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Objectives: To investigate possible differences in morbidity, malnutrition, sarcopenia and specific drug use in patients with hip fracture, ten years apart. To analyse 1-year mortality and possible associations with variables. Design: A prospective, observational study. Setting: Örebro University Hospital, Sweden. Participants: Two cohorts of patients with hip fracture, included in 2008 (n=78) and 2018 (n=76). Measurements: Presence of comorbidity according to the Elixhauser comorbidity measure, multimorbidity defined as ≥3 comorbidities, preoperative American Society of Anaesthesiologists Classification (ASA-class), malnutrition according to the definition by the Global Leadership Initiative on Malnutrition (GLIM), sarcopenia according to the most recently revised definition by the European Working Group on Sarcopenia in Older People (EWGSOP), polypharmacy defined as ≥5 prescribed medications, use of Potentially Inappropriate Medications (PIM) and Fall-Risk-Increasing-Drugs (FRID) and postoperative 1-year mortality. Results: When comparing the cohorts, significant increases over time was seen for mean comorbidity-count (Difference −1; p=0.002), multimorbidity (Difference −15%; 95%CI −27;−2), ASA-class 3–4 (Difference −25%; 95%CI −39;−9) and polypharmacy (Difference −17%; 95%CI −32;−2). Prevalence of malnutrition and sarcopenia coherently decreased with 22% (95%CI 5;37) and 14% (95%CI 1;29) respectively. One-year mortality remained unchanged and a significant association was found for a higher ASA-class in 2008 (OR 3.5, 95%CI 1.1;11.6) when adjusted for age. Results on PIM exposure suggest a decrease while exposure to FRID remained high. Conclusion: Our findings support an increasing morbidity within the population over time. However, also presented is a coherent decrease in malnutrition and sarcopenia, suggesting a decrease in frailty as a possible explanation for the observed unaltered mortality, in turn suggesting advances in treatment of comorbidities. [ABSTRACT FROM AUTHOR]

Objectives: There is a lack of detailed information on dietary intake in elderly people at an individual level, which is crucial for improvement of nutritional support. The aim of this study was to investigate the dietary intake in elderly people in two types of living situations. Design: Observational study, analysing prospective data. Setting: The dietary intake was studied in elderly people living at home or in nursing home, in different cities of Sweden. Participants: A total of 264 elderly people (mean age 84) participated in the observational study. Measurements: Dietary intake was measured using weighed food records and food diaries, comparing females and males. The observed dietary intake was related to Recommended intake and Lower intake level. Results: All dietary intake and patient characteristic variables showed large individual differences (ranges). We found no significant differences (p>0.05) between those living at home and nursing home residents regarding the average intake of energy, protein and water when expressed as total intake per kg of body weight. A very low daily intake of energy (<20 kcal/kg body weight/day) was observed in 16% of the participants. For vitamin D and iron, 19% and 15%, respectively, had intakes below the Lower intake level. There was no correlation between intake of energy, protein or water and resident characteristics such as age, autonomy, morbidity, nutritional state or cognition. Conclusions: The large individual differences (ranges) in energy, nutrients and water show that the use of mean values when analysing dietary intake data from elderly people is misleading. From a clinical perspective it is more important to consider the individual intake of energy, nutrients and water. Ageism is intrinsic in the realm of 'averageology'. [ABSTRACT FROM AUTHOR]

