investigate the effect of ExCR overall and the interactions between ExCR and participant characteristics.ResultsIPD was obtained from 13 trials for 3,990 patients, predominantly (97%) with reduced ejection fraction HF. Compared with the control group, there was a statistically significant difference in favor of ExCR for HRQoL and exercise capacity. At 12-month follow-up, improvements were seen in 6-min walk test (mean 21.0 m; 95% confidence interval: 1.57 to 40.4 m; p = 0.034) and Minnesota Living With HF score (mean improvement 5.9; 95% confidence interval: 1.0 to 10.9; p = 0.018). No consistent evidence was found of differential intervention effects across patient subgroups.ConclusionsThese results, based on an IPD meta-analysis of randomized trials, confirm the benefit of ExCR on HRQoL and exercise capacity and support the Class I recommendation of current international clinical guidelines that ExCR should be offered to all HF patients. (Exercise Training for Chronic Heart Failure [ExTraMATCH II]: protocol for an individual participant data meta-analysis; PROSPERO: international database of systematic reviews CRD42014007170).

Published
2019

19. A scoping review of the measurement and analysis of frailty in randomised controlled trials.

Author

Sun, Yanhe, Witham, Miles D, Clegg, Andy, Taylor, Rod S, Dibben, Grace, McAllister, David, and Hanlon, Peter

Subjects
*MEDICAL information storage & retrieval systems, *RESEARCH funding, *FRAIL elderly, *CINAHL database, *RANDOMIZED controlled trials, *SYSTEMATIC reviews, *MEDLINE, *GERIATRIC assessment, *AGING
Abstract

Background Frailty is of increasing interest in trials, either as a target of intervention, as an outcome or as a potential treatment modifier. However, frailty measurement is often highly variable. This scoping review assessed how frailty is quantified in randomised controlled trials (RCTs), in what context and for what purposes. Methods We searched five electronic databases for RCTs in which frailty was measured among trial participants. We extracted data on intervention type, the frailty measure used and the purpose for which frailty was assessed. We then compared these data according to reasons for frailty assessment. Results We identified 415 RCTs assessing frailty across a range of interventions. Frailty was used to define the target population (166 trials), as an outcome (156 trials), as an effect modifier examining interaction of frailty on treatment effect (61 trials), as a purely descriptive characteristic (42 trials) or as a prognostic marker examining the impact of frailty on future health outcome (78 trials). The trials used 28 different measures of frailty (plus 29 additional trial-specific measures). The frailty phenotype model was the most common overall (164 trials), for defining the target population (90/166 trials) and as an outcome (81/156 trials). The cumulative deficit model frailty index was also frequently used (102 trials) and was most common among trials assessing treatment effect modification (21/61 trials). Conclusion Frailty measurement in RCTs is highly variable. Understanding the properties of respective frailty measures and how these relate to frailty as encountered in clinical practice is a priority to ensure that trial findings can inform healthcare delivery for people living with frailty. [ABSTRACT FROM AUTHOR]

Published
2024
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20. Describing Community-Based Nurses' Knowledge, Attitudes, and Practices in the Nutritional Care of Older Adults: Results of a UK Survey.

Author

Shield, Ashley, Romano, Vittoria, Robinson, Sian M., and Witham, Miles D.

Subjects
NURSING audit, CROSS-sectional method, MOTIVATIONAL interviewing, COMMUNITY health nurses, GERIATRIC nursing, STATISTICAL sampling, QUESTIONNAIRES, NUTRITIONAL assessment, DESCRIPTIVE statistics, CONFIDENCE, DECISION making in clinical medicine, NURSES' attitudes, PHYSICIAN practice patterns, RESEARCH methodology, GERIATRIC assessment, NEEDS assessment, JUDGMENT (Psychology), DIET therapy, HEALTH care teams
Abstract

