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Aim: The present study examined the relationship between body mass index and the ability to perform the activities of daily living in patients with vertebral compression fractures. Methods: A retrospective cohort analysis of patients aged >65 years hospitalized with a vertebral compression fracture was carried out using a nationwide database in Japan. Body mass index was categorized as underweight (<18.5 kg/m2), normal weight (18.5–22.9 kg/m2), overweight (23.0–27.4 kg/m2) and obese (≥27.5 kg/m2) according to the World Health Organization criteria for the Asia–Pacific region. The primary outcome was Barthel Index gain, namely, the change in the Barthel Index score at discharge from that at admission. Secondary outcomes were the length of hospital stay and readmission within 30 days of discharge. Results: Among 41 423 participants, 24.5% were classified as underweight, excluding those with missing body mass index data. The underweight group had a significantly lower Barthel Index gain than the normal, overweight and obese groups (median 20 vs 25 vs 30 vs 30, respectively, P < 0.001). The underweight group also had longer hospital stays and higher 30‐day readmission rates than the other groups. A multivariable analysis showed that being underweight was independently associated with a Barthel Index gain −3.63 points (95% confidence interval −4.58 to −2.68) lower than normal weight. Furthermore, being underweight was an independent variable affecting the length of hospital stay and readmission within 30 days (P < 0.001). Conclusions: In patients with vertebral compression fractures, being underweight leads to lower Barthel Index scores, longer hospital stays and increased readmissions within 30 days of discharge. Geriatr Gerontol Int 2023; 23: 788–794. [ABSTRACT FROM AUTHOR]

Aims: This study investigated the usefulness of frailty for predicting adverse events in patients with vertebral compression fractures (VCFs) during hospitalization using data obtained from the Japanese health insurance system. Methods: This retrospective cohort study of patients with VCFs aged ≥65 years was conducted using a nationwide database in Japan. We examined the relationships between frailty risk, classified using the Hospital Frailty Risk Score (HFRS), in‐hospital mortality, and complications such as pressure ulcers and pneumonia. Multivariate logistic regression analysis was used to estimate the association between the HFRS and the outcomes of patients with VCFs. Results: In this study, the data of 30 980 in‐patients with VCFs were analyzed. Of these patients, 76.8%, 21.3%, and 1.9% had low, intermediate, and high risks of frailty, respectively. The higher the risk of frailty, the higher the rate of in‐hospital mortality and the occurrence of all complications (P < 0.001 for trend). An intermediate risk of frailty was independently associated with in‐hospital mortality (odds ratio [OR], 1.421; P < 0.001), whereas a high risk of frailty did not show statistical significance (OR, 1.385; P = 0.150). Each frailty risk was independently associated with the occurrence of all complications during hospitalization. Conclusions: The HFRS, which can assess the risk of frailty based on routinely collected medical records, was predictive of adverse events in older patients with VCFs based on a nationwide database in Japan. Future studies need to assess approaches to preventing adverse events in frail VCF patients. Geriatr Gerontol Int 2022; 22: 233–239. [ABSTRACT FROM AUTHOR]

Objectives: To determine the association between SARC-F scores and the in-hospital mortality risk among older patients admitted to acute care hospitals. Design: Single-center retrospective study. Setting: A university hospital. Participants: All consecutive patients aged older than 65 were admitted and discharged from the study hospital between July 2019 and September 2019. Measurements: Relevant patient data included age, sex, body mass index, nutritional status, fat-free mass, disease, activities of daily living (ADL), duration of hospital stay, SARC-F, and occurrence of death within 30 days of hospitalization. The diseases that caused hospitalization and comorbidities (Charlson Comorbidity Index; CCI) were obtained from medical records. The Eastern Cooperative Oncology Group-performance status (PS) was used to determine ADL, and the in-hospital mortality rate within 30 days of hospitalization as the outcome. Results: We analyzed 2,424 patients. The mean age was 75.9±6.9 and 55.5% were male. Fifty-three in-hospital mortalities occurred among the participants within the first 30 days of hospitalization. Patients who died in-hospital were older, had poorer nutritional status and severer PS scores, and more comorbidities than those who did not. A SARC-F score of ≥4 predicted a higher mortality risk within those 30 days with the following precision: sensitivity 0.792 and specificity 0.805. There were significantly more deaths in Kaplan-Meier curves regarding a score of SARC-F≥4 than a score of SARC-F<4 (p<0.001). Cox proportional hazard analysis was used to identify the clinical indicators most associated with in-hospital mortality. SARC-F≥4 (Hazard Ratio: HR 5.65, p<0.001), CCI scores (HR1.11, p=0.004), and infectious and parasitic diseases (HR3.13, p=0.031) were associated with in-hospital mortality. The SARC-F items with significant in-hospital mortality effects were assistance with walking (HR 2.55, p<0.001) and climbing stairs (HR 2.46, p=0.002). Conclusion: The SARC-F questionnaire is a useful prognostic indicator for older adults because a SARC-F ≥4 score during admission to an acute care hospital predicts in-hospital mortality within 30 days of hospitalization. [ABSTRACT FROM AUTHOR]