BACKGROUND AND AIMS: Frail elderly people often suffer from a combination of unintentional weight loss and/or low body mass index, as well as a low physical activity level. No studies have investigated the effect of physical training alone or in combination with nutritional intervention on aerobic capacity in frail elderly people. The aim of this pilot study was to determine if a physical training program can affect aerobic capacity in frail elderly people. METHODS: Ninety-six community-dwelling frail elderly people (58 women) were included in the study. Subjects were randomized to four different groups: i) physical training program (aerobic, muscle strength, balance), ii) a nutritional intervention program (individually targeted advice and group sessions), iii) a combination of these interventions, and iv) a control group. At baseline, subjects were screened for aerobic capacity, leg muscle strength, spirometry, heart disease and cardiovascular drugs. Aerobic capacity and leg muscle strength were analyzed immediately after the 3-month intervention period (1st follow-up), and after another 6 months (2nd follow-up). RESULTS: Subjects mean age was 83 years. The mean compliance rate with the physical training program was 65%. There were no observed effects on aerobic capacity measured as maximal workload, or work time, with or without beta-receptor blockade. Subjects in the training groups without lung disease significantly increased maximal work time when compared with subjects with lung disease. Physical training significantly increased lower extremity muscle strength compared with nutrition alone at the 1st follow-up. No serious adverse events occurred during assessment or physical training. CONCLUSIONS: Further studies with larger sample sizes and a more specific aerobic component in the training program are necessary before any further conclusions can be drawn. [ABSTRACT FROM AUTHOR]

BACKGROUND AND AIMS: There is a great need to evaluate renal function regularly in elderly people. This study aimed at analyzing renal function in stable, community-dwelling elderly people of 75 years and over, to compare measured and predicted glomerular filtration rates (GFR) and to develop an accurate prediction equation for this age group. METHODS: Forty-five ambulatory elderly people in stable health in ordinary living were randomly selected into four age-classes, aged 75-95. Demographic data, personal activities of daily living, continuous drug prescriptions, body composition, blood pressure and blood chemistry were analysed. GFR was measured as Iohexol clearance based on three timepoints 3, 4 and 7 hours after Iohexol injection. RESULTS: Mean GFR was well preserved in all four ageclasses. The GFR range was 18-83 mL/min and declined with age. The Cockcroft-Gault prediction equation systematically underestimated measured GFR. A new 'GFRA' prediction equation is presented, based on the inverse of serum cystatin C and independent of gender, body surface area, body weight, lean body mass or serum creatinine. The proposed equation underestimated measured GFR with a mean of only 0.1 mL/min, had better precision compared with the Cockcroft-Gault equation, and was evaluated by the method of cross-validation. CONCLUSIONS: GFR exhibits extensive heterogeneity in frail, communitydwelling elderly people. The proposed GFRA was clearly more precise than the Cockcroft-Gault prediction equation in the study group. However, it needs to be validated in a larger population of elderly subjects, including more individuals in stable health with substantially reduced renal function in whom GFR is measured by a reference method with adequate sampling time. [ABSTRACT FROM AUTHOR]

BACKGROUND AND AIMS: There are few studies published that combine the interventions of physical training and nutrition. The aim of the present study was to describe the impact of a physical and nutritional intervention program for frail community- dwelling elderly people over the age of 75. METHODS: Ninety-six community-dwelling elderly people (58 women) were randomized to four different groups: i) a physical training program (aerobic, muscle strength, balance), ii) a nutritional intervention program (individually targeted advice and group sessions), iii) a combination of these interventions, and iv) a control group. At baseline subjects were screened for physical performance such as muscle strength, balance, mobility and activities of daily living, as well as nutritional aspects such as energy intake, body weight and fat-free mass. These measurements were repeated immediately after the intervention, which lasted for 12 weeks, and after another 6 months. RESULTS: The intention-to-treat analysis indicated significant improvements in lower- extremity muscle strength in both training groups compared with the nutrition group at 1st follow-up. There were small significant changes for some of the balance measurements in the training group without nutrition treatment. The nutrition intervention did not show any significant results. CONCLUSIONS: This study shows the positive effect on lower-extremity muscle strength directly after the intervention. Balance training most probably needs to be more individualized in order to be effective for frail elderly people. Further studies are needed, with larger sample sizes, to investigate the effects of these types of interventions before any further conclusions can be drawn. [ABSTRACT FROM AUTHOR]