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Background and importance Records of prescribed medication in the primary care setting have a high level of discrepancies regarding the medication that geriatric patients are really taking, when they are consulted at the hospital level. Aim and objectives To review the rate of discrepancies between medication prescribed at the primary care level and medication that patients really need to take, in the geriatric population consulted with a multidisciplinary team in the hospital setting. Material and methods An ambispective study was carried out by a multidisciplinary team (nurse, geriatrician, pharmacist) in all patients at a geriatric specialised outpatient office attended by a doctor in the hospital level setting, during the first fortnight of January 2020. An interview with every patient was carried out by a nurse, who was responsible for documenting in the medication records what every patient was really taking in that moment. Afterwards, a geriatrician made an evaluation of the clinical situation and adjusted treatment accordingly in every patient who attended. The pharmacist was then responsible for reconciliation of the medication. Demographic data, number of drugs prescribed, types of discrepancies and rate of acceptance by the physician were collected. Results 34 patients, median age 85.5 years, were reviewed (8 men, 26 women), with a median of 10 (IQR 8.25–14) drugs prescribed. 61 discrepancies were detected with a mean of 1.8/patient (IQR 0–4). These discrepancies were: 47 (77.05%) inappropriate dosage, 8 (13.11%) drug omission, 2 (3.28%) drug duplication, 2 drug interaction and 2 commission. 46 discrepancies were reconciled with Turriano (tool for prescribing drugs in the primary care setting by general practitioners): 9 (19.56%) interventions adding drugs to the prescription, 15 (32.60%) referrals for drug discontinuing and 22 (47.82%) proposals to change the dosage. The remaining 15 were not accepted: 8 were unfunded drugs, 4 posology was conditioned to the clinical situation (intentional discrepancies), 2 due to ignorance of the prescription and 1 due to a computer problem. Only 4 patients (11.76%) did not present any discrepancy. Conclusion and relevance The high percentage of patients with discrepancies in Turriano represents a significant safety problem for patients. In this study, a large number of discrepancies were found and corrected, leading to an improvement in quality of treatment and patient safety. These interventions are essential in elderly, multipathological and polymedicated patients. References and/or acknowledgements Conflict of interest No conflict of interest

The purposes of this study were: (i) to evaluate the association of sit-to-stand (STS) power and body composition parameters [body mass index (BMI) and legs skeletal muscle index (SMI)] with age; (ii) to provide cut-of points for low relative STS power (STSrel), (iii) to provide normative data for well functioning older adults and (iv) to assess the association of low STSrel with negative outcomes. Cross-sectional design (1369 older adults). STS power parameters assessed by validated equations, BMI and Legs SMI assessed by dual-energy X-ray absorptiometry were recorded. Sex- and age adjusted segmented and logistic regression analyses and receiver operator characteristic curves were used. Among men, STSrel showed a negative association with age up to the age of 85 years (− 1.2 to − 1.4%year−1; p < 0.05). In women, a negative association with age was observed throughout the old adult life (− 1.2 to − 2.0%year−1; p < 0.001). Cut-of values for low STSrel were 2.5W ­kg−1 in men and 1.9W ­kg−1 in women. Low STSrel was associated with frailty (OR [95% CI] = 5.6 [3.1, 10.1]) and low habitual gait speed (HGS) (OR [95% CI] = 2.7 [1.8, 3.9]) in men while low STSrel was associated with frailty (OR [95% CI] = 6.9 [4.5, 10.5]) low HGS (OR [95% CI] = 2.9 [2.0, 4.1]), disability in activities of daily living (OR [95% CI] = 2.1 [1.4, 3.2]), and low quality of life (OR [95%CI] = 1.7 [1.2, 2.4]) in women. STSrel declined with increasing age in both men and women. Due to the adverse outcomes related to STSrel, the reported cut-of points can be used as a clinical tool to identify low STSrel among older adults.

