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Background and aims To assess experts’ preference for sarcopenia outcomes. Methods A discrete-choice experiment was conducted among 37 experts (medical doctors and researchers) from different countries around the world. In the survey, they were repetitively asked to choose which one of two hypothetical patients suffering from sarcopenia deserves the most a treatment. The two hypothetical patients differed in five pre-selected sarcopenia outcomes: quality of life, mobility, domestic activities, fatigue and falls. A mixed logit panel model was used to estimate the relative importance of each attribute. Results All sarcopenia outcomes were shown to be significant, and thus, important for experts. Overall, the most important sarcopenia outcome was falls (27%) followed by domestic activities and mobility (24%), quality of life (15%) and fatigue (10%). Discussion and conclusion Compared to patient’s preferences, experts considered falls as a more important outcome of sarcopenia, while the outcomes fatigue and difficulties in domestic activities were considered as less important.

Frailty is a multidimensional geriatric syndrome characterized by the loss of the individual reserve capacity and increased vulnerability to internal and external stressors. Frailty in older adults is associated with an increased risk for falls and loss of autonomy as well as an increased mortality. The identification of patients who suffer from frailty can trigger a comprehensive geriatric assessment and justify targeted treatment options. Furthermore, by the detection of frailty each patient with an increased risk of an unfavorable treatment outcome can be identified. There are a confusing number of instruments available for the detection of frailty but only a limited number of these instruments are available in a German version. The choice of an appropriate instrument is largely dependent on the clinical setting and the available resources.Frailty ist ein multidimensionales geriatrisches Syndrom, das durch einen Verlust an individueller Reservekapazität und eine erhöhte Vulnerabilität gegenüber internen und externen Stressoren gekennzeichnet ist. Frailty ist mit einem erhöhten Risiko für Stürze und einen Autonomieverlust sowie mit einer erhöhten Mortalität verbunden. Die Identifikation von Personen, die eine Frailty aufweisen, kann ein umfangreiches geriatrisches Assessment triggern und gezielte Therapieangebote begründen. Darüber hinaus können durch die Erfassung von Frailty jene Patient*innen identifiziert werden, die ein erhöhtes Risiko für ungünstige Behandlungsverläufe haben. Für die Erfassung von Frailty gibt es eine unübersichtliche Zahl an Instrumenten, wobei nur eine eingeschränkte Auswahl dieser Instrumente in einer deutschen Version vorliegt. Die Wahl des Instruments sollte sich am klinischen Setting und den vorhandenen Ressourcen orientieren.

The obesity epidemic has reached old age in most industrialized countries, but trials elucidating the benefits and risks of weight reduction in older adults above 70 years of age with obesity remain scarce. While some findings demonstrate a reduced risk of mortality and other negative health outcomes in older individuals with overweight and mild obesity (i.e. body mass index (BMI) 27 kg/m2), especially when combined with exercise. However, in this age group weight reduction is usually associated with a reduction of muscle mass and bone mineral density. Since uncertainty persists as to which level overweight or obesity might be tolerable (or even beneficial) for older persons, current recommendations are to consider weight reducing diets only for older persons that are obese (BMI ≥ 30 kg/m2) and have weight-related health problems. Precise treatment modalities (e.g. appropriate level of caloric restriction and indicated dietary composition, such as specific dietary patterns or optimal protein content) as well as the most effective and safest way of adding exercise are still under research. Moreover, the long-term effects of weight-reducing interventions in older individuals remain to be clarified, and dietary concepts that work for older adults who are unable or unwilling to exercise are required. In conclusion, further research is needed to elucidate which interventions are effective in reducing obesity-related health risks in older adults without causing relevant harm in this vulnerable population.

Background In 2016, an expert working group was convened under the auspices of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) and formulated consensus recommendations for the conduct of clinical trials for drugs to prevent or treat sarcopenia. Aims The objective of the current paper is to provide a 2020 update of the previous recommendations in accordance with the evidence that has become available since our original recommendations. Methods This paper is based on literature reviews performed by members of the ESCEO working group and followed up with face to face meetings organized for the whole group to make amendments and discuss further recommendations. Results The randomized placebo-controlled double-blind parallel-arm drug clinical trials should be the design of choice for both phase II and III trials. Treatment and follow-up should run at least 6 months for phase II and 12 months for phase III trials. Overall physical activity, nutrition, co-prescriptions and comorbidity should be recorded. Participants in these trials should be at least 70-years-old and present with a combination of low muscle strength and low physical performance. Severely malnourished individuals, as well as bedridden patients, patients with extremely limited mobility or individuals with physical limitations clearly attributable to the direct effect of a specific disease, should be excluded. Multiple outcomes are proposed for phase II trials, including, as example, physical performance, muscle strength and mass, muscle metabolism and muscle-bone interaction. For phase III trials, we recommend a co-primary endpoint of a measure of functional performance and a Patient Reported Outcome Measure. Conclusion The working group has formulated consensus recommendations on specific aspects of trial design, and in doing so hopes to contribute to an improvement of the methodological robustness and comparability of clinical trials. Standardization of designs and outcomes would advance the field by allowing better comparison across studies, including performing individual patient-data meta-analyses, and different pro-myogenic therapies.

Trotz der zunehmend positiven Evidenz bezuglich der Mortalitat fur die unfallchirurgisch-geriatrische Zusammenarbeit im Rahmen eines Zentrums fur Alterstraumatologie (ZAT) sind Auswirkungen auf den Verlauf nach der akutstationaren Krankenhausbehandlung noch unzureichend untersucht. Uber 75-jahrige Patienten, die einer Rehabilitation im Anschluss an die akutstationare Behandlung bedurften, wurden vor (retrospektiv, n = 90) und nach (prospektiv, n = 99) Einfuhrung eines zertifizierten ZAT untersucht. Hier interessierten v. a. die Entlassungshaufigkeit in eine indikationsspezifische und geriatrische Rehabilitation, die motorische Funktion (u. a. Five Chair Rising Test, Short Physical Performance Battery [SPPB]) und die Alltagskompetenz (Barthel-Index [BI]). Vor Einfuhrung des ZAT konnten 6,7 % (95 %-Konfidenzintervall [95 %-KI]: 1–12 %) und nach Einfuhrung des ZAT 17,2 % (95 %-KI: 10–25 %; p

ZusammenfassungIm Rahmen der demographischen Entwicklung in Deutschland nimmt die Zahl der Personen, welche einen Schlaganfall erleiden, stetig zu. Überlebende eines Schlaganfalls haben im Vergleich zur altersgleichen Bevölkerung ein erhöhtes Risiko, eine Fragilitätsfraktur zu erleiden. Für Personen über 65 Jahre mit Schlaganfall wurde eine Inzidenz von 33,6 Frakturen pro 1000 Personenjahre berechnet im Vergleich zu 21,4 pro 1000 Personenjahre in der altersgleichen Bevölkerung. Ursachen sind hier die erhöhte Sturzneigung sowie eine Verminderung der Knochendichte auf der paretischen Seite. Das Risiko für eine sturzbedingte Fraktur ist dabei abhängig von der wiedererlangten Selbständigkeit. Personen mit anhaltendem Pflegebedarf weisen daher ein deutlich erhöhtes Frakturrisiko auf. In Ermangelung einer ausreichenden spezifischen Evidenz für diese Risikogruppe sollten die Empfehlungen zur Sturzprävention für ambulant lebende Menschen berücksichtigt werden. Hier ist insbesondere ein Gleichgewichtstraining in Kombination mit einem Krafttraining anzuraten. Die Indikation zu einer Basisdiagnostik nach DVO Leitlinie sollte unter besonderer Berücksichtigung des Sturzrisikos überprüft werden. Bei Personen mit einer residuellen Hemiparese sollte die DXA Messung auf der paretischen Seite erfolgen.