Purpose: To ascertain current nutritional knowledge and training needs of community-based nurses caring for older adults in the United Kingdom. Method: A descriptive cross-sectional, anonymized, online survey of nurses' knowledge, attitudes, and practices related to older adults' nutrition was developed. Community-based nurses working with older adults in the United Kingdom were recruited via social media and convenience sampling. Results: Responses were received from 194 community-based nurses. Nutritional care was seen as a multidisciplinary responsibility by 62% of participants. Most undertook nutrition screening (93%), were confident in providing nutritional advice (83%), and ease of identifying those in need (88%) was high. However, some aspects of nutritional knowledge were less complete, including recommended daily intakes of protein (60% unsure) and fiber (52% unsure). Conclusion: High confidence in delivering nutritional advice contrasted with uncertainty around some aspects of nutritional knowledge, suggesting opportunities to improve training on the nutritional needs of older adults. [Journal of Gerontological Nursing, 50(11), 13–19.] [ABSTRACT FROM AUTHOR]

Published
2024
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21. Impact of exercise‐based cardiac rehabilitation in patients with heart failure (ExTraMATCH II) on mortality and hospitalisation: an individual patient data meta‐analysis of randomised trials

Author

Taylor, Rod S, Walker, Sarah, Smart, Neil A, Piepoli, Massimo F, Warren, Fiona C, Ciani, Oriana, O'Connor, Christopher, Whellan, David, Keteyian, Steven J, Coats, Andrew, Davos, Constantinos H, Dalal, Hasnain M, Dracup, Kathleen, Evangelista, Lorraine, Jolly, Kate, Myers, Jonathan, McKelvie, Robert S, Nilsson, Birgitta B, Passino, Claudio, Witham, Miles D, Yeh, Gloria Y, Zwisler, Ann‐Dorthe O, and Collaboration, on behalf of the ExTraMATCH II

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Clinical Trials and Supportive Activities, Heart Disease, Clinical Research, Cardiovascular, Rehabilitation, Good Health and Well Being, Cardiac Rehabilitation, Exercise, Exercise Therapy, Global Health, Heart Failure, Hospitalization, Humans, Quality of Life, Randomized Controlled Trials as Topic, Survival Rate, Cardiac rehabilitation, Exercise training, Meta-analysis, Systematic review, ExTraMATCH II Collaboration, Cardiorespiratory Medicine and Haematology, Cardiovascular System & Hematology, Cardiovascular medicine and haematology
Abstract

AimsTo undertake an individual patient data (IPD) meta-analysis to assess the impact of exercise-based cardiac rehabilitation (ExCR) in patients with heart failure (HF) on mortality and hospitalisation, and differential effects of ExCR according to patient characteristics: age, sex, ethnicity, New York Heart Association functional class, ischaemic aetiology, ejection fraction, and exercise capacity.Methods and resultsRandomised trials of exercise training for at least 3 weeks compared with no exercise control with 6-month follow-up or longer, providing IPD time to event on mortality or hospitalisation (all-cause or HF-specific). IPD were combined into a single dataset. We used Cox proportional hazards models to investigate the effect of ExCR and the interactions between ExCR and participant characteristics. We used both two-stage random effects and one-stage fixed effect models. IPD were obtained from 18 trials including 3912 patients with HF with reduced ejection fraction. Compared to control, there was no statistically significant difference in pooled time to event estimates in favour of ExCR although confidence intervals (CIs) were wide [all-cause mortality: hazard ratio (HR) 0.83, 95% CI 0.67-1.04; HF-specific mortality: HR 0.84, 95% CI 0.49-1.46; all-cause hospitalisation: HR 0.90, 95% CI 0.76-1.06; and HF-specific hospitalisation: HR 0.98, 95% CI 0.72-1.35]. No strong evidence was found of differential intervention effects across patient characteristics.ConclusionExercise-based cardiac rehabilitation did not have a significant effect on the risk of mortality and hospitalisation in HF with reduced ejection fraction. However, uncertainty around effect estimates precludes drawing definitive conclusions.