Objectives: Community-dwelling older adults with sarcopenia are likely to fall. However, few studies have investigated whether sarcopenia is associated with falls during hospitalization in older adults. The purpose of this study was to determine whether the SARC-F when used as a simple screening tool for sarcopenia at the time of admission, predicts in-hospital falls. Design: A retrospective, observational study. Setting: A 900-bed university hospital. Participants: A total of 9,927 patients aged 65 years and older were hospitalized at the hospital between April 2019 and March 2020. Measurements: The SARC-F contains five items: strength, assistance in walking, rise from a chair, climb stairs, and falls were evaluated at hospital admission. To investigate the relationship between the SARC-F score and falls, a ROC curve analysis was performed. Multivariate analysis adjusted for fall-related confounding factors such as age, gender, ADL, and disease were performed. Results: Mean age: 75.9±6.7 years; male: 56.2% were analyzed, and 159 patients (1.6%) fell during hospitalization. SARC-F scores at admission were significantly higher in the fall group than in the control group (3 [1–6] points vs. 0 [¬0–2] point, p<0.001). Statistical association was observed between the SARC-F and in-hospital fall (area under the curve = 0.721 [0.678–0.764], p < 0.001). The cut-off value for the highest sensitivity and specificity of the SARC-F score for in-hospital falls was two (sensitivity = 0.679, specificity = 0.715). Among the subitem of the SARC-F, the hazard ratios for climbing stairs were significantly higher (HR = 1.52 [1.10–2.09], p = 0.011) and for a history of fall was significantly higher (HR = 1.41 [1.02–1.95], p = 0.036). A SARC-F score ≥ 2 had a significantly higher incidence of in-hospital falls compared to a SARC-F score <2 (3.7% vs. 0.7%, p < 0.001). Also, a SARC-F score ≥ 2 had a significantly higher hazard ratio for falls (2.11 [1.37–3.26], p < 0.001). Conclusion: SARC-F can help predict falls among hospitalized older adults. [ABSTRACT FROM AUTHOR]

BACKGROUND: The Functional Assessment for Control of Trunk (FACT) was developed to evaluate trunk function after stroke. However, only a few studies used FACT to show functional outcome. OBJECTIVE: This study aimed to validate the FACT predictive ability for functional outcome following stroke and create an English version of the FACT. METHODS: This retrospective, observational study was conducted with patients aged≥65 years with stroke. Patients were divided into two groups according to the median FACT score at admission: trunk impairment or high trunk function group. Multiple regression analysis was performed for Functional Independence Measure (FIM) gain and FIM efficiency to examine the relationship between trunk function assessed by FACT at admission and functional prognosis. RESULTS: 105 participants (mean age, 80.2±7.6, 57.1%were men) were included. Of these, 48 (45.7%) and 57 (54.3%) were categorized to the trunk impairment group and high trunk function group, respectively. FACT score at admission was associated with FIM gain (coefficient = 0.875, P = 0.001) and FIM efficiency (coefficient = 0.015, P = 0.016) after adjusting for confounders. CONCLUSIONS: Trunk impairment at admission assessed by FACT could predict functional prognosis. The English version of FACT was created and further demonstrated the validity of FACT. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to develop appendicular skeletal muscle mass (ASM) estimating formulas that also consider the presence of paralysis for older adults and people with disabilities. Methods: This retrospective study analyzed 315 consecutive patients, post‐stroke, aged ≥65 years, in a rehabilitation hospital. Six different ASM estimating formulas were developed using a five‐fold cross‐validation method and compared with the measured ASM obtained from bioelectrical impedance analysis. These formulas included age, gender, height, weight, arm circumference, triceps skinfold, calf circumference and presence of paralysis. Using Pearson's correlation coefficients (r) and intraclass correlation coefficient (ICC), we examined the correlation between the formulas and the measured ASM. The accuracy of the ASM estimating formula for detecting decreased muscle mass was evaluated using the F‐value and Matthew's correlation coefficient. Results: Patients' mean ± SD age was 79.0 ± 8.1 years, and 51.4% of them were men. The mean ± SD bioelectrical impedance analysis‐measured ASM was 13.7 ± 4.3 kg. Furthermore, 241 (76.5%) patients had decreased measured ASM. The mean adjusted R2 of the developed six formulas was 0.861–0.871. In all formulas, the r and ICC of the estimated ASM for the measured ASM were strong (r = 0.936–0.930 and ICC = 0.928–0.934). These formulas revealed excellent sensitivity (86.0–88.2%), specificity (72.5–81.1%), accuracy (0.838–0.870), F‐value (0.899–0.918) and Matthew's correlation coefficient (0.509–0.612) for measured ASM depletion. Conclusions: We successfully developed ASM estimating formulas using anthropometric measurements considering the presence of paralysis. Thus, these formulas are beneficial for diagnosing sarcopenia in older adults, without requiring any special equipment. Geriatr Gerontol Int 2020; 20: 1145–1150. [ABSTRACT FROM AUTHOR]