The obesity pandemic has reached old age but the effect of obesity on functional recovery in geriatric rehabilitation patients has not been investigated to date. In this prospective cohort study, patients admitted into geriatric rehabilitation were consecutively included between September 2015 and September 2016, aged ≥70 years. Individual activities of daily living were documented by the Barthel index (BI, 0–100 points). Obesity was assessed by the measurement of body mass index (BMI, kg/m²), waist circumference (WC, cm) and percentage of body fat mass (%FM) based on triceps’ skinfold thickness at admission (t1), discharge (t2) and six months after discharge (t3). A total of 122 patients were included in the analysis. Prevalence of obesity according to BMI, WC and %FM was 33.6%, 83.6% and 71.3% respectively. Patients with a high WC and patients with a high BMI had lower BI values at t1, t2, t3 and the improvement in BI (t1–t2, t2–t3) was lower than in those with low WC and low BMI, but without statistical significance. In multiple regression analysis, BMI, WC and %FM were not associated with BI at t3 and improvement of BI (t2–t3). Obesity was highly prevalent in geriatric rehabilitation patients, but it was not associated with BI during the 6-month follow-up.

It is well recognized that poor muscle function and poor physical performance are strong predictors of clinically relevant adverse events in older people. Given the large number of approaches to measure muscle function and physical performance, clinicians often struggle to choose a tool that is appropriate and validated for the population of older people they deal with. In this paper, an overview of different methods available and applicable in clinical settings is proposed. This paper is based on literature reviews performed by members of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) working group on frailty and sarcopenia. Face-to-face meetings were organized afterwards where the whole group could amend and discuss the recommendations further. Several characteristics should be considered when choosing a tool: (1) purpose of the assessment (intervention, screening, diagnosis); (2) patient characteristics (population, settings, functional ability, etc.); (3) psychometric properties of the tool (test–retest reliability, inter-rater reliability, responsiveness, floor and ceiling effects, etc.); (4) applicability of the tool in clinical settings (overall cost, time required for the examination, level of training, equipment, patient acceptance, etc.); (5) prognostic reliability for relevant clinical outcomes. Based on these criteria and the available evidence, the expert group advises the use of grip strength to measure muscle strength and the use of 4-m gait speed or the Short Physical Performance Battery test to measure physical performance in daily practice. The tools proposed are relevant for the assessment of muscle weakness and physical performance. Subjects with low values should receive additional diagnostic workups to achieve a full diagnosis of the underlying condition responsible (sarcopenia, frailty or other).

Objectives To describe life-space mobility and identify its determinants in older persons with cognitive impairment after discharge from geriatric rehabilitation. Methods A cross-sectional study in older community-dwelling persons with mild to moderate cognitive impairment (Mini-Mental State Examination, MMSE: 17–26) following geriatric rehabilitation was conducted. Life-space mobility (LSM) was evaluated by the Life-Space Assessment in Persons with Cognitive Impairment (LSA-CI). Bivariate analyses and multivariate regression analyses were used to investigate associations between LSM and physical, cognitive, psychosocial, environmental, financial and demographic characteristics, and physical activity behavior. Results LSM in 118 older, multimorbid participants (age: 82.3 ± 6.0 years) with cognitive impairment (MMSE score: 23.3 ± 2.4 points) was substantially limited, depending on availability of personal support and equipment. More than 30% of participants were confined to the neighborhood and half of all patients could not leave the bedroom without equipment or assistance. Motor performance, social activities, physical activity, and gender were identified as independent determinants of LSM and explained 42.4% (adjusted R²) of the LSA-CI variance in the regression model. Conclusion The study documents the highly restricted LSM in older persons with CI following geriatric rehabilitation. The identified modifiable determinants of LSM show potential for future interventions to increase LSM in such a vulnerable population at high risk for restrictions in LSM by targeting motor performance, social activities, and physical activity. A gender-specific approach may help to address more advanced restrictions in women.

When treating older adults, a main factor to consider is physical frailty. Because specific assessments in clinical trials are frequently lacking, critical appraisal of treatment evidence with respect to functional status is challenging. Our aim was to identify and categorize assessments for functional status given in clinical trials in older adults to allow for a retrospective characterization and indirect comparison of treatment evidence from these cohorts. We conducted 4 separate systematic reviews of randomized and nonrandomized controlled clinical trials in older people with hypertension, diabetes, depression, and dementia. All assessments identified that reflected functional status were analyzed. Assessments were categorized across 4 different functional status levels. These levels span from functionally not impaired, slightly impaired, significantly impaired, to severely impaired/disabled. If available from the literature, cut-offs for these 4 functioning levels were extracted. If not, or if the existing cut-offs did not match the predefined functional levels, cut-off points were defined by an expert group composed of geriatricians, pharmacists, pharmacologists, neurologists, psychiatrists, and epidemiologists using a patient-centered approach. We identified 51 instruments that included measures of functional status. Although some of the assessments had clearly defined cut-offs across our predefined categories, many others did not. In most cases, no cut-offs existed for slightly impaired or severely impaired older adults. Missing cut-offs or values to adjust were determined by the expert group and are presented as described. The functional status assessments that were identified and operationalized across 4 functional levels could now be used for a retrospective characterization of functional status in randomized controlled trials and observational studies. Allocated categories only serve as approximations and should be validated head-to-head in future studies. Moreover, as general standard, upcoming studies involving older adults should include and explicitly report functional impairment as a baseline characteristic of all participants enrolled.

Background: Following a timely update process, the nutrition societies of Germany, Austria, and Switzerland (D-A-CH) revised the reference values for the intake of protein in 2017. The Working Group conducted a structured literature search in PubMed considering newly published papers (2000– 2017). Summary: For infants < 4 months, the estimated values were set based on the protein intake via breast milk. Reference values for infants > 4 months, children, adolescents, pregnant, and lactating women were calculated using the factorial method considering both requirement for growth and maintenance. For adults, reference values were derived from nitrogen balance studies; for seniors (> 65 years), reports on metabolic and functional parameters under various protein intakes were additionally considered. Reference ­values (g protein/kg body weight per day) were set as follows: infants < 4 months: 2.5–1.4, children: 1.3–0.8, adults < 65 years: 0.8, adults > 65 years: 1.0. Key Messages: The reference values for infants, children, adolescents, and adults < 65 years are essentially unchanged compared to recently published values. Scientifically reliable data published between 2000 and 2017 guided the D-A-CH Working Group to set a higher estimated value for adults > 65 years. Since the energy consumption continuously decreases with age, this new estimated protein intake value might be a challenge for the introduction of food-based nutrition concepts for older people.