Published
2018

22. Establishing a clinical phenotype for cachexia in end stage kidney disease – study protocol

Author

Reid, Joanne, Noble, Helen R, Adamson, Gary, Davenport, Andrew, Farrington, Ken, Fouque, Denis, Kalantar-Zadeh, Kamyar, Mallett, John, McKeaveney, C, Porter, S, Seres, David S, Shields, Joanne, Slee, Adrian, Witham, Miles D, and Maxwell, Alexander P

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Health Sciences, Nutrition, Clinical Research, Kidney Disease, Aetiology, 2.1 Biological and endogenous factors, Renal and urogenital, Good Health and Well Being, Cachexia, Humans, Kidney Failure, Chronic, Longitudinal Studies, Patient Selection, Phenotype, Renal Dialysis, United Kingdom, End-stage kidney disease, Definition, Longitudinal, Urology & Nephrology, Clinical sciences, Health services and systems, Nursing
Abstract

BackgroundSurveys using traditional measures of nutritional status indicate that muscle wasting is common among persons with end-stage kidney disease (ESKD). Up to 75% of adults undergoing maintenance dialysis show some evidence of muscle wasting. ESKD is associated with an increase in inflammatory cytokines and can result in cachexia, with the loss of muscle and fat stores. At present, only limited data are available on the classification of wasting experienced by persons with ESKD. Individuals with ESKD often exhibit symptoms of anorexia, loss of lean muscle mass and altered energy expenditure. These symptoms are consistent with the syndrome of cachexia observed in other chronic diseases, such as cancer, heart failure, and acquired immune deficiency syndrome. While definitions of cachexia have been developed for some diseases, such as cardiac failure and cancer, no specific cachexia definition has been established for chronic kidney disease. The importance of developing a definition of cachexia in a population with ESKD is underscored by the negative impact that symptoms of cachexia have on quality of life and the association of cachexia with a substantially increased risk of premature mortality. The aim of this study is to determine the clinical phenotype of cachexia specific to individuals with ESKD.MethodsA longitudinal study which will recruit adult patients with ESKD receiving haemodialysis attending a Regional Nephrology Unit within the United Kingdom. Patients will be followed 2 monthly over 12 months and measurements of weight; lean muscle mass (bioelectrical impedance, mid upper arm muscle circumference and tricep skin fold thickness); muscle strength (hand held dynamometer), fatigue, anorexia and quality of life collected. We will determine if they experience (and to what degree) the known characteristics associated with cachexia.DiscussionCachexia is a debilitating condition associated with an extremely poor outcome. Definitions of cachexia in chronic illnesses are required to reflect specific nuances associated with each disease. These discrete cachexia definitions help with the precision of research and the subsequent clinical interventions to improve outcomes for patients suffering from cachexia. The absence of a definition for cachexia in an ESKD population makes it particularly difficult to study the incidence of cachexia or potential treatments, as there are no standardised inclusion criteria for patients with ESKD who have cachexia. Outcomes from this study will provide much needed data to inform development and testing of potential treatment modalities, aimed at enhancing current clinical practice, policy and education.

Published
2018

25. Correction: Trial Forge Guidance 3: randomised trials and how to recruit and retain individuals from ethnic minority groups—practical guidance to support better practice

Author

Dawson, Shoba, Banister, Katie, Biggs, Katie, Cotton, Seonaidh, Devane, Declan, Gardner, Heidi, Gillies, Katie, Gopalakrishnan, Gosala, Isaacs, Talia, Khunti, Kamlesh, Nichol, Alistair, Parker, Adwoa, Russell, Amy M., Shepherd, Victoria, Shiely, Frances, Shorter, Gillian, Starling, Bella, Williams, Hywel, Willis, Andrew, Witham, Miles D., and Treweek, Shaun

Published
2022
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26. Trial Forge Guidance 3: randomised trials and how to recruit and retain individuals from ethnic minority groups—practical guidance to support better practice

Author

Dawson, Shoba, Banister, Katie, Biggs, Katie, Cotton, Seonaidh, Devane, Declan, Gardner, Heidi, Gillies, Katie, Gopalakrishnan, Gosala, Isaacs, Talia, Khunti, Kamlesh, Nichol, Alistair, Parker, Adwoa, Russell, Amy M., Shepherd, Victoria, Shiely, Frances, Shorter, Gillian, Starling, Bella, Williams, Hywel, Willis, Andrew, Witham, Miles D., and Treweek, Shaun

Published
2022
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34. The Benchmarking Exercise Programme for Older People (BEPOP): Design, Results and Recommendations from The First Wave of Data Collection.