Object: The SARC-F questionnaire is a sarcopenia screening tool. However, the validity of the SARC-F score ≥4 (SARC-F≥4) for the evaluation of sarcopenia in the hospital setting has not been investigated. This study investigated the validity of SARC-F≥4 as a screening tool for sarcopenia among hospitalized older adults. Design: Cross-sectional retrospective study. Setting: A university hospital. Participants: This study included older adult patients (age ≥65 years) who were hospitalized at, and subsequently discharged from, the hospital between April and September 2019 and underwent a nutritional assessment by the nutrition support team during their hospitalization. Measurements: SARC-F was recorded at the time of admission, and the criteria specified by the Asia Working Group for Sarcopenia in 2019 (AWGS 2019) were applied to diagnose sarcopenia and possible sarcopenia. Appendicular muscle mass was estimated through validated equations, and three different models were developed for sarcopenia diagnosis. The sensitivity, specificity, and positive/negative likelihood ratios were calculated to analyze the accuracy of the SARC-F≥4 for sarcopenia and possible sarcopenia. Receiver-operating characteristic analyses were conducted to calculate the area under the curve (AUC). Results: In total, 1,689 patients (mean age: 77.2±13 years; male: 54.4%) were analyzed, and 636 patients (37.7%) had SARC-F≥4. Patients with SARC-F≥4 had a statistically significant higher prevalence of AWGS 2019-defined sarcopenia than patients with SARC-F <4 in the models (65.4–78.9% vs 40.9–15.2%, p<0.001). The sensitivity, specificity, and positive/negative likelihood ratios of SARC-F≥4 for sarcopenia and possible sarcopenia were 49.1–51.3%, 73.9–81.2%, and 1.88–2.72/0.60–0.69 and 48.0%, 84.5%, and 3.11/0.62, respectively. The AUC for sarcopenia and possible sarcopenia were 0.644–0.695 and 0.708, respectively. The AUC of SARC-F for possible sarcopenia was equivalent to or larger than that for sarcopenia (DeLong test p=0.438, 0.088, and <0.001 vs the three models). Conclusions: SARC-F≥4 is suitable as a screening tool for sarcopenia in hospitalized older adults. SARC-F assessment could facilitate the detection and exclusion of sarcopenia at hospitalization and may lead to early adoption of a therapeutic and preventive approach. [ABSTRACT FROM AUTHOR]

Aim: The Geriatric Nutritional Risk Index (GNRI) can predict nutritional risk. However, just a few studies have validated the optimal cut‐off value of GNRI for nutrition screening in older patients. Hence, this study aimed to determine the optimal value of GNRI to screen the risk of malnutrition among older patients. Methods: This retrospective cross‐sectional study was carried out with 5867 consecutive older adult patients who were admitted to an academic hospital in Japan. Receiver operating characteristic curve analyses were carried out to obtain the optimal cut‐off value of GNRI, and the results were compared against the Mini Nutritional Assessment – Short Form and Malnutrition Universal Screening Tool. The validation of the obtained cut‐off value was examined on the concordance rate of malnutrition diagnosis based on the European Society of Clinical Nutrition and Metabolism criteria. Results: The mean age of the patients was 76.0 ± 7.0 years. The optimal cut‐off value of GNRI for Mini Nutritional Assessment – Short Form ≤11 points was 95.92 (area under the curve 0.827 [0.817–0.838], P < 0.001), and that for Malnutrition Universal Screening Tool ≥1 point was 95.95 (area under the curve 0.788 [0.776–0.799], P < 0.001). By adapting GNRI <96 points as an initial screening cut‐off in the European Society of Clinical Nutrition and Metabolism‐defined malnutrition process, the concordance rates of comparisons were 98.5% and 98.5% for Mini Nutritional Assessment – Short Form‐based and MUST‐based diagnosis, respectively. Conclusions: The study showed GNRI <96 points as the optimal cut‐off value for nutritional screening. GNRI might be one of the easy‐to‐use tools for nutritional screening and for diagnosing malnutrition in older adults. Geriatr Gerontol Int 2020; 20: 811–816. [ABSTRACT FROM AUTHOR]