A version of the Life-Space Assessment in persons with cognitive impairment (LSA-CI) has recently been developed. To establish a cut-off value for the newly developed Life-Space Assessment in persons with cognitive impairment (LSA-CI). In a cross-sectional study including 118 multimorbid, older persons with cognitive impairment, life-space mobility (LSM) was documented by the LSA-CI. The analysis was rationalized by Global Positioning System (GPS)-based measures of spatial distance from home. A receiver-operating characteristic (ROC) curve was created and the cut-off point for the LSA-CI was identified with the Youden’s Index. ROC curve analysis indicated a critical value of 26.75 (within a range of 0–90) to differentiate between low and high LSM with a sensitivity of 78.1% and specificity of 84.2%. Diagnostic interpretation of the ROC curves revealed that low and high LSM groups can be differentiated with the proposed cut-off. The proposed LSA-CI cut-off score can be recommended to tailor clinical interventions and evaluate change over time.

BackgroundSelf-reported life-space assessment methods so far focus on community-dwelling persons, with a lack of validated assessment methods for institutionalized settings. This study evaluated construct validity, test-retest reliability, sensitivity to change, and feasibility of a new Life-Space Assessment for Institutionalized Settings (LSA-IS) in geriatric patients.MethodsPsychometric properties of the LSA-IS in 119 hospitalized geriatric patients (83.0 ± 6.2 years) with and without cognitive impairment (CI) [Mini-Mental State Examination: 22.4 ± 4.9 scores] were evaluated within a comprehensive validation design. For the total group and subgroups according to cognitive status, construct validity was assessed by calculating Spearman’s rank correlation coefficients (rho) with established construct variables, test–retest reliability by intra-class correlation coefficients (ICCs), sensitivity to change by standardized response means (SRMs) calculated for effects of early ward-based rehabilitation during hospital stay.ResultsThe LSA-IS (total score) demonstrated good test–retest reliability (ICC = .704), and large sensitivity to change (SRM = .806), while construct validity was small to high indicated by significant correlations of the LSA-IS to construct variables (rho = .208–716), depending on relative construct association. On average results of LSA-IS sub-scores confirmed results of the total score. Subgroups according to cognitive status did not differ for most analyzed variables. A completion rate of 100% and a completion time of 3.2 ± 1.2 min documented excellent feasibility.ConclusionsThe interview-based LSA-IS has proven to be valid, reliable, sensitive, and feasible in hospitalized, multi-morbid, geriatric patients with and without CI documenting good psychometric properties for institutionalized settings.Trial registrationDRKS00016028

Bathing robots have the potential to foster the independence of older adults who require assistance with bathing. Making human-robot interaction (HRI) for older persons as easy, effective, and user-satisfying as possible is, however, a major challenge in the development of such robots. The study aimed to evaluate the effectiveness (coverage, step effectiveness) and user satisfaction (After-Scenario Questionnaire, ASQ) with three operation modes (autonomous operation, shared control, tele-manipulation) for the HRI with a bathing robot in potential users. Twenty-five older adults who require bathing assistance tested these operation modes in a water rinsing task for the upper back. Autonomous operation led to maximum effectiveness (100%), which was significantly worse in the shared control (51.6-79.4%

This study aimed to identify determinants of quantitative dimensions of physical activity (PA, duration, frequency, and intensity) in community-dwelling, multi-morbid, older persons with cognitive impairment (CI). In addition, qualitative and quantitative aspects of habitual PA have been described. Quantitative PA and qualitative gait characteristics while walking straight and while walking turns were documented by a validated, sensor-based activity monitor. Univariate and multiple linear regression analyses were performed to delineate associations of quantitative PA dimensions with qualitative characteristics of gait performance and further potential influencing factors (motor capacity measures, demographic, and health-related parameters). In 94 multi-morbid, older adults (82.3 &plusmn, 5.9 years) with CI (Mini-Mental State Examination score: 23.3 &plusmn, 2.4), analyses of quantitative and qualitative PA documented highly inactive behavior (89.6% inactivity) and a high incidence of gait deficits, respectively. The multiple regression models (adjusted R&sup2, = 0.395&ndash, 0.679, all p &lt, 0.001) identified specific qualitative gait characteristics as independent determinants for all quantitative PA dimensions, whereas motor capacity was an independent determinant only for the PA dimension duration. Demographic and health-related parameters were not identified as independent determinants. High associations between innovative, qualitative, and established, quantitative PA performances may suggest gait quality as a potential target to increase quantity of PA in multi-morbid, older persons.

Zusammenfassung Aufgrund des demographischen Wandels steigt die Zahl hochbetagter, multimorbider Menschen mit Rehabilitationsbedarf und -potenzial. Dieser Entwicklung wurde bereits in den 90er Jahren durch die Unterstützung der geriatrischen Rehabilitation begegnet. Mit ihren diversen Ausgestaltungen hilft diese, die rehabilitativen Bedarfe älterer Menschen in den verschiedenen Versorgungssektoren abzudecken. Dabei erfolgt die gut etablierte und wissenschaftlich fundierte stationäre geriatrische Rehabilitation häufig nach einem akutstationären Aufenthalt. Demgegenüber unterstützt die ambulante und mobile geriatrische Rehabilitation die Versorgung im prä- und poststationären Sektor. Aktuelle Zahlen belegen die Entwicklungsdynamik in diesem Bereich. Der derzeitige Entwicklungsfokus liegt auf der Optimierung präventiver und rehabilitativer Maßnahmen im ambulanten Bereich sowie im stationären Pflegebereich. Unterstützt wird dies durch zahlreiche Innovationsfonds-Projekte des G-BA und durch eine europaweite Zusammenarbeit. Zudem gilt es Gesetze zur Stärkung der Teilhabe älterer Menschen besser umzusetzen.

Body-fixed sensor (BFS) technology offers portable, low-cost and easy-to-use alternatives to laboratory-bound equipment for analyzing an individual&rsquo, s gait. Psychometric properties of single BFS systems for gait analysis in older adults who require a rollator for walking are, however, unknown. The study&rsquo, s aim was to evaluate the concurrent validity, test-retest-reliability, and sensitivity to change of a BFS (DynaPort MoveTest, McRoberts B.V., The Hague, The Netherlands) for measuring gait parameters during rollator-assisted walking. Fifty-eight acutely hospitalized older patients equipped with the BFS at the lower back completed a 10 m walkway using a rollator. Concurrent validity was assessed against the Mobility Lab (APDM Inc., Portland, OR, USA), test-retest reliability over two trials within a 15 min period, and sensitivity to change in patients with improved, stable and worsened 4 m usual gait speed over hospital stay. Bland&ndash, Altman plots and intraclass correlation coefficients (ICC) for gait speed, cadence, step length, step time, and walk ratio indicate good to excellent agreement between the BFS and the Mobility Lab (ICC2,1 = 0.87&ndash, 0.99) and the repeated trials (ICC2,1 = 0.83&ndash, 0.92). Moderate to large standardized response means were observed in improved (gait speed, cadence, step length, walk ratio: 0.62&ndash, 0.99) and worsened patients (gait speed, cadence, step time: &minus, 0.52 to &minus, 0.85), while those in stable patients were trivial to small (all gait parameters: &minus, 0.04&ndash, 0.40). The BFS appears to be a valid, reliable and sensitive instrument for measuring spatio-temporal gait parameters during rollator-assisted walking in geriatric patients.