Background: The purposes of this study were: i) to evaluate the association of sit-to-stand (STS) power and body composition parameters [body mass index (BMI) and legs skeletal muscle index (SMI)] with age; ii) to provide cut-off points for low relative STS power (STSrel), ii) to provide normative data for well-functioning older adults and iv) to assess the impact of low STSrel on negative outcomes.Methods: Cross-sectional design (1369 older adults). STS power parameters assessed by validated equations, BMI and Legs SMI assessed by dual-energy X-ray absorptiometry were recorded. Sex- and age-adjusted segmented and logistic regression analyses and receiver operator characteristic curves were used.Results: Among men, STSrel showed a negative association with age up to the age of 85 years (‒1.2 to ‒1.4%year-1; pyear-1; prel were 2.5 W∙kg-1 in men and 1.9 W∙kg-1 in women. Low STSrel was associated with frailty (OR[95%CI]= 5.6 [3.1, 10.1]) and low habitual gait speed (HGS) (OR[95%CI]= 2.7 [1.8, 3.9]) in men while low STSrel was associated with frailty (OR[95%CI]= 6.9 [4.5, 10.5]) low HGS (OR[95%CI]= 2.9 [2.0, 4.1]), disability in activities of daily living (OR[95%CI]= 2.1 [1.4, 3.2]), and low quality of life (OR[95%CI]= 1.7 [1.2, 2.4]) in women. Conclusions: STSrel declined with increasing age in both men and women. Due to the adverse outcomes related to STSrel, the reported cut-off points can be used as a clinical tool to identify this condition among older adults.

Background The purpose of this study was to evaluate the relationship of lower-limb muscle power with mortality and hospitalization. Methods A total of 1 928 participants from the Toledo Study for Healthy Aging were included. Muscle power was assessed with the 5-repetition sit-to-stand test and participants were classified into different groups of relative power (ie, normalized to body mass) according to sex-specific tertiles and their inability to perform the test. Mean follow-up periods for hospitalization and all-cause mortality were 3.3 and 6.3 years, respectively. Results Compared to the high relative muscle power group, men with low (HR [95% CI] = 2.1 [1.2–3.6]) and women with very low and low (HR [95% CI] = 4.7 [3.0–7.4] and 1.8 [1.2–2.7]) relative power had an increased age-adjusted risk of hospitalization. After adjusting for several covariates (age, physical activity, body mass index education, depression, comorbidities, disability, and handgrip strength), these effects were attenuated (men and women with very low relative power: HR [95% CI] = 1.6 [0.9–2.9] and 2.8 [1.6–4.9]). The very low relative muscle power group had also an increased all-cause mortality risk (age-adjusted) in both men and women (HR [95% CI] = 2.3 [1.4–3.9] and 2.9 [1.6–5.3]). After adjusting for all the covariates, a significantly increased mortality risk was observed only in men (HR [95% CI] = 2.1 [1.1–3.8]; women HR [95% CI] = 1.6 [0.8–3.2]), with very low levels of relative power. Conclusions Relative muscle power was independently and negatively associated with mortality and hospitalization in older adults. An augmented all-cause mortality risk was noted in the lowest group of relative muscle power.

This study compared the reliability and validity of different protocols evaluating the force-velocity (F-V) relationship and muscle power in older adults. Thirty-one older men and women (75.8±4.7 years) underwent two F-V tests by collecting the mean and peak force and velocity data exerted against increasing loads until one repetition maximum (1RM) was achieved in the leg press exercise. Two attempts per load were performed, with a third attempt when F-V points deviated from the linear F-V regression equation. Then, the subjects performed 2×3 repetitions at 60% 1RM to compare purely concentric and eccentric-concentric repetitions. The Short Physical Performance Battery was conducted to assess the validity of the different protocols. Significant differences were found in maximal power (Pmax) between mean and peak values and between protocols differing in the number of attempts per load (p3), was significantly more reliable (Pmax: CV=2.6%; ICC=0.99) than the other alternatives. Mean values were also observed to be more associated with physical function than peak values (R2=0.34 and 0.15, respectively; p

