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Importance Sarcopenia, the age-related loss of muscle mass and strength/function, is an important clinical condition. However, no international consensus on the definition exists. Objective The Global Leadership Initiative in Sarcopenia (GLIS) aimed to address this by establishing the global conceptual definition of sarcopenia. Design The GLIS steering committee was formed in 2019–21 with representatives from all relevant scientific societies worldwide. During this time, the steering committee developed a set of statements on the topic and invited members from these societies to participate in a two-phase International Delphi Study. Between 2022 and 2023, participants ranked their agreement with a set of statements using an online survey tool (SurveyMonkey). Statements were categorised based on predefined thresholds: strong agreement (>80%), moderate agreement (70–80%) and low agreement (<70%). Statements with strong agreement were accepted, statements with low agreement were rejected and those with moderate agreement were reintroduced until consensus was reached. Results 107 participants (mean age: 54 ± 12 years [1 missing age], 64% men) from 29 countries across 7 continents/regions completed the Delphi survey. Twenty statements were found to have a strong agreement. These included; 6 statements on 'general aspects of sarcopenia' (strongest agreement: the prevalence of sarcopenia increases with age (98.3%)), 3 statements on 'components of sarcopenia' (muscle mass (89.4%), muscle strength (93.1%) and muscle-specific strength (80.8%) should all be a part of the conceptual definition of sarcopenia)) and 11 statements on 'outcomes of sarcopenia' (strongest agreement: sarcopenia increases the risk of impaired physical performance (97.9%)). A key finding of the Delphi survey was that muscle mass, muscle strength and muscle-specific strength were all accepted as 'components of sarcopenia', whereas impaired physical performance was accepted as an 'outcome' rather than a 'component' of sarcopenia. Conclusion and relevance The GLIS has created the first global conceptual definition of sarcopenia, which will now serve to develop an operational definition for clinical and research settings. [ABSTRACT FROM AUTHOR]

Background. Progressive resistance exercise training (PRT) has been shown to increase muscle strength and fat-free mass (FFM) in elderly persons. Limited information is available regarding the effects of PRT on lean and fat mass in frail elderly persons. Methods. Ninety-one community-dwelling sedentary men and women, 78 years and older with physical frailty (defined using standardized objective criteria) were enrolled in a 9-month trial of exercise training (ET). Physical frailty was defined as having 2 of the 3 following criteria: modified Physical Performance Test score between 18 and 32, peak aerobic power between 10 and 18 ml/kg/min, or self-report of difficulty or assistance with two instrumental activities of daily living or one basic activity of daily living. Participants were randomly assigned to either a control (CTL) group that performed a low intensity home exercise program or a supervised ET group that performed 3 months of low intensity exercise and 3 months of PRT. Results. After completion of PRT, ET participants had greater improvements than did CTL participants in maximal voluntary force production for knee extension (mean [DELTA] +5.3 [+ or -] 13 ft/lb vs +1.1 [+ or -] 11 ft/lb, p = .05), measured using isokinetic dynamometry. Total body FFM (measured using dual energy x-ray absorptiometry) increased in the ET group, but not in the CTL group (mean [DELTA] +0.84 [+ or -] 1.4 kg vs +0.01 [+ or -] 1.5 kg, p = .005). Total, trunk, intra-abdominal, and subcutaneous fat mass (measured using dual energy x-ray absorptiometry and [sup.1]H-magnetic resonance imaging) did not change in response to PRT. Conclusions. Three months of supervised PRT induced improvements in maximal voluntary thigh muscle strength and whole body FFM in frail, community-dwelling elderly women and men. This supervised exercise program may not be sufficient to reduce whole-body or intra-abdominal fat area in this population.

A study to determine whether the extended outpatient rehabilitation, which includes progressive resistance training, improves physical function and reduces disability compared with low-intensity home exercise among physically frail elderly patients with hip fracture is presented. The results indicate that six months of extended outpatient rehabilitation can improve physical function and quality of life, and reduce disability compared with low intensity home exercise.

Background. Scant information exists about the risk of functional decline following treatment of acute illness in the nursing home (NH) setting. The aim of this study was to determine the incidence of short-term (30-day) functional decline among survivors of NH-acquired lower respiratory tract infection (LRI) and the factors that predict such decline, including the role of initial hospitalization. Methods. We used a prospective cohort design to study 781 episodes of LRI in 1044 NH residents in 36 NHs in central Missouri and the St. Louis metropolitan area. Functional decline was defined as a 3-point increase on the Minimum Data Set (MDS) activities of daily living (ADL) long form scale. Results. Of 781 LRI cases who survived to 30 days, the incidence of ADL decline was 28.8%. In a logistic regression model that used generalized estimating equations to adjust for clustering, variables associated with ADL decline included the following: chronic feeding tube use (AOR = 4.54, 95% confidence interval, or CI, 1.61, 12.80), decubitus ulcer (adjusted odds ratio [AOR] = 2.29, 95% CI 1.35, 3.90), shortness of breath (AOR = 2.18, 95% CI 1.44, 3.30), short-term memory problems (AOR = 2.07, 95% CI 1.33, 3.23), decline in self-performance of toilet use in the 24 hours prior to evaluation (AOR = 1.65, 95% CI 1.29, 2.12), age (AOR = 1.02, 95% CI 1.00, 1.05), and baseline ADL score. Addition of treatment variables to the model showed that initial hospitalization was also associated with ADL decline (AOR = 1.90, 95% CI 1.20, 3.00). Residents with ADL decline at 30 days were less likely to recover to their baseline ADL status at 90 days. Conclusions. Many NH residents who survive to 30 days following LRI develop new functional limitations, and such individuals are at risk for ADL decline at 90 days. A limited number of clinical variables may predict short-term functional decline. Initial hospitalization for acute treatment of LRI may increase the risk of subsequent ADL decline among individuals who survive to 30 days.