ZusammenfassungDie Diabetesprävalenz liegt in der Altersgruppe ab 80 Jahren bei über 30 %. Bei der Diagnostik und Therapie älterer Menschen mit Typ-1- und Typ-2 Diabetes müssen altersspezifische Besonderheiten wie funktionelle und kognitive Einschränkungen sowie Komorbiditäten und Aspekte der Polypharmazie in besonderem Maße berücksichtigt werden. Die S2k-Leitlinie der Deutschen Diabetes Gesellschaft wurde mit 6 weiteren Fachgesellschaften (Deutsche Gesellschaft für Kardiologie, Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin, Deutsche Gesellschaft für Geriatrie, Deutsche Gesellschaft für Ernährungsmedizin, Deutsche Gesellschaft für Pflegewissenschaft, Deutsche Gesellschaft für Palliativmedizin) und der Patientenvertretung (DBW) erarbeitet. Therapieziele wie Erhalt der Lebensqualität und strikte Vermeidung von Akutkomplikationen wie schwere Hypoglykämien treten in den Vordergrund. HbA1c-Ziele sollten gemeinsam mit den Patienten in Abhängigkeit der individuellen Wünsche und Fähigkeiten festgelegt werden. Altersspezifische Besonderheiten einzelner Medikamente müssen insbesondere im Kontext der Multimorbidität beachtet werden. In der Leitlinie werden pflegerische Aspekte, Schnittstellenmanagement, Schmerztherapie sowie häufige Komorbiditäten bei Diabetes wie Hypertonie, Frailty, Sarkopenie, Demenz, Depression, End-of-Life Situationen ausführlich dargestellt.

In Kliniken fur Geriatrie wird eine grose Zahl von akut erkrankten Patienten mit kognitiver Einschrankung behandelt. Seit 1990 bestehen in Deutschland geriatrische Einrichtungen mit Spezialstationen fur diese Patientengruppe. Eine erste Bestandsaufnahme war 2010 erfolgt, jedoch nicht im Rahmen einer nationalen Umfrage. Bundesweite strukturierte Erfassung von Spezialbereichen fur Patienten mit kognitiver Beeintrachtigung in geriatrischen Einrichtungen. Mit einem Online-Fragebogen (SurveyMonkey®, San Mateo, CA, USA) wurden alle Weiterbildungsbefugten des Faches Geriatrie mit einer Weiterbildungsermachtigung von mindestens 12 Monaten befragt. Bundesweit wurden 495 geriatrische Einrichtungen angeschrieben, von denen 161 (32,5 %) antworteten. Weitere 13 Einrichtungen antworteten uber einen Weblink, der in einem Newsletter der Deutschen Gesellschaft fur Geriatrie (DGG) versandt wurde. Im Jahr 2017 waren 42 Spezialstationen mit einer Grose von durchschnittlich 13,5 ± 4,7 Betten in Betrieb. Funfzehn weitere Einrichtungen planten die zeitnahe Eroffnung eines Spezialbereiches, davon 5 im Jahr 2018. Vier Spezialbereiche wurden wieder aufgelost. Alle Spezialbereiche wiesen architektonische, strukturelle und personelle Besonderheiten auf, die den Empfehlungen des Positionspapiers der DGG entsprechen. Vereinzelte Evaluationen weisen auf positive Effekte bezuglich Mobilitat und Verhaltensauffalligkeiten hin. Es zeigt sich eine Zunahme an Neueroffnungen von Spezialbereichen in den letzten Jahren. Eine methodisch optimierte Evaluation hinsichtlich des klinischen Verlaufs der Patienten, incl. Follow-up und Kosteneffektivitat, fehlt und sollte in naher Zukunft erfolgen.

Key summary pointsAimTo investigate associations of sarcopenia with adverse health-related outcomes, through an umbrella review method.FindingsSarcopenia appears to be significantly associated with several adverse outcomes in older people, with a strong evidence for increased risk of mortality, disability, and falls.MessageSarcopenia is associated with several adverse health-related outcomes in older people, indicating the need of assessing this condition in daily practice. AbstractBackgroundThe clinical relevance of sarcopenia has increasingly been recognized. However, whether it is associated with the development of other medical conditions is still unclear. Therefore, we aimed to capture the scale of outcomes that have been associated with the presence of sarcopenia and systematically assess the quality, strength, and credibility of these associations using an umbrella review methodology.MethodsA systematic review in several databases was carried out, until 20th February 2019. For each association, random-effects summary effect size, 95% confidence intervals (CIs), heterogeneity (I-2), evidence for small-study effect, evidence for excess significance bias, and 95%-prediction intervals were estimated. We used these metrics to categorize the evidence of significant outcomes (p

This systematic review and meta-analysis aims to characterize the nutritional status of geriatric rehabilitation patients and its association with functional parameters. Malnutrition is prevalent in a relevant percentage of geriatric rehabilitation patients, whereas body mass index (BMI) is in the normal to overweight range. Furthermore, data suggest that protein and energy intake is reduced and vitamin D deficiency is prevalent in this population. Decreased physical function is associated with malnutrition according to Mini-Nutritional Assessment (MNA) and MNA short form, whereas BMI did not show any clear association. Nutritional status is reduced in a relevant percentage of geriatric rehabilitation patients and associated with decreased physical function which emphasizes the need for screening and targeted interventions. Since there is only limited evidence available for geriatric rehabilitation patients, this systematic review and meta-analysis aims to characterize the nutritional status in this population and its relationship with functionality. Eight databases were searched for full-text articles reporting baseline nutritional intake and status of adults ≥ 60 years in rehabilitation settings. Pooled estimates were calculated for prevalence of malnutrition and risk of malnutrition based on the Mini Nutritional Assessment (MNA) and for mean body mass index (BMI). Associations between nutritional status (MNA, MNA short form and BMI) and functional status (Barthel Index and Functional Independence Measure) and prevalence of sarcopenia were reviewed. 62 out of 1717 references were eligible for inclusion. Pooled prevalence [95% confidence interval (CI)] of malnutrition and risk of malnutrition were 13 (5–20) % and 47 (40–54) %. Pooled estimate (95% CI) for BMI was 23.8 (23.2–24.5) kg/m2. Existing data suggest a risk for low protein and energy intake and vitamin D deficiency. Functional status differed widely. Seven out of ten studies reported significant associations between reduced nutritional status and reduced functionality, whilst two out of seven studies reported significant associations between higher BMI and functionality. Prevalence of sarcopenia was high with 40–76% in this population. Although geriatric rehabilitation populations and settings were heterogeneous, a relevant percentage of geriatric rehabilitation patients were affected by a reduced nutritional status. Nutritional status was associated with decreased functionality. This emphasizes the need for screening for malnutrition and targeted nutritional intervention.

AimsThe use of Alzheimer disease medication for the treatment of dementia symptoms has shown significant benefits with regards to functional and cognitive outcomes as well as nursing home placement (NHP) and mortality. Hospitalisations in these patient groups are characterised by extended length of stays (LOS), frequent readmissions, frequent NHP and high-mortality rates. The impact of Alzheimer disease medication on the aforementioned outcomes remains still unknown. This study assessed the association of Alzheimer disease medication with outcomes of hospitalisation among patients with Alzheimer disease and other forms of dementia.MethodsA dynamic retrospective cohort study from 2004 to 2015 was conducted which claims data from a German health insurance company. People with dementia (PWD) were identified using ICD-10 codes and diagnostic measures. The main predictor of interest was the use of Alzheimer disease medication. Hospitalisation outcomes included LOS, readmissions, NHP and mortality during and after hospitalisation across four hospitalisations. Confounding was addressed using a propensity score throughout all analyses.ResultsA total of 1380 users of Alzheimer disease medication and 6730 non-users were identified. The use of Alzheimer disease medication was associated with significantly shorter LOS during the first hospitalisations with estimates for the second, third and fourth showed a tendency towards shorter hospital stays. In addition, current users of Alzheimer disease medication had a lower risk of hospital readmission after the first two hospitalisations. These associations were not significant for the third and fourth hospitalisations. Post-hospitalisation NHP and mortality rates also tended to be lower among current users than among non-users but differences did not reach statistical significance.ConclusionsOur results indicate that Alzheimer disease medication might contribute to a reduction of the LOS and the number of readmissions in PWD.