Author

Caulfield, Lorna, Arnold, Susanne, De Biase, Sarah, Buckland, Charlotte, Heslop, Philip, Hurst, Christopher, Sayer, Avan A., Skelton, Dawn A., and Witham, Miles D.

Subjects
OLDER people, RESISTANCE training, EXERCISE therapy, PHYSICAL mobility, FRAILTY
Abstract

Objectives: The Benchmarking Exercise Programme for Older People (BEPOP) service improvement project seeks to determine and promote the exercise training characteristics associated with positive outcomes for resistance exercise for older people living with, or at risk of, sarcopenia or physical frailty. Methods: Mixedmethods service improvement project. Ten UK National Health Service physiotherapist-led therapy services delivering exercise interventions for older people submitted anonymized data for up to 20 consecutive patients. A multidisciplinary expert panel generated a report and recommendations with site-specific benchmarking data and feedback. In parallel, participating physiotherapy team members were interviewed to elicit feedback on BEPOP rationale, processes and perceived value. Results: Data from 188 patients were included, mean age 80 years (range 60-101). 115 (61%) received objective assessment of strength-based physical performance. Bodyweight exercises (173 [92%]) and resistance bands (49 [26%]) were the commonest exercise modalities. Exercises progressed predominantly through increased repetitions (163 [87%]) rather than increased load. 50 (30%) had no reassessment of outcomes; only 68 (41%) were signposted to follow-on exercise services. Staff interviews identified themes around knowledge, diagnosis, data collection and practice reflection. Conclusion: BEPOP was feasible to deliver and generated actionable insights for service improvement via improved diagnosis, measurement and progression of resistance exercise. [ABSTRACT FROM AUTHOR]

Published
2024
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38. The use of natural language processing for the identification of ageing syndromes including sarcopenia, frailty and falls in electronic healthcare records: a systematic review.

Author

Osman, Mo, Cooper, Rachel, Sayer, Avan A, and Witham, Miles D

Subjects
RESEARCH funding, FRAIL elderly, CINAHL database, NATURAL language processing, META-analysis, SYSTEMATIC reviews, MEDLINE, AGING, ELECTRONIC health records, ONLINE information services, SARCOPENIA, ACCIDENTAL falls, ALGORITHMS
Abstract

Background Recording and coding of ageing syndromes in hospital records is known to be suboptimal. Natural Language Processing algorithms may be useful to identify diagnoses in electronic healthcare records to improve the recording and coding of these ageing syndromes, but the feasibility and diagnostic accuracy of such algorithms are unclear. Methods We conducted a systematic review according to a predefined protocol and in line with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Searches were run from the inception of each database to the end of September 2023 in PubMed, Medline, Embase, CINAHL, ACM digital library, IEEE Xplore and Scopus. Eligible studies were identified via independent review of search results by two coauthors and data extracted from each study to identify the computational method, source of text, testing strategy and performance metrics. Data were synthesised narratively by ageing syndrome and computational method in line with the Studies Without Meta-analysis guidelines. Results From 1030 titles screened, 22 studies were eligible for inclusion. One study focussed on identifying sarcopenia, one frailty, twelve falls, five delirium, five dementia and four incontinence. Sensitivity (57.1%–100%) of algorithms compared with a reference standard was reported in 20 studies, and specificity (84.0%–100%) was reported in only 12 studies. Study design quality was variable with results relevant to diagnostic accuracy not always reported, and few studies undertaking external validation of algorithms. Conclusions Current evidence suggests that Natural Language Processing algorithms can identify ageing syndromes in electronic health records. However, algorithms require testing in rigorously designed diagnostic accuracy studies with appropriate metrics reported. [ABSTRACT FROM AUTHOR]

Published
2024
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39. Nutritional Screening, Initial Management and Referral for Older People with Sarcopenia or Frailty - Results from a UK-Wide Survey.