The assessment and treatment of low relative muscle power in older people has received little attention in the clinical setting when compared to sarcopenia. Our main goal was to assess the associations of low relative power and sarcopenia with other negative outcomes in older people. Methods: The participants were 1189 subjects (54% women; 65–101 years old) from the Toledo Study for Healthy Aging. Probable sarcopenia was defined as having low handgrip strength, while confirmed sarcopenia also included low appendicular skeletal muscle index (assessed by dual energy X-ray absorptiometry) (EWGSOP2’s definition). Low relative (i.e. normalized to body mass) muscle power was assessed with the 5-repetition sit-tostand power test (which uses an equation that converts sit-to-stand performance into mechanical power) and diagnosed in those subjects in the lowest sex-specific tertile. Low usual gait speed (UGS), frailty (according to Fried’s criteria and the Frailty Trait Scale), limitations in basic (BADL) and instrumental activities of daily living (IADL) and poor quality of life were also recorded. Results: Age-adjusted logistic regression analyses demonstrated that low relative muscle power was associated with low UGS (odds ratio (OR) = 1.9 and 2.5), frailty (OR = 3.9 and 4.7) and poor quality of life (OR = 1.8 and 1.9) in older men and women, respectively, and with limitations in BADL (OR = 1.6) and IADL (OR = 3.8) in older women (all p < 0.05). Confirmed sarcopenia was only associated with low UGS (OR = 2.5) and frailty (OR = 5.0) in older men, and with limitations in IADL in older women (OR = 4.3) (all p < 0.05). Conclusions: Low relative muscle power had a greater clinical relevance than low handgrip strength and confirmed sarcopenia among older people. An operational definition and algorithm for low relative muscle power case finding in daily clinical practice was presented.

Objectives To develop short versions of the Frailty Trait Scale (FTS) for use in clinical settings. Design Prospective population-based cohort study. Setting and Participants Data from 1634 participants from the Toledo Study for Healthy Aging. Methods The 12-item Frailty Trait Scale (FTS) reduction was performed based on an area under the curve (AUC) analysis adjusted by age, sex, and comorbidity. Items that maximized prognostic information for adverse events were selected. Each item score was done at the same time as the reduction, identifying the score that maximized the predictive ability for adverse events. For each short version of the FTS, cutoffs that optimized the prognostic information (sensitivity and specificity) were chosen, and their predictive value was later compared with a surrogate gold standard for frailty (the Fried Phenotype). Results Two short forms, the 5-item (FTS5) (range 0-50) and 3-item (FTS3) (range 0-30), were identified, both with AUCs for health adverse events similar to the 12-item FTS. The identified cutoffs were >25 for the FTS5 scale and >15 for the FTS3. The frailty prevalence with these cutoffs was 24% and 20% for the FTS5 and FTS3, respectively, whereas frailty according to Fried Phenotype (FP) reached 8% and prefrailty reached 41%. In general, the FTS5 showed better prognostic performance than the FP, especially with prefrail individuals, in whom the FTS5 form identified 65% of participants with an almost basal risk and 35% with a very high risk for mortality (OR: 4) and frailty (OR: 6.6-8.7), a high risk for hospitalization (OR: 1.9-2.1), and a moderate risk for disability (OR: 1.7) who could be considered frail. The FTS3 form had worse performance than the FTS5, showing 31% of false negatives between frail participants identified by FP with a high risk of adverse events. Conclusions and Implications The FTS5 is a short scale that is easy to administer and has a similar performance to the FTS, and it can be used in clinical settings for frailty diagnosis and evolution.