BACKGROUND: All proposed definitions of sarcopenia include the measurement of muscle mass, but the techniques and threshold values used vary. Indeed, the literature does not establish consensus on the best technique for measuring lean body mass. Thus, the objective measurement of sarcopenia is hampered by limitations intrinsic to assessment tools. The aim of this study was to review the methods to assess muscle mass and to reach consensus on the development of a reference standard. METHODS: Literature reviews were performed by members of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis working group on frailty and sarcopenia. Face-to-face meetings were organized for the whole group to make amendments and discuss further recommendations. RESULTS: A wide range of techniques can be used to assess muscle mass. Cost, availability, and ease of use can determine whether the techniques are better suited to clinical practice or are more useful for research. No one technique subserves all requirements but dual energy X-ray absorptiometry could be considered as a reference standard (but not a gold standard) for measuring muscle lean body mass. CONCLUSIONS: Based on the feasibility, accuracy, safety, and low cost, dual energy X-ray absorptiometry can be considered as the reference standard for measuring muscle mass.

Gesture-based human-robot interaction (HRI) depends on the technical performance of the robot-integrated gesture recognition system (GRS) and on the gestural performance of the robot user, which has been shown to be rather low in older adults. Training of gestural commands (GCs) might improve the quality of older users' input for gesture-based HRI, which in turn may lead to an overall improved HRI.To evaluate the effects of a user training on gesture-based HRI between an assistive bathing robot and potential elderly robot users.Twenty-five older adults with bathing disability participated in this quasi-experimental, single-group, pre-/post-test study and underwent a specific user training (10-15 min) on GCs for HRI with the assistive bathing robot. Outcomes measured before and after training included participants' gestural performance assessed by a scoring method of an established test of gesture production (TULIA) and sensor-based gestural performance (SGP) scores derived from the GRS-recorded data, and robot's command recognition rate (CRR).Gestural performance (TULIA = +57.1 ± 56.2 %, SGP scores = +41.1 ± 74.4 %) and CRR (+31.9 ± 51.2 %) significantly improved over training (p .001). Improvements in gestural performance and CRR were highly associated with each other (r = 0.80-0.81, p .001). Participants with lower initial gestural performance and higher gerontechnology anxiety benefited most from the training.Our study highlights that training in gesture-based HRI with an assistive bathing robot is highly beneficial for the quality of older users' GCs, leading to higher CRRs of the robot-integrated GRS, and thus to an overall improved HRI.

Background Hospital care of older adults, especially of those with dementia, is associated with a high risk of complications and increased mortality. Adverse events are often triggered by hospital-related factors, hence the time spent in hospitals should be limited. There is little knowledge of the specific factors influencing hospitalizations of older persons. Objectives To assess the duration of length of stay (LOS) and risk factors of increased LOS, and, specifically, the role of delirium and neuropsychiatric symptoms (NPS) among a large sample of older adults with and without dementia in Germany. Methods A claims data based dynamic retrospective cohort study from 2004 to 2015 was conducted. People with dementia (PWD) were identified using ICD-10 codes and the application of diagnostic measures. A control group without diagnosis of dementia (CG) were matched in a 3: 1 ratio. Multivariate methods were used to investigate the factors associated with LOS. Results 7,139 PWD and 21,417 controls were included. PWD had longer hospitalizations (first LOS: +4.3 days; second LOS: +0.2 days) than the CG. Diagnosis of delirium was associated with LOS, both for PWD (first LOS: +9.6 days; second LOS: +5.3 days) and CG (first LOS: +13.7 days; second LOS: +7.2 days). Conclusion Major determinants of LOS were similar in PWD and the CG. The strongest association was found for the presence of delirium and NPS. Future research should focus on prevention and intervention strategies that may reduce the impact of delirium as well as NPS on the length of stay especially for PWD.

Dysphagia is becoming increasingly more common in aging societies and, like the classical geriatric syndromes, it is a relevant functional impairment. The prevalence of dysphagia is highest in the group of old patients with neurological disorders, particularly in patients with stroke, dementia and Parkinson’s disease. In the various neurological diseases of older people disease-specific factors often have a decisive influence on the clinical management of dysphagia. In addition, the concept of primary and secondary presbyphagia plays an important role in understanding age-related dysphagia. Whereas at the organ level of the International Classification of Functioning, Disability and Health (ICF) model, the diagnosis and treatment of dysphagia in neurogeriatrics have already made progress, more research is needed on the levels of activity/mobility, social environment, personal factors and the environment. This article summarizes the pathophysiological aspects as well as the current evidence for diagnosis and treatment of neurogeriatric dysphagia. Due to its high clinical relevance dysphagia should be added to the geriatric syndromes as “impaired swallowing”.

The co-existence of impaired bone health (osteopenia/osteoporosis), reduced muscle mass and strength (sarcopenia), and increased adiposity (obesity) in middle-aged and older people has been identified in recent studies, leading to a proposal for the existence of "osteosarcopenic obesity" as a distinct entity. Evidence for the pathophysiological overlap of these conditions is mounting, although a causal relationship is yet to be established. Each component condition occurs frequently with increasing age, and with shared risk factors in many instances, thus, an overlap of these three conditions is not surprising. However, whether the concurrent existence of sarcopenia, osteoporosis and obesity leads to an increased risk of adverse musculoskeletal outcomes and mortality above and beyond the risks associated with the sum of the component parts remains to be proven and is a question of research interest. In this article, we review evidence for the existence of osteosarcopenic obesity including the current operational definition of osteosarcopenic obesity, prevalence, pathophysiology, outcomes and exploratory approaches to the management of components. We conclude that, there is insufficient evidence to support a discrete clinical entity of osteosarcopenic obesity at this time. To expand knowledge and understanding in this area, there is a need for consensus on a definition of osteosarcopenic obesity which will allow for identification, further epidemiological studies and comparisons between studies. Additionally, studies should assess whether the clinical outcomes associated with osteosarcopenic obesity are worse than the mere addition of those linked with its components. This will help to determine whether defining a person as having this triad will eventually result in a more effective treatment than addressing each of the three conditions separately.

