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Despite the introduction of a diagnostic code and acceptance of a diagnostic process for sarcopenia as a new health technology in Korea, many practitioners remain unfamiliar with the evaluation of sarcopenia. Thus, the Korean Working Group on Sarcopenia (KWGS) developed clinical practice guidelines for the diagnosis of sarcopenia in older Korean adults. A two-phase Delphi interview comprising 19 questions was conducted with 40 expert panelists, 22 of whom participated in the first round between June and August 2022. The second round of the Delphi interview included the remaining 11 questions that were not agreed upon in the first round. The screening process for sarcopenia includes various questionnaires and examinations used in different research and clinical settings. The diagnostic process for sarcopenia was simplified by combining the steps of case finding and assessment. The Short Physical Performance Battery test was given particular emphasis owing to its multifaceted nature. Regardless of muscle mass, having low muscle strength with low physical performance is considered clinically relevant and newly defined as “functional sarcopenia.” Comprehensive geriatric assessment is important for diagnosing sarcopenia. The KWGS’s clinical guideline aims to facilitate the early detection of sarcopenia by allowing various screening tools to be used in a unified process and reducing confusion about which tools to use for diagnosis. This recommendation expands the conceptual definition of sarcopenia as a complex pathophysiological state in line with the concept of frailty and aims to stimulate further research on the diagnosis and management of sarcopenia in clinical settings.

In recent years, we have faced challenges in managing coronavirus disease 2019 (COVID-19), especially in older adults. We have witnessed a crisis in geriatric care services, mining the possibility for older adults to maintain their capacities and abilities during the pandemic. Disruption of the routine management of chronic diseases, physical inactivity, deteriorating physical function and quality of life, malnutrition, and mental disorders have been suggested as major threats to the health of older adults.1 To address these problems and plan the reactivation of normal care activities, this article summarizes the contents of a webinar held by the Annals of Geriatric Medicine and Research (AGMR) regarding the future directions of geriatric medicine and research in the post-COVID-19 era.

Muscle aging ultimately leads to the deterioration of human physiological functioning, including declining muscle strength, loss of muscle mass, and decreased quality of life in advanced age. Eccentric exercise is a key intervention that has the potential to ameliorate this problem. Recent studies have focused on evidence-based exercise interventions to prevent declines in muscle strength and physical function in older adults. This paper reviewed relevant literature on the use of eccentric exercise to improve muscle and mobility function in older adults. We explained not only the changes in mobility that occur with aging but also the rationale for and positive effects of eccentric intervention in older adults. We also explored several proposed mechanisms for the intramuscular changes caused by eccentric muscle contraction and considered the safety and side effects accompanying eccentric training. We concluded by suggesting that eccentric exercise is an exercise modality that can potentially improve muscle strength and enhance mobility in older adults.

Background/aim Annals of Geriatric Medicine and Research held its inaugural international editorial board virtual meeting on September 16, 2021, to brainstorm ideas for sustainable growth. This special article summarizes the key concepts obtained from the webinar proceedings, with further development of ideas from ensuing discussions occurring after the meeting. Methods From the initial discussion points provided by eight editorial board members, including six presenters, email discussions further enriched these ideas to construct the current special article. The key points discussed were: 1) impactful research and impact factors, 2) international and Asian perspectives, and 3) challenges to sustainable growth. Results The editors noted the existing gap between the impact factor and research impact as a challenge for the growth paths of regional journals. However, they agreed that persevering with impactful research would ultimately translate into parallel and gradual gains in impact, which is, therefore, consistent with the organic growth of the journal. Acknowledging challenges in navigating between unique Asian perspectives and international outlooks, the editors encouraged academic journals to serve as bridges linking international evidence with the richness of local perspectives. For sustainable growth, the editors suggested that journals may be forged into the academic ecosystems of the region, diversify value streams, and establish themselves as reputable brands in disciplines. Conclusion By combining these discussions, we proposed the 'IMPACT' strategy for journals on the growth path in the region, which stands for 1) IMmersive user experience encompassing authors, reviewers, and readers; 2) Pasteur's quadrant use-inspired research; 3) Asia-Pacific context; 4) Collaborative; and 5) Translation to practice and policy.

Background Korea, as one of the fastest-aging countries worldwide, requires an improved healthcare service model for older adults. We evaluated the current healthcare system and developed a service model based on information and communication technologies (ICT) for use in older patients in long-term care facilities (LTCF). Methods We conducted a qualitative literature review, focus group interviews (FGIs), and structured survey to identify the current technology use and status of healthcare systems. We then developed a web-based platform with necessary, high-priority, and usable content for the care of older patients in LTCF. Results We reviewed 60 (23 hypertension, 18 diabetes, and 19 heart failure) articles on information and communication technologies (ICT)-based disease management for clinical effectiveness and improved patient satisfaction. FGIs and structured surveys were used to evaluate the inconvenience in patient and medical information transfer between hospitals and cost and time required for its process. Accordingly, we confirmed the unmet need for an ICT-based service model for management, monitoring, and consultation among older patients and developed the Health-RESPECT (integrated caRE Systems for elderly PatiEnts using iCT), a service platform for older patients residing in LTCF. The medical information exchange system was used to transfer medical information. Health-RESPECT includes an established algorithm for evidence-based comprehensive geriatric assessment and customized management; chronic disease management; management of potentially inappropriate medications; rehabilitation; and consultation and videoconferencing. Conclusion This study identified the current status and unmet needs of healthcare systems for older adults. We developed an ICT-based system to manage older institutionalized patients. However, the Health-RESPECT service model requires further validation.