Chronic obstructive pulmonary disease (COPD) is characterized by persistent respiratory symptoms and airflow limitation. Apart from the ventilatory limitations, patients with COPD present an impaired exercise capacity that limits their ability to perform the activities of daily living and impacts negatively on their quality of life. Limb muscle dysfunction is a systemic consequence of COPD associated with exercise intolerance, poor quality of life and increased mortality. This COPD-related syndrome is characterized by reduced muscle cross-sectional area, strength and endurance, and is highly prevalent among COPD patients. Thus, pulmonary rehabilitation (PR) is recommended in order to combat the negative consequences of COPD on patients’ exercise capacity and quality of life. Exercise training is regarded as the cornerstone of PR and can be implemented at any stage of the disease. To date, the combination of resistance and endurance training (i.e. concurrent training) has demonstrated to be the most beneficial exercise intervention in COPD. Concurrent training provides clinically and statistically significant benefits in exercise tolerance and quality of life to patients with COPD. In addition, there are other potential adjuncts to exercise training and strategies to enhance the implementation of PR programs in COPD patients., La enfermedad pulmonar obstructiva crónica (EPOC) se caracteriza por la persistencia de síntomas respiratorios y limitación al flujo de aire. Además de las limitaciones ventilatorias, los pacientes con EPOC presentan una reducida capacidad para realizar ejercicio que limita su habilidad para realizar actividades de la vida diaria e impacta negativamente sobre su calidad de vida. La disfunción muscular de las extremidades es un síntoma sistémico consecuencia de la EPOC y está asociada con la intolerancia al ejercicio, la reducción de la calidad de vida y el aumento de la mortalidad. Este síndrome relacionado con la EPOC se caracteriza por la reducción del área de sección transversal del músculo esquelético, la fuerza y la resistencia, y es altamente prevalente entre los pacientes con EPOC. Así, la rehabilitación pulmonar (RP) está recomendada para combatir las consecuencias negativas de la EPOC sobre la capacidad para realizar ejercicio y la calidad de vida de los pacientes. El entrenamiento con ejercicio es considerado una pieza clave de la RP y puede implementarse en cualquier estadio de la enfermedad. Hasta la fecha, la combinación de entrenamiento de resistencia y fuerza (entrenamiento concurrente) ha demostrado ser la intervención con ejercicio más beneficiosa para la EPOC. El entrenamiento concurrente proporciona beneficios clínica y estadísticamente significativos con respecto a la tolerancia al ejercicio y calidad de vida de los pacientes con EPOC. Además, existen otras terapias y estrategias que potencialmente pueden complementar al entrenamiento con ejercicio para la mejora de la implementación de los programas de RP en pacientes con EPOC.

The aim was to establish whether a short supervised facility-based exercise program improved frailty, physical function and performance in comparison with usual care treatment.This was a quasi-experimental, non-randomized controlled intervention study in frail (2.75 ± 1.25 Frailty Phenotype criteria) older adults (range:77.2-95.8 years). The exercise (EX) group (n = 11) performed concurrent training (power training + high-intensity interval training, HIIT) twice weekly for 6 weeks while the control (CT) group (n = 9) followed usual care.The exercise intervention improved frailty status in 64% of the subjects improving Frailty Phenotype by 1.6 points (95%CI 0.8-2.5, p 0.05), and increasing SPPB score by 3.2 points (95%CI: 2.4-4.0, Cohen's d = 2.0, p 0.05), muscle power by 47% (95%CI: 7-87%, Cohen's d = 0.5, p 0.05), muscle strength by 34%(95%CI: 7-60, Cohen's d = 0.6, p 0.05) and the aerobic capacity by 19% (6 minute walking test +45 m, 95%CI: 7-83, Cohen's d = 0.7, p = 0.054). The CT did not experience any significant changes in frailty status, physical function or performance.A short concurrent exercise program of muscle power and walking-based HIIT training is a feasible and safe method to increase physical performance and improve function and frailty in elder (pre)frail patients.