Purpose: Measurement of muscle mass is paramount in the screening and diagnosis of sarcopenia. Besides muscle quantity however, also quality assessment is important. Ultrasonography (US) has the advantage over dual-energy X-ray absorptiometry (DEXA) and bio-impedance analysis (BIA) to give both quantitative and qualitative information on muscle. However, before its use in clinical practice, several methodological aspects still need to be addressed. Both standardization in measurement techniques and the availability of reference values are currently lacking. This review aims to provide an evidence-based standardization of assessing appendicular muscle with the use of US. Methods: A systematic review was performed for ultrasonography to assess muscle in older people. Pubmed, SCOPUS and Web of Sciences were searched. All articles regarding the use of US in assessing appendicular muscle were used. Description of US-specific parameters and localization of the measurement were retrieved. Results: Through this process, five items of muscle assessment were identified in the evaluated articles: thickness, cross-sectional area, echogenicity, fascicle length and pennation angle. Different techniques for measurement and location of measurement used were noted, as also the different muscles in which this was evaluated. Then, a translation for a clinical setting in a standardized way was proposed. Conclusions: The results of this review provide thus an evidence base for an ultrasound protocol in the assessment of skeletal muscle. This standardization of measurements is the first step in creating conditions to further test the applicability of US for use on a large scale as a routine assessment and follow-up tool for appendicular muscle., SCOPUS: ar.j, info:eu-repo/semantics/published

Background: Some studies have already suggested that exergame interventions can be effective to improve physical, cognitive, motor-cognitive, and psychological outcomes in patients with dementia (PwD). However, little is known about the training volume required to induce such positive effects and the inter-individual differences in training response among PwD. The aim of the study was to analyze the time course of changes in motor-cognitive exergame performances during a task-specific training program and to identify predictors of early training response in PwD. Methods: Secondary analyses of data from the intervention group (IG) of a randomized, placebo-controlled trial to improve motor-cognitive performances in PwD. Fifty-six geriatric patients with mild-to-moderate dementia randomized to the IG underwent a 10-week, task-specific training program (2×/week) on an exergame-based balance training system (Physiomat®), combining postural control tasks with cognitive tasks of an established neuropsychological test (Trail Making Test). Main outcome was the time required to complete different Physiomat®-Tasks (PTs) assessed at baseline (T1), training session 7 (TS7) and 14 (TS14), and post-intervention after 20 training sessions (T2). Reliable change indices were used to identify early responders from T1 to TS7. A multivariate logistic regression analysis was performed to determine independent predictors of early training response. Results: Completion time significantly improved already from T1 to TS7 in all PTs (p ≤ .001–.006), with moderate to very large effect sizes (r = .38–.52; Cohen’s d = .85–1.45). For most PTs, significant progressive improvements from TS7 to TS14 and TS14 to T2 were not observed. Thirty-one (59.6%) participants were classified as early responders and 21 (40.4%) as non-early responders. Lower baseline exergame performance and lower visuospatial and divided attention abilities were independently associated with early training response. Conclusions: Substantial task-specific improvements in complex motor-cognitive exergame performances can be obtained within a surprisingly short intervention period in PwD. Our results confirm that not only an excellent training response can be achieved in this patient population, but also that more vulnerable patients with greater deficits in domain-specific cognitive functions associated with fall risk may even reap the most and fastest benefit from motor-cognitive exergame interventions. Trial registration: ISRCTN registry, ISRCTN37232817 (retrospectively registered on 04/02/2012).

In later life a high body mass index (BMI) is associated with the lowest age-related mortality rate. The BMI range used by the World Health Organization (WHO) to classify overweight, a BMI of 25-30 kg/m2, can be regarded as normal weight in old age; nevertheless, obesity is associated with an increased risk of disability and of a deterioration in physical functionality, particularly among older age groups. This relationship to obesity has also been established for frailty. For this reason, a reduction in weight may be appropriate under functional aspects if BMI values exceed 30 kg/m2; however, such a decision cannot be made on the basis of an individual BMI alone. The functional status, body composition, comorbidities and, in particular the life perspectives of the patient should also be taken into consideration. If weight loss is intended, it must always be performed under strict medical supervision involving optimized protein intake, a carefully calculated moderate reduction in calories and adequate physical training. In the case of chronically ill elderly patients, weight reduction is not usually appropriate. Restrictive diets of any kind should principally be critically viewed in old age because even temporary inadequate energy intake may lead to accelerated deterioration of muscle and bone structure.

Sensor technology, in particular wearable inertial sensors, has the potential to help researchers objectively assess the functionality of older adults. The following review provides an overview about the possible use of sensor technology to detect and prevent pre-frailty and frailty.A systematic literature search in PubMed and the Cochrane Library was conducted. Articles were selected according to the following criteria: frail and/or pre-frail population, use of wearable and non-wearable sensor technology to measure or enhance human movements or activities of daily living and a focus on frailty assessment.A total of 28 publications were found. Sensor-derived parameters obtained during assessment of gait, functional performances and physical activity were reported to be relevant for screening and monitoring pre-frailty and frailty; however, current findings are limited to cross-sectional studies, which do not allow establishment of a causal relationship between motor performance, physical activity and specific frailty states. No study monitored specific activities of daily living.Outcome variables from technology-based assessment seem to provide valuable information for frailty assessment. Strenuous testing conditions as well as increased variability in gait, functional performance and physical activity may be useful in identifying frailty. Outcome variables derived from gait, motor assessment and physical activity must still be validated in large cohorts and under daily living conditions in order to develop robust screening tools for pre-frailty and frailty. Further research should focus on specific activities of daily living in pre-frail or frail older adults and technology-based approaches for intervention and prevention.

Sarcopenia and osteopenia/osteoporosis show a high prevalence in old age and incur a high risk for falls, fractures, and further functional decline. Physical performance and bone metabolism in patients suffering from the so-called osteosarcopenia—the combination of sarcopenia and osteopenia—are currently still unknown. This study investigates physical performance and bone metabolism in osteosarcopenic, prefrail, community-dwelling older adults. 68 prefrail adults between 65 and 94 years were assigned to four groups according to mean DXA results: osteosarcopenic [low T-score and low appendicular lean mass (aLM)], sarcopenic (low aLM), osteopenic (low T-score), and controls. Multiple linear regression analysis, adjusted for age, gender, physical activity, and 25-OH-vitamin D3 serum level, was used to identify the influence of being osteosarcopenic, sarcopenic, or osteopenic on physical performance (hand grip, chair rise test, sit-to-stand power, gait speed, SPPB) and serum markers for increased bone turnover [osteocalcin, β-crosslaps and procollagen type 1 amino-terminal propeptide (P1NP)]. Only osteosarcopenic participants showed significantly reduced hand grip strength, increased chair rising time, and STS power time as well as significantly increased bone turnover markers. Due to low physical performance and high bone turnover, older adults with osteosarcopenia have to be regarded as the most at-risk population for fractures and further functional decline. Up-to-date osteoporosis and post-fracture management of older persons should aim at both, bone and muscle.

Summary Rationale Many malnutrition screening tools are used to screen for risk of malnutrition in older adults. An aim of the Joint Programming Initiative (JPI) ‘A Healthy Diet for a Healthy Life’ (HDHL) MalNutrition in the ELderly Knowledge hub (MaNuEL) is to devise recommendations on the best tools to screen for risk of malnutrition in older adults in community and healthcare settings across Europe. The aim of this paper was to develop and apply a scoring system to rate malnutrition screening tools. Methods Using a targeted literature search strategy, 48 malnutrition screening tools used to screen for risk of malnutrition in older adults were identified across community, rehabilitation, residential care and hospital settings. Criteria to rate each tool were developed; these were based on published evidence and expert opinion. These criteria were translated into a scoring system. Results The scoring system had three equally weighted sections; validation, parameters and practicability, and was applied to all 48 tools. Overall, the highest scoring tools per setting for screening for risk of malnutrition in older adults were i) DETERMINE your health checklist for the community setting; ii) the Nutritional Form for the Elderly (NUFFE) for the rehabilitation setting; iii) the Short Nutritional Assessment Questionnaire-Residential Care (SNAQRC) for residential care and iv) both the Malnutrition Screening Tool (MST) and the Mini Nutritional Assessment Short Form Version 1 (MNA-SF-V1) for the hospital setting. Conclusion Setting-specific tools are more appropriate for use with older adults. These findings will inform recommendations for the optimal screening of geriatric malnutrition across Europe.