A 78-year-old man presented with the aggravation of weakness in the lower extremities, gait disturbance, and cognitive impairment. He was diagnosed with sarcopenia, distal sensorimotor polyneuropathy, and Alzheimer’s disease. Low-grade chronic elevation of inflammatory markers was also revealed. We assumed that chronic low-grade inflammation with aging, also called “inflammaging,” contributed to the development of multiple comorbidities. After multidisciplinary treatment and comprehensive rehabilitation, he could ambulate again with minimal to moderate assistance. Various age-related disorders should be suspected when older patients present with chronic low-grade inflammation.

The advent of the fourth industrial revolution which combines the physical, digital, and biological spaces based on the information and communication technology (ICT) is changing the paradigm of the healthcare industry. As the concept of “aging-in-place” and wellness are attracting attention in super-aged society, smart care has been noticed as a core service for home healthcare. The effectiveness of remote medical services using smart devices has already been confirmed, and a hospital in the home may be recognized as another medical unit in the next 10 years. Though, prior to the expansion of home healthcare services, it is necessary to review the related considerations and response strategies to minimize potential risks. By means of appropriate utilization of biometric information from digital technologies and institutional supports, a human-centered home healthcare is expected to establish accurate, safe, and sustainable services in tandem with the fourth industrial revolution.

Background : Decline in physical performance has been established as a risk factor for mortality and disability in older adults. Although previous studies have reported the age-related changes in finger-tapping ability, no study has been published describing the prognostic implications of finger tap reaction time among community-dwelling older adults. Methods : A total of 433 participants (227 men and 206 women) aged over 65 years were enrolled in the Korean Longitudinal Study on Health and Aging. According to the finger tap reaction time, participants were divided into 2 groups: a fast-reaction group and a slow-reaction group. We analyzed the interaction between delay in motor speed measured using the finger-tapping task and 5-year poor functional outcome, defined as short physical performance battery (SPPB) scores of 9 or less or mortality, during the follow-up period. Results : A significant increase in the risk of poor functional outcome was observed in the slow-reaction group, compared with in the fast-reaction group, even after covariate adjustment using multiple logistic regression analysis (odds ratio, 2.21; 95% confidence interval, 1.37-3.58). Conclusion : We conclude that delayed finger tap reaction time is an independent prognostic factor for poor functional outcome in older adults.

Background : In at-risk older adults, gait speed is an important factor associated with quality of life and falling risk. In this study, we assessed whether therapeutic exercise could improve gait speed. Methods : We conducted a meta-analysis to evaluate the ‘best’ therapeutic exercise method by analyzing each exercise in terms of intensity, type, and several gait speed indices. For the analysis, we gathered 122 papers through a database search and selected 9 (n=627) that were appropriate for the meta-analysis. Results : In 8 of the 9 included papers, gait speed improved with therapeutic exercise. Usual gait speed (n=246) improved more than maximal gait speed (n=574). A resistance program was more effective than a nonresistance program for improving maximal, but not usual, gait speed. We also found that the effects of therapeutic exercise were greater in noncommunity than in community-dwelling elderly people. Conclusion : In conclusion, therapeutic exercise was effective in improving gait speed.

Falls and fall-related injuries are common amongst the elderly population and have deleterious effects on the quality of life or independence in daily living in the elderly. Falling is also associated with substantial morbidity, mortality, nursing home admission, and an increase in medical costs. Given that Korea has shown an extreme demographic shift with its population aging at the fastest pace among developed countries, assessment of fall risks and implementing intervention strategies to the high-risk population are getting more important. The guidelines for the prevention of falls were developed first by The Korean Association of Internal Medicine and The Korean Geriatric Society. These guidelines were developed by an adaptation process and the use of an evidence-based method; 4 guidelines were retrieved by systematic review and by the AGREE (appraisal of guidelines for research and evaluation) II process and 7 statements were made based on the grading of evidence, and these recommendations followed the GRADE (grades of recommendation, assessment, development, and evaluation) framework. Given that falls result from a various combination of many factors, the guidelines contain multidimensional assessment measures and multimodal strategies to prevent falls. These guidelines were developed not only for use by primary physicians but also for patients and the general population. Therefore, these guidelines provide detailed recommendations and concrete measures for the assessment of the risk of a fall and to prevent falls amongst the elderly population. Keywords: Accidental falls; Guidelines; Aged; Prevention Language: ko

Copyright©2015 Korean Geriatric Society This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/). ▸Received: June 14, 2015 ▸Revised: June 16, 2015 ▸Accepted: June 19, 2015 Address for correspondence: Jae-Young Lim, MD, PhD Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro 173 beon-gil, Bundang-gu, Seongnam 463-707, Korea Tel: +82-31-787-7732, Fax: +82-31-787-4051 E-mail: drlim1@snu.ac.kr 초고령 노인의 신체기능장애와 재활 전략

Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Department of Internal Medicine, Korea University College of Medicine, Seoul, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Department of Internal Medicine, Hallym University Kangnam Sacred Hospital, Seoul, Department of Internal Medicine, Inje University College of Medicine, Busan, Health and Exercise Science Laboratory, Institute of Sports Science, Department of Physical Education, Seoul National University, Seoul, Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Department of Family Medicine, Kyung Hee University College of Medicine, Seoul, Korea

Muscle cramps are defined as painful, spasmodic, involuntary skeletal muscle contractions during or immediately after physical exercise. Muscle cramps have a typical clinical presentation, as the definition and the diagnosis is made based on a typical history together with the findings on clinical examination. Muscle cramps are self-extinguishing within seconds to minutes or relieved by stretching, and is often accompanied by a palpable knotting of the muscle. Old adults are prone to get muscle cramps, which may occur in patients with diseases, but also occur often in healthy subjects with no history of nervous system or metabolic disorders. Comorbidity and multiple medications, including diuretics due to an underlying disease, can be a part of the reason in old adults. We reviewed articles regarding the etiology of muscle cramps and introduced a new hypothesis of ‘altered neuromuscular control’, which has been documented recently.

Shoulder pain is a common problem in the elderly, which can frequently lead to disabilities. Adhesive capsulitis, rotator cuff disease, and osteoarthritis are main causes of shoulder pain in the elderly. Because the use of the upper extremity is especially pertinent to maintain independence in the elderly, proper management of shoulder pain is crucial to preserve or restore functional independence by reducing the degree of pain as much as possible. Successful treatment of shoulder pain in the elderly depends on not only an accurate diagnosis of etiologies and appropriate treatments according to clinical characteristics, but also understanding that the mechanisms of developing those diseases were closely related to the degenerative changes with age.

Background: To investigate the physical function of elderly people in Korea using quantitative and objective tools and to assess the impact of declined physical function on their quality of life. Methods: The Korean Longitudinal Study on Health and Aging was designed as a population-based prospective cohort study on the health and aging of the elderly people in Korea aged 65 years and older. Within one city's central metro- politan area, 1,000 subjects including a simple random sample and an oldest-old subpopulation participated in a base- line study for one year. We evaluated the isokinetic peak torque of the knee extensors and flexors, grip force, and Short Physical Performance Battery (SPPB) and surveyed their daily physical activities and quality of life using the 36-Item Short Form Health Survey (SF-36). Results: Overall, 676 subjects completed the evaluations of physical function and activity. The isokinetic torque of the knee extensors and flexors declined with age in both men and women. The women in the old-old (75-84 years) group showed lower SPPB and physical activity than women in the young-old (65-74 years) group, but these measures were main- tained till age 85 in the men. SPPB and physical activity were significantly associated with the physical component scale (PCS) of the SF-36 in both men and women, while isokinetic torque was associated with PCS in women only. Conclusion: Physical performance and activity declined differently in Korean elderly men and women. Both these meas- ures showed to be the main factors associated with quality of life.

Methods: The study participants were community-dwelling elderly people aged 65 years or old as a population based sample of one large city. A total of 828 people 65 years or older participated in this study. They were interviewed over the telephone by a trained interviewer using a structured questionnaire to obtain a fall history and details of their most recent fall including date, time, place, circumstances, and associated injury. As for risk factors for falls, we asked about living arran- gement (with family or alone), alcohol intake, exercise, visual and hearing impairments, memory and sensory problems, lower limb weakness, and arthritis symptoms. Fear of falling and fear-related activity restriction were also evaluated. Results: The incidence of falls during the last one year was 13.0%. Women experienced falls more frequently. Falls occurred mainly in spring and summer and from 10 AM to 3 PM. Common causes of falls were slipping and tripping. 14.9% of those who fell suffered consequent fractures. Being female was a significant risk factor for falls; and females tended to get injured more severely following a fall. During the recent one year, decreased proprioception in the lower extremity was a significant risk factor for falls. Those with histories of falls, and especially women, tended to limit their activities due to the fear of falling. Conclusion: Overall, it appears that elderly women are more greatly affected by falls at several levels. Female partici- pants fell more frequently and suffered more severe consequences. Fall-related injuries and risk factors for falls dis- proportionately affected women. And, being female and any amount of decreased sensation in the feet were significant risk factors for falls.

Results: SPPB scores in women decreased more than that of men in those younger than 85 years, but this difference was not significant for those older than 85 years. ABC scores showed the same decreasing pattern, and sex difference continued in the oldest group. For pain related disabilities, a remarkable gender gap was identified. Hand and thigh strengths decreased with age, with the more prominent decrease seen in men than in women from the older age group. Although most variables correlated with the physical performance evaluated by the SPPB, only the ABC significantly influenced the SPPB after controlling for the covariates. Conclusion: Balance confidence in the specific activity plays a major role in physical performance and function.