Researchers have developed a health status indicator that can identify nursing home patients who have a high risk of death from a respiratory tract infection. The indicator includes blood urea nitrogen, white blood cell count, body mass index, pulse rate, activities of daily living status, absolute lymphocyte count, sex, and mood changes., Context Lower respiratory tract infection (LRI) is a leading cause of mortality and hospitalization in nursing home residents, Treatment decisions may be aided by a clinical prediction rule that identifies residents at low and high risk of mortality. Objective To identify patient characteristics predictive of 30-day mortality in nursing home residents with an LRI. Design, Setting, and Patients Prospective cohort study of 1406 episodes of LRI in 1044 residents of 36 nursing homes in central Missouri and the St Louis, Mo, area between August 15,1995, and September 30, 1998. Main Outcome Measure Thirty-day all-cause mortality. Results Thirty-day mortality was 14.7% (n = 207). In a logistic analysis, using generalized estimating equations to adjust for clustering, we developed an 8-variable model to predict 30-day mortality, including serum urea nitrogen, white blood cell count, body mass index, pulse rate, activities of daily living status, absolute lymphocyte count of less than 800/[micro]L (0.8 X 10(9)/L), male sex, and deterioration in mood over 90 days. In validation testing, the model exhibited reasonable discrimination (c = .76) and calibration (nonsignificant Hosmer-Lemeshow goodness-of-fit statistic, P = 54). A point score based on this model&apos;s variables fit to the entire data set closely matched observed mortality. Fifty-two percent of residents had low (score of 0-4) or relatively low (score of 5-6) predicted 30-day mortality, with 2.2% and 6.2% actual mortality, respectively. Conclusions Our model distinguishes nursing home residents at relatively low risk for mortality due to LRI. If independently validated, our findings could help physicians identify nursing home residents in need of different therapeutic approaches for LRI.

Background. The relationship between cognitive function and physical disability in nondemented older adults is not well characterized. The purpose of this study was to determine the relationship between performance on psychometric measures and a modified Physical Performance Test (modified PPT) in older men and women. Methods. One hundred twenty-five men and women aged 75 years and older, who were enrolled in randomized, controlled trials of exercise or hormone replacement therapy, were recruited from the community-at-large and from congregate living sites. Measures obtained included Trailmaking A and B tests, Cancellation Random Figure tests, Weschler Associate Learning and 20-minute Delayed Recall, Verbal Fluency test, a modified PPT, and self-reports about performance of activities of daily living, medication use, and hospitalization in the previous year. Results. Simple regression analysis demonstrated that speed of performance on the Trailmaking B and Cancellation Random Figure tests was significantly associated with total modified PPT score (r = .29, p < .001 and r = .36, p < .001, respectively). A factor analysis of the psychometric test battery demonstrated that two factors, a cognitive speed factor and a memory factor, accounted for 55% of the variance in cognitive test performance. Hierarchical multiple regression analyses demonstrated that age, number of medications, and the cognitive speed factor were independent predictors of total modified PPT score. Conclusions. Cognitive processing speed is a significant component of physical frailty in this population, although it accounts for a small percentage of variance on a standardized physical performance test.

Background. The purpose of this study was to determine the relationship between peak aerobic power [Mathematical Expression Omitted] and performance on a modified Physical Performance Test (modified PPT) in older women. Methods. One hundred one women aged 75 years and older seeking enrollment in randomized, controlled trials of exercise and/or hormone replacement therapy were recruited from the community-at-large and from congregate living sites. Measures obtained included [Mathematical Expression Omitted], a modified PPT, and self-reports about performance of activities of daily living. Results. Simple regression analysis demonstrated that [Mathematical Expression Omitted] was associated with total PPT score (r = .53, p < .001), gait speed (r = .44, p < .001), time to arise from a chair five times (r = .43, p = < .001), and time to climb one flight of stairs (r = .36, p = .007). Multiple regression analysis revealed that the relationships between [Mathematical Expression Omitted] and total modified PPT score, gait speed, chair rise time, and time to climb one flight of stairs were independent of age. Conclusions. Peak aerobic power is a significant independent predictor of performance on a standardized test of physical function in older women and is an important component of physical frailty in this population.