To identify the functional decline as related to aging, geriatric assessments are an established instrument. Within such assessments, the functional ability is evaluated and consists of the three major components: strength, mobility, and balance. Counter movement jumps (CMJ) are well-suited to test these three essential elements of functional ability within a single assessment item. Since common balance measures have been shown to be significantly prone to algorithmic and technical variations, a robust alternative method is required. Thus, we introduce a model-based approach for balance and strength analyses, where the human lower extremities are modeled as an oscillating system during the phase of landing and recovery after a vertical jump. In the System and Control Technology, a transfer function of an oscillating system is described by a second-order delay element (PT2-element), which is characterized by the parameters natural frequency and damping. We analyze the jumps of 30 participants (70–87 years) regarding their jump phases and the mentioned parameters. A linear correlation between jump power and jump height, which are sensitive indicators of the muscle performance and the strength could be confirmed. While a correlation between jump power and spring constant could be observed, a significant relationship between the balance ability and natural frequency could not be identified.

However, semantics aside, we think that DXA can indeed serve as a reference standard for measuring muscle mass. Obviously, CT and MRI are advanced techniques that can and have been used to obtain important information such as muscle size/volume and more recently amount and distribution of intra‐ and intermuscular adipose tissue. Also individual muscles can be assessed separately. However, with respect to muscle mass, the comparison of DXA with CT/MRI is rather difficult because DXA and QCT/MRI measure different physical parameters

The original version of this article unfortunately contained a mistake in one of the co-author's name. The co-author Cyrus Cooper's degree “FMedSci” was incorrectly tagged as family name. This has been corrected with this erratum.

BACKGROUND Dementia is a frequent diagnosis in geriatric rehabilitation. Studies in patients with dementia on the development of their cognitive status during rehabilitation and its relation to functional outcomes have been scarce. OBJECTIVES To describe the changes in cognitive status in patients with dementia during inpatient rehabilitation and to determine its association with patient characteristics and rehabilitation outcome. METHODS Cohort study in a geriatric rehabilitation center with data collection at admission and discharge. Outcome measures were change in global and domain-related cognitive functioning and its association with activities of daily living (ADL) and discharge home. RESULTS 154 patients (mean age 83.7 years) diagnosed with mild to moderate dementia were included. Cognitive performance significantly improved from admission to discharge for all cognitive variables tested (p

Background Geriatric patients with cognitive impairment (CI) show an increased risk for a negative rehabilitation outcome and reduced functional recovery following inpatient rehabilitation. Despite this obvious demand, evidence-based training programs at the transition from rehabilitation to the home environments are lacking. The aim of this study is to evaluate the efficacy of a feasible and cost-effective home-based training program to improve motor performance and to promote physical activity, specifically-tailored for post-ward geriatric patients with CI. Methods A sample of 101 geriatric patients with mild to moderate stage CI following ward-based rehabilitation will be recruited for a blinded, randomized controlled trial with two arms. The intervention group will conduct a 12 week home-based training, consisting of (1) Exercises to improve strength/power, and postural control; (2) Individual walking trails to enhance physical activity; (3) Implementation of patient-specific motivational strategies to promote behavioral changes. The control group will conduct 12 weeks of unspecific flexibility exercise. Both groups will complete a baseline measurement before starting the program, at the end of the intervention, and after 24 weeks for follow-up. Sensor-based as well as questionnaire-based measures will be applied to comprehensively assess intervention effects. Primary outcomes document motor performance, assessed by the Short Physical Performance Battery, and level of physical activity (PA), as assessed by duration of active episodes (i.e., sum of standing and walking). Secondary outcomes include various medical, psycho-social, various PA and motor outcomes, including sensor-based assessment as well as cost effectiveness. Discussion Our study is among the first to provide home-based training in geriatric patients with CI at the transition from a rehabilitation unit to the home environment. The program offers several unique approaches, e.g., a comprehensive and innovative assessment strategy and the integration of individually-tailored motivational strategies. We expect the program to be safe and feasible in geriatric patients with CI with the potential to enhance the sustainability of geriatric rehabilitation programs in patients with CI. Trial registration International Standard Randomized Controlled Trial (# ISRCTN82378327 ). Registered: August 10, 2015.

To examine the effects of a computerized, game-based training on motor-cognitive performances, the transfer of training effects on untrained tasks, and the sustainability of training gains in people with dementia.Ninety-nine individuals with a mean age of 82.9 (5.8) and dementia participated in a 10-week randomized controlled trial with three-month follow-up. The intervention group (IG) received a motor-cognitive training on (Physiomat®) including concurrent dual-tasks of balance control with cognitive demands (Physiomat®-Trail Making Tasks (PTMTs)). The control group (CG) performed non-specific, low-intensity exercises. Duration and accuracy at different complexity levels of trained and untrained PTMTs and the number of successfully performed tasks (PTMT score) were assessed.Physiomat® training significantly improved the duration and accuracy at almost all complexity levels of trained (P ≤ 0.001-0.047, ηPhysiomat® is feasible and has the potential to sustainably improve motor-cognitive performances in people with dementia.

The age-related dysregulation of the immune system in older persons results in reduced responses to vaccination and greater susceptibility to infection, especially in frail individuals who suffer the greatest of morbidity and mortality due to infection. Recently, significantly reduced anti-influenza antibody titers and increased rates of influenza infection after vaccination were reported in community-dwelling American frail older adults. The aim of our study was to further assess the relative impact of frailty and of each individual Fried frailty criterion on influenza vaccine response. Prefrail and frail community-dwelling German persons aged ≥70 years were recruited for a nutritional randomized double-blind placebo-controlled clinical trial conducted during the 2014–2015 influenza season. Herein, we present a sub-analysis study of the placebo group to compare 76 prefrail and frail participants. Previous seasonal influenza vaccination rate was relatively high (77.6%) in the 76 volunteers aged from 70 to 93 years. Of these participants, 65.8% were diagnosed as prefrail and 34.2% as frail according to the Fried frailty criteria. In both prefrail and frail groups, elevated levels of pre-vaccination seroprotection were observed to all vaccine strains (H1N1: 54% and 32%, H3N2: 60% and 72%, B: 10% and 16%). Post-vaccination, similar increases in haemagglutination-inhibiting antibody titers were observed for the three vaccine strains in both prefrail and frail groups. No significant difference in geometric mean titer (GMT) ratios and in rates of seroconversion or seroprotection were observed between prefrail and frail groups. Regarding the five Fried frailty criteria, only participants with low physical activity had significantly lower GMT to the strains H3N2 (55.4 vs 103.7, p = 0.001) and B (13.9 vs 20.0, p = 0.06), as compared to those having normal physical activity. Influenza vaccine response was not significantly affected by the frail phenotype, as defined by Fried frailty criteria, in community-dwelling German individuals. However, low physical activity may be a relevant predictor of lower serological response in vaccinated older individuals. Clinicaltrials.gov NCT02262091 (October 8, 2013).