Author

Bowler, Caroline, Moriarty, Elizabeth, Chawner, Melody, Clegg, Andrew, De Biase, Sarah, Offord, Natalie, Romano, Vittoria, Sayer, Avan A., Smith, Alison, Todd, Oliver, and Witham, Miles D.

Subjects
OLDER people, SARCOPENIA, MEDICAL screening, THEMATIC analysis, FRAILTY
Abstract

Objectives: We surveyed healthcare staff working with older people to understand current practice in nutrition screening, initial management and referral for older people with sarcopenia and frailty. Methods: We conducted a UK-wide web-based survey of staff working with older people in both hospital and community settings. Surveys were distributed through professional organisation e-mail lists and social media channels. Descriptive data were generated from categorical responses and inductive thematic analysis was applied to free-text responses. Results: Data were analysed from 169 respondents (110 hospital, 59 community), representing 99 healthcare organisations. 91 (83%) hospital respondents and 24 (41%) community respondents reported that nutrition screening was performed on all patients with sarcopenia or frailty. The Malnutrition Universal Screening Tool was most commonly used to trigger referral to dietetics teams, but there was considerable variation in management before referral, referral thresholds and referral pathways. Themes derived from free-text responses included the need for training, issues of responsibility and ownership, inadequate resources (time, staff and equipment) and ineffective or inefficient processes for referral and management. Conclusions: Current UK nutritional care for older people with sarcopenia and frailty is heterogeneous. There are opportunities for better tools, processes, training and resources to improve current practice and pathways. [ABSTRACT FROM AUTHOR]

Published
2024
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41. Geriatric medicine and Olympic elite sports—parallels and philosophies.

Author

McDonald, Claire, Sayer, Avan A, and Witham, Miles D

Subjects
GERIATRICS, PHILOSOPHY, PHYSICAL education, PHYSICAL training & conditioning, SPORTS events, GERIATRIC assessment, ATHLETIC ability, BODY movement, HEALTH promotion, SARCOPENIA, ACTIVE aging, DOPING in sports
Abstract

The 30th Olympiad took place in July 2024. At first glance, sports science and training of elite athletes may appear to be of little relevance to geriatric medicine. However, there are important parallels between the practice of geriatric medicine and elite sports and lessons that we can learn from our sports science colleagues. Elite athletes and older people are operating at the margins of physiological capacity. Both benefit from tailored, scientifically informed training programmes delivered and monitored by a multidisciplinary team. There are parallels between the comprehensive geriatric assessment and the philosophy of marginal gains pioneered by British Cycling. Insights into the biology of skeletal muscle function are beginning to translate into the development of clinical interventions and substances that offer an unfair advantage in sport by improving muscle strength and physical performance may be of therapeutic benefit in sarcopenia. The 2024 Olympics provide an opportunity for us to learn lessons for excellence in our research and provide an opportunity to promote exercise across the life course—important for healthy ageing. [ABSTRACT FROM AUTHOR]

Published
2024
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45. Sarcopenia and sarcopenic obesity among community-dwelling Peruvian adults: A cross-sectional study.

Author

Flores-Flores, Oscar, Zevallos-Morales, Alejandro, Pollard, Suzanne L., Checkley, William, Siddharthan, Trishul, Hurst, John R., Bernabé-Ortiz, Antonio, Runzer-Colmenares, Fernando M., Witham, Miles D., and Parodi, Jose F.