Introduction Skeletal muscle power has been demonstrated to be a stronger predictor of functional limitations than any other physical capability. However, no validated alternatives exist to the usually expensive instruments and/or time-consuming methods to evaluate muscle power in older populations. Our aim was to validate an easily applicable procedure to assess muscle power in large cohort studies and the clinical setting and to assess its association with other age-related outcomes. Methods Forty community dwelling older adults (70–87 years) and 1804 older subjects (67–101 years) participating in the Toledo Study for Healthy Aging were included in this investigation. Sit-to-stand (STS) velocity and muscle power were calculated using the subject's body mass and height, chair height and the time needed to complete five STS repetitions, and compared with those obtained in the leg press exercise using a linear position transducer. In addition, STS performance, physical (gait speed) and cognitive function, sarcopenia (skeletal muscle index (SMI)) and health-related quality of life (HRQoL) were recorded to assess the association with the STS muscle power values. Results No significant differences were found between STS velocity and power values and those obtained from the leg press force-velocity measurements (mean difference ± 95% CI = 0.02 ± 0.05 m·s−1 and 6.9 ± 29.8 W, respectively) (both p > 0.05). STS muscle power was strongly associated with maximal muscle power registered in the leg press exercise (r = 0.72; p Conclusion The STS muscle power test proved to be a valid, and in general, a more clinically relevant tool to assess functional trajectory in older people compared to traditional STS time values. The low time, space and material requirements of the STS muscle power test, make this test an excellent choice for its application in large cohort studies and the clinical setting.

Introduction: The effects of replacing sedentary time with light or moderate- to vigorous-intensity physical activity on frailty are not well known. Aim: To examine the mutually independent associations of sedentary time (ST), light-intensity physical activity (LPA), and moderate- to vigorous-intensity physical activity (MVPA) with frailty status in older adults. Methods: A total of 628 people aged 65 years from the Toledo Study of Healthy Aging (TSHA) participated in this cross-sectional study. Frailty was measured using the Frailty Trait Scale. Hip-worn accelerometers were used to capture objective measurements of ST, LPA, and MVPA. Linear regression and isotemporal substitution analyses were used to examine associations of ST, LPA, and MVPA with frailty status. Analyses were also stratified by comorbidity. Results: In single and partition models, LPA and MVPA were negatively associated with frailty. Time in sedentary behavior was not associated with frailty in these models. In the isotemporal substitution models, replacing 30 minutes/d of ST with MVPA was associated with a decrease in frailty [b 2.460; 95% confidence interval (CI): 3.782, 1.139]. In contrast, replacing ST with LPA was not associated with favorable effects on this outcome. However, when the models were stratified by comorbidity, replacing ST with MVPA had the greatest effect on frailty in both the comorbidity (b 2.556; 95% CI: 4.451, 0.661) and the no comorbidity group (b 2.535; 95% CI: 4.343, 0.726). Moreover, the favorable effects of LPA in people with comorbidities was found when replacing 30 minutes/d of ST with LPA (b 0.568; 95% CI: 1.050, 0.086). Conclusions: Substituting ST with MVPA is associated with theoretical positive effects on frailty. People with comorbidity may also benefit from replacing ST with LPA, which may have important clinical implications in order to decrease the levels of physical frailty.

Introduction The actual mechanisms leading to a reduced muscle power and functional ability in older adults are poorly understood. We investigated the association between different force-velocity (F-V) profiles and impaired muscle power, physical and cognitive function, frailty, and health-related quality of life (HRQoL) in older people. Methods Physical function (habitual gait speed, timed up-and-go test, sit-to-stand and stair-climbing ability), cognitive function, HRQoL and frailty were evaluated in 31 older subjects (70–85 years). The F-V relationship and maximal muscle power (Pmax) were assessed in the leg press exercise. The skeletal muscle index (SMI) and fat index, moderate-to-vigorous physical activity (MVPA) and sedentary time were obtained from DXA scans and accelerometry, respectively. Results While some subjects showed a force deficit (FDEF), others presented a velocity deficit (VDEF), both leading to an impaired muscle power [Effect size (ES) = 1.30–1.44], and to a likely-very likely moderate harmful effect in their physical and cognitive function, HRQoL and frailty levels (except the VDEF group for cognitive function) [ES = 0.76–1.05]. Leg muscle mass and specific force were similarly associated with force at Pmax, while MVPA but not sedentary time was related to fat index, force at Pmax, and power values (all p Conclusion Older subjects exhibited different mechanisms (force vs. velocity deficits) leading to impaired muscle power. Both deficits were associated with a lower physical function and quality of life, and a higher frailty, whereas only a force deficit was associated with a lower cognitive function. Interventions aimed at reversing age- and/or disuse-related impairments of muscle power might evaluate the specific responsible mechanism and act accordingly.