This study aimed to clarify the association between malnutrition and improvement of swallowing ability during rehabilitation of stroke patients. This was a retrospective cohort study. One hundred eighty-eight older adults with oropharyngeal dysphagia after stroke who were admitted to a rehabilitation hospital. The International Dysphagia Diet Standardization Initiative Functional Diet Scale (IDDSI-FDS) was used to assess swallowing ability. The Global Leadership Initiative on Malnutrition (GLIM) definition was used to diagnose malnutrition. The primary outcome was IDDSI-FDS score at discharge. The mean age of the patients was 78.9 ± 7.7 years, and 36.7% were women. A total of 122 (64.8%) patients were diagnosed with malnutrition. Compared with those without malnutrition, malnourished patients had more severe dysphagia on admission. After adjusting for confounders, malnutrition was an independent contributor to the IDDSI-FDS scores at discharge (standardized coefficient: −0.165, P =.011). In patients with oropharyngeal dysphagia after stroke, malnutrition at admission inversely affected their swallowing ability at discharge. Dysphagia rehabilitation, including early nutritional intervention, may be effective in the recovery of swallowing ability. [ABSTRACT FROM AUTHOR]

Aim: Calf circumference, which is a known simple indicator of muscle mass, increases during edema. However, the extent to which edema increases calf circumference in older adults is unclear. Methods: This retrospective cross‐sectional study included patients aged ≥65 years whose nutritional status was assessed by nutrition support teams. Two different types of matching models in each sex were created according to the presence of edema on the right lower limb. All models were adjusted by age, body height, handgrip strength and performance status. Sarcopenia was diagnosed based on both reduced calf circumference and decline of handgrip strength. The prevalence of sarcopenia was estimated before and after adjustment for increment of calf circumference. Results: In total, 2101 patients were included. Multifactor matching models showed that the mean difference in calf circumference between pairs was 1.6 cm (95% confidence interval [CI] 1.1–2.1, P < 0.001) for women and 2.1 cm (95% CI 1.6–2.7, P < 0.001) for men. The propensity score matching model similarly showed a mean difference of 1.6 cm (95% CI 1.1–2.1, P < 0.001) for women and 2.0 cm (95% CI 1.5–2.6, P < 0.001) for men. The prevalence of sarcopenia before and after adjusting for an edema‐related increase in calf circumference was 42.6%/48.6% for women and 35.3%/38.5%–38.7% for men. Conclusions: Edema in the lower limb increased the calf circumference by approximately 2 cm. When using calf circumference to assess muscle mass in patients with edema, the increase in circumference should be subtracted from the baseline circumference for an accurate assessment. Geriatr Gerontol Int 2019; 19: 993–998. [ABSTRACT FROM AUTHOR]

• Association between frailty risk and adverse events in patients with hip fractures. • Patients at frailty risk had a higher incidence of adverse events. • Patients at frailty risk had a poor functional outcomes. Background: Frailty may predict adverse events in patients with hip fractures. This study aimed to investigate the association between frailty and adverse events in patients with hip fractures after surgery using information from Japanese health insurance. Methods: This retrospective cohort study included patients with hip fractures aged ≥ 65 years using a nationwide database in Japan. We examined the relationship of the frailty risk, which was defined using the Hospital Frailty Risk Score (HFRS), with in-hospital mortality, complications such as delirium and pneumonia, and functional outcomes. We used descriptive analysis, logistic regression, and linear regression analysis to estimate the association between the HFRS and outcomes in patients with hip fracture. Results: We analysed data from 36,192 patients with hip fractures after surgery (mean age: 83.6 ± 6.7 years, female: 79.5%). The proportions of low, intermediate, and high risk of frailty were 68.4%, 28.1%, and 3.5%, respectively. The frailty risk was independently associated with in-hospital mortality (intermediate risk: odds ratio [OR] 1.385, P < 0.001; high risk: OR 1.572; P < 0.001) and the occurrence of complications. Furthermore, each frailty risk was negatively associated with the Barthel Index score at discharge (intermediate risk: coefficient –11.919, P < 0.001; high risk: coefficient –18.044; P < 0.001). Conclusions: The HFRS could predict adverse events, including in-hospital mortality, in Japanese older patients with hip fractures. This finding supports the validity of using the HFRS in clinical practice for patients with hip fractures. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to research on the hospitalization of elderly individuals with pneumonia.