Subjects
SARCOPENIA, MUSCLE mass, MUSCLE strength, CROSS-sectional method, BIOELECTRIC impedance, BODY mass index
Abstract

Introduction: Sarcopenia and sarcopenic obesity (SO) have emerged as significant contributors to negative health outcomes in the past decade. We aimed to estimate the prevalence of probable sarcopenia, sarcopenia, and SO in a community-dwelling population of 1151 adults aged ≥55 years in Lima, Peru. Methods: This cross-sectional study was conducted between 2018 and 2020. Sarcopenia was defined as the presence of low muscle strength (LMS) and low muscle mass (LMM) according to European (EWGSOP2), US (FNIH) and Asian (AWGS2) guidelines. We measured muscle strength by maximum handgrip strength and muscle mass using bioelectrical impedance analyzer. SO was defined as a body mass index ≥ 30 kg/m2 and sarcopenia. Results: The study participants had a mean age of 66.2 years (SD 7.1), age range between 60 to 92 years old, of which 621 (53.9%) were men. Among the sample, 41.7% were classified as obese (BMI ≥30.0 kg/m²). The prevalence of probable sarcopenia was estimated to be 22.7% (95%CI: 20.3–25.1) using the EWGSOP2 criteria and 27.8% (95%CI: 25.2–30.4) using the AWGS2 criteria. Sarcopenia prevalence, assessed using skeletal muscle index (SMI), was 5.7% (95%CI: 4.4–7.1) according to EWGSOP2 and 8.3% (95%CI: 6.7–9.9) using AWGS2 criteria. The prevalence of sarcopenia based on the FNIH criteria was 18.1% (95%CI: 15.8–20.3). The prevalence of SO, considering different sarcopenia definitions, ranged from 0.8% (95%CI: 0.3–1.3) to 5.0% (95%CI: 3.8–6.3). Conclusion: Our findings reveal substantial variation in the prevalence of sarcopenia and SO, underscoring the necessity for context-specific cut-off values. Although the prevalence of SO was relatively low, this result may be underestimated. Furthermore, the consistently high proportion of probable sarcopenia and sarcopenia point to a substantial public health burden. [ABSTRACT FROM AUTHOR]

Published
2024
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46. Improving care for patients with multiple long-term conditions admitted to hospital: challenges and potential solutions.

Author

McDonald, Claire, Cooper, Rachel, Sayer, Avan A, and Witham, Miles D

Abstract

Increasing numbers of people live with multiple long-term conditions. These people are more likely to be admitted to hospital, experience adverse outcomes and receive poorer quality care than those with a single condition. Hospitals remain organised around a model of single-organ, disease-specific care which is not equipped to meet the needs of people living with multiple long-term conditions. This article considers these challenges and explores potential solutions. These include different service models to provide holistic, multidisciplinary inpatient and outpatient care across specialty boundaries, training a workforce to deliver high-quality hospital care for people living with multiple long-term conditions, and developing technological, financial and cultural enablers of change. Considerably more research is required to fully appreciate the shared risk factors, underlying mechanisms, patterns and consequences of multiple long-term conditions. This is essential to design and deliver better structures and processes of hospital care for people living with multiple long-term conditions. [ABSTRACT FROM AUTHOR]

Published
2024
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49. Why are older adults living with the complexity of multiple long-term conditions, frailty and a recent deterioration in health under-served by research? A narrative synthesis review of the literature.

Author

Dismore, Lorelle, Hurst, Christopher, Granic, Antoneta, Tullo, Ellen, Witham, Miles D., Dodds, Richard M., Sayer, Avan A., and Robinson, Sian M.

Subjects
LITERATURE reviews, OLDER people, FRAILTY, RESEARCH personnel, HERPES zoster vaccines
Abstract

Older adults living with the complexity of multiple long-term conditions (MLTC), frailty and a recent deterioration in health are under-served by research. As a result, current treatment guidelines are often based on data from studies of younger and less frail participants, and often single disease focused. The aims of this review were (i) to identify why older adults living with the complexity of MLTC, frailty and a recent deterioration in health are underserved by research and (ii) to identify strategies for increasing their recruitment and retention. Although a range of factors have been suggested to affect the participation of older adults with MLTC and frailty in research, this review shows that much less is known about the inclusion of older adults living with the complexity of MLTC, frailty and a recent deterioration in health. Researchers should focus on strategies that minimise participation burden for these patients, maintaining an adaptive and flexible approach, to increase their recruitment and retention. Future research should include qualitative interviews to provide further insights into how best to design and conduct research to suit the needs of this population group. [ABSTRACT FROM AUTHOR]

Published
2023
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