The executive function is a complex set of skills affected during the aging process and translate into subclinical cerebrovascular disease. Postural instability or motor slowness are some clinical manifestations, being consubstantial with the frailty phenotype, genuine expression of aging. Executive dysfunction is also considered a predictor of adverse health events in the elderly. To study whether the executive dysfunction can be used as an early marker for frailty and the viability of use as a predictor of mortality, hospitalization and/or disability in a Mediterranean population. A population-based cohort study using data from the Toledo Study for Healthy Aging (TSHA). 1690 Spanish elders aged ≥65 years underwent a neuropsychological evaluation in order to measure executive function. To assess whether the accumulation of dysfunctions (in severity and amplitude) could increase the predictive value of adverse health events in relation to each dimension separately an executive dysfunction cumulative index was constructed. Cox proportional hazards model was used to examine mortality and hospitalization over 5.02 and 3.1 years of follow-up, respectively. Executive dysfunction is a powerful predictor of mortality, frailty and disability. Cumulative differences in executive function are associated with high risk of frailty and disability, thus, for each one point increment in the executive function index, the risk of death increased by 7 %, frailty by 13% and disability by 11% (P

This study compared the reliability and validity of different protocols evaluating the force-velocity (F-V) relationship and muscle power in older adults. Thirty-one older men and women (75.8 ± 4.7 years) underwent two F-V tests by collecting the mean and peak force and velocity data exerted against increasing loads until one repetition maximum (1RM) was achieved in the leg press exercise. Two attempts per load were performed, with a third attempt when F-V points deviated from the linear F-V regression equation. Then, the subjects performed 2 × 3 repetitions at 60 % 1RM to compare purely concentric and eccentric- concentric repetitions. The Short Physical Performance Battery was conducted to assess the validity of the different protocols. Significant differences were found in maximal power (Pmax) between mean and peak values and between protocols differing in the number of attempts per load (p < 0.01). Registering mean values, a third attempt, and multiple loads (>3), was significantly more reliable (Pmax: CV = 2.6 %; ICC = 0.99) than the other alternatives. Mean values were also observed to be more associated with physical function than peak values (R2 = 0.34 and 0.15, respectively; p < 0.05). No significant differences were observed between concentric and eccentric-concentric repetitions. Thus, collecting mean force and velocity values against multiple loads, while monitoring the linearity of the F-V relationship, seemed to be the more adequate procedure to assess the F-V profile and muscle power in older adults.

Aging is a process that involves a reduction in muscle strength and anabolic hormone concentrations, which impacts significantly on health.To study the hormone/total strength (H/TS) ratio as a proxy of anabolic insensitivity status in elders, and its relationship with disability, hospitalization, and mortality risk.A total of 1462 persons aged ≥65 years from the Toledo Study of Healthy Aging participated in this study. Serum concentrations of insulin like growth factor 1, total and free testosterone, dehydroepiandrosterone, dehydroepiandrosterone sulfate, and 17β-estradiol were measured. Total maximal voluntary isometric strength was obtained (handgrip, shoulder, hip, and knee) using standardized techniques and equipment. Physical activity was recorded by physical activity scale for the elderly questionnaire. Associations of the H/TS ratio with hospitalization and mortality were assessed using logistic regression models, and participants stratified into quartiles for each H/TS ratio.In women, all individual ratio H/TS models showed a strong to moderate increased risk for death and hospitalization. In men, all models revealed a significant positive association of the ratio H/TS with mortality rate but not for hospitalization (P .01). Participants who have 2 or more H/TS ratios in the worst quartile increased the risk of hospitalization and mortality at least by 2-fold.We demonstrate the main role that muscle function plays in the relationship between the hormonal status and hospitalization and mortality risk; this could be taken into consideration as a way to classify patients for hormonal therapy.