The goal of the DiDiER project is to verifiably improve services in the field of dietary counselling. This will be achieved by digitising information to increase counselling intensity and to improve workflows for the service provider. The project will develop an IT-based support system for dietary counselling, covering two use cases, facilitation and support of the work of nutritionists in ambulatory allergological nutrition counselling and of nutritionists involved in the care of geriatric patients, especially of those with frailty. One of the project's significant features is that the user's sensitive data remain under his or her personal control at all times.

Early detection of changes in mobility associated with functional decline can increase the therapeutic success by prolonging self-determined living. To get an unbiased and high frequently status of the physical performance of the persons at risk, unsupervised assessments of their functional abilities should ideally take place in their homes. Thus, we have developed a minimized unsupervised technical assessment of physical performance in domestic environments. By conducting an exploratory factor analysis, based on the results of 79 study participants with a minimum age of 70 years, we could clarify that common assessment items mainly represent three key parameters of functional performance "mobility and endurance", "strength" and "balance". Consequently, we identified a minimal set of assessment items that is suitable for home-assessments and that, since covering all three parameters, is able to generate clinical meaningful and relevant insights about the functional status. Regarding the parameter mobility, we developed a technical assessment of physical performance for domestic environments, which utilizes short distance walk times assessed via ambient presence sensors as an indicator for potential functional decline. In a field trial over ten months with 20 participants with a mean age of 84.25 years, we could confirm the general feasibility of our approach and the proposed system.

Background: Post-ward geriatric rehabilitation programs have hardly been developed and validated, which leaves a substantial gap in rehabilitative care in older adults and hinders full exploitation of maintained, but often unrecognized rehabilitation potentials. Geriatric rehabilitation patients with cognitive impairment represent a highly vulnerable population which is often affected by a lack of an ongoing support at the intersection between ward-based and post-ward rehabilitation. Objective: To determine the effect of a standardized home-based training program in geriatric patients with cognitive impairment following ward-based rehabilitation. Methods: A randomized controlled, single-blinded intervention trial (RCT) with wait list control design was used. Geriatric patients (n = 34; age: 81.9 ± 5.7 years) with cognitive impairment (MMSE: 18.8 ± 4.7), identified by predefined in- and exclusion criteria, were consecutively recruited from a geriatric rehab ward. Patients in the intervention group (IG, n = 17) performed a 6-week strength and functional home training. The control group (CG, n = 17) started an identical training 6 weeks later with an initial usual care period during the intervention for the IG. Functional performance (Short Physical Performance Battery; SPPB), clinically relevant functional deficits (Performance Oriented Assessment; POMA), and physical activity (Assessment of Physical Activity For Older Persons questionnaire; APAFOP) represented primary outcome measurements complemented by additional secondary outcome parameters. Results: The IG significantly increased functional performances in SPPB (total score: p = 0.012; chair rise: p = 0.007, balance: p = 0.066), reduced gait and balance deficits in POMA (total score: p = 0.006; balance: p = 0.034; gait: p = 0.019), and increased physical activity (APAFOP; p = 0.05) compared to the CG. Effect sizes showed medium to large effects for significant parameters (eta2 = 0.14-0.45). Training benefits and adherence were more pronounced following the immediate onset of post-ward training compared to a delayed start (eta2 = 0.06-0.23). Conclusion: Results of this pilot study show that a feasible and easy to handle, home-based rehabilitation program increased functional performance and physical activity in a vulnerable, multimorbid patient group with cognitive impairment, in particular when the post-ward training onset was not postponed.

The place of calcium supplementation, with or without concomitant vitamin D supplementation, has been much debated in terms of both efficacy and safety. There have been numerous trials and meta-analyses of supplementation for fracture reduction, and associations with risk of myocardial infarction have been suggested in recent years. In this report, the product of an expert consensus meeting of the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and the International Foundation for Osteoporosis (IOF), we review the evidence for the value of calcium supplementation, with or without vitamin D supplementation, for healthy musculoskeletal ageing. We conclude that (1) calcium and vitamin D supplementation leads to a modest reduction in fracture risk, although population-level intervention has not been shown to be an effective public health strategy; (2) supplementation with calcium alone for fracture reduction is not supported by the literature; (3) side effects of calcium supplementation include renal stones and gastrointestinal symptoms; (4) vitamin D supplementation, rather than calcium supplementation, may reduce falls risk; and (5) assertions of increased cardiovascular risk consequent to calcium supplementation are not convincingly supported by current evidence. In conclusion, we recommend, on the basis of the current evidence, that calcium supplementation, with concomitant vitamin D supplementation, is supported for patients at high risk of calcium and vitamin D insufficiency, and in those who are receiving treatment for osteoporosis.

Background & aims No generalizable formulas exist that are derived from bioelectrical impedance analysis (BIA) for predicting appendicular lean mass (ALM) and fat mass (AFM) in sarcopenic older adults. Since precision of regional body composition (BC) data in multicentre trials is essential, this study aimed to: 1) develop and cross-validate soft tissue BIA equations with GE Lunar and Hologic DXA systems as their reference 2) to compare our new ALM equation to two previously published models and 3) to assess the agreement between BIA- and DXA-derived soft tissue ratios as indicators of limb tissue quality. Methods Two-hundred and ninety-one participants with functional limitations (SPPB-score 4–9; sarcopenia class I or II, measured by BIA) were recruited from 18 study centres in six European countries. BIA equations, using DXA-derived ALM and AFM as the dependent variable, and age, gender, weight, impedance index and reactance as independent variables, were developed using a stepwise multiple linear regression approach. Results Cross-validation gave rise to 4 equations using the whole sample: ALMLUNAR (kg) = 1.821 + (0.168*height2/resistance) + (0.132*weight) + (0.017*reactance) − (1.931*sex) [R2 = 0.86 and SEE = 1.37 kg] AFMLUNAR (kg) = −6.553 − (0.093* height2/resistance) + (0.272*weight) + (4.295*sex) [R2 = 0.70 and SEE = 1.53 kg] ALMHOLOGIC (kg) = 4.957 + (0.196* height2/resistance) + (0.060*weight) − (2.554*sex) [R2 = 0.90 and SEE = 1.28 kg] AFMHOLOGIC (kg) = −4.716 − (0.142* height2/resistance) + (0.316*weight) + (4.453*sex) − (0.040*reactance) [R2 = 0.73 and SEE = 1.54 kg] Both previously published models significantly overestimated ALM in our sample with biases of −0.36 kg to −1.05 kg. For the ratio of ALM to AFM, a strong correlation (r = 0.82, P

rratum to “The role of dietary protein and vitamin D in maintaining usculoskeletal health in postmenopausal women: A consensus tatement from the European Society for Clinical and Economic spects of Osteoporosis and Osteoarthritis (ESCEO)” Maturitas 79 (2014) 122–132] ene Rizzoli a,∗, John C. Stevensonb, Jurgen M. Bauerc, Luc J.C. van Loond, tephane Walrande, John A. Kanis f, Cyrus Cooperg,h, Maria-Luisa Brandi i, dolfo Diez-Perez j, Jean-Yves Reginsterk,l, for the ESCEO Task Force