Search

Background This study aimed to evaluate the predictive value of the domains of intrinsic capacity (ie, cognition, locomotion, sensory, vitality, and psychosocial) proposed by the World Health Organization (WHO) on the 3-year adverse health outcomes of nursing home residents. Methods A 3-year incidence of mortality, falls, repeated falls, and autonomy decline (ie, a one-unit increase in the Katz score) was assessed in a cohort of Belgian nursing home residents. Cognition was assessed using the Mini-Mental State Examination (MMSE). For locomotion, balance, gait speed and chair stand performance were evaluated by the Short Physical Performance Battery test. The sensory domain was measured using the Strawbridge questionnaire for audition and vision. For vitality, abdominal circumference, body mass index, nutritional status (by Mini Nutritional Assessment [MNA]) and handgrip strength were assessed. Psychosocial status was evaluated by the EQ-5D and the Center for Epidemiological Studies Depression scale. Missing data were handled by multiple imputations. Cox proportional hazard models, logistic regressions, and analysis of variance were used for the analyses. Results In the multivariable model, a one-unit increase in balance performance and in the nutrition score decreased the probability of death by 12% (Hazard ratio [HR] = 0.88; 95% confidence interval [CI] 0.78–0.99) and 4% (HR = 0.96; 95% CI 0.93–0.99), respectively. The risk of falling decreased when there was a one-unit increase in balance performance (HR = 0.87, 95% CI 0.79–0.96) and in the nutrition score (HR = 0.96, 95% CI 0.93–0.98). No association was found for intrinsic capacity and repeated falls. Low scores in nutrition (odds ratio = 0.86, 95% CI 0.77–0.96) were associated with a higher probability of autonomy decline. Conclusion Some domains of intrinsic capacity predicted health outcomes among nursing home residents. Nutrition and balance should be regularly checked among this population.

Given the potential consequences of falls among older adults, a major challenge is to identify people at risk before the first event. In this context, gait parameters have been suggested as markers of fall risk. To examine, among older people, the prospective relationship between gait patterns assessed in comfortable and challenging walking conditions, and future fall(s). A total of 105 adults older than 65 years, living independently at home and without a recent fall history were included in a 2-year, longitudinal, observational study. All underwent physical and functional assessment. Gait speed, stride length, frequency, symmetry and regularity and Minimum Toe Clearance (MTC) were recorded in comfortable (CW), fast (FW) and dual task walking (DTW) conditions. Gait parameter changes occurring between CW and FW and between CW and DTW were calculated and expressed in percent. DTW cost was calculated as the change of DTW relative to CW. Fall events were recorded using fall diaries. Comparisons according to fall occurrence were performed by means of univariate analysis and multivariate binary logistic regression analysis. Two-year follow-up was available for 96 participants, of whom 35 (36.5%) fell at least once. Comparative analysis showed that future fallers had shorter FW stride length and higher symmetry DTW cost than non-fallers (p

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 The aim of this study was to assess the energy expenditure of Belgian nursing home residents using indirect calorimetry and compare the energy expenditure with energy intake. Methods Indirect calorimetry was performed in nursing home residents to estimate their basal metabolism. The basal metabolism was multiplied by a physical activity level coefficient and energy expenditure that was related to thermogenesis (i.e., 10% of the total amount of energy ingested over 24 h) was added. In this way, we obtained the total energy expenditure of each nursing home resident. The nutritional intake of each resident was calculated using the precise food-weighing method over a 3-d period. The difference between energy expenditure and consumption was calculated for each patient and the mean of the difference in the population was calculated. These quantitative variables were compared by means of analysis of variance. Results A total of 25 subjects were included in this study (88.1 ± 5.8 y; 84% women). The estimated mean basal metabolism was 1087.2 ± 163.2 kcal. The physical activity level was 1.29 ± 0.1 on average and the energy expenditure due to thermogenesis was 163.1 ± 28.9 kcal. Thus, the mean daily energy expenditure was 1575.2 ± 210.6 kcal, which was within the range of the actual calculated energy intake of the residents (1631.5 ± 289.3 kcal; P = 0.33). Conclusions The estimated energy intake of Belgian nursing home residents seems appropriate for their energy expenditure.

The purpose of this study was to perform a systematic review to assess the utility of accelerometric methods to identify older adults at risk of falls. The Preferred Reporting Item for Systematic review and Meta-Analysis (PRISMA) guidelines were followed during all steps of this systematic review. Cross sectional and longitudinal studies assessing gait parameters in older adults using accelerometric devices, and comparing groups based on the risk of falls or fall history were identified from studies published in the MEDLINE, SCOPUS and Cochrane Database of Systematic Reviews databases between January 1996 and January 2017. Study selection and data extraction were performed independently by two reviewers. The quality of the methodology used in the studies included was assessed using the Newcastle–Ottawa Scale. In total, 354 references were identified through the database search. After selection, ten studies were included in this systematic review. According to the cross sectional studies, people who fall or are at risk of fall are slower, and walk with shorter steps, lower step frequency, worse stride and step regularity in terms of time, position and acceleration profiles. One longitudinal study suggests considering harmonic ratio of upper trunk acceleration in the vertical plane. Two other longitudinal studies highlight the importance of considering more than one gait parameter, and sophisticated statistical tools to discern older adults at risk for future fall(s). This systematic review essentially highlights the lack of available literature providing strong evidence that gait parameters obtained using acceleration-based methods could be useful to discern older people at risk of fall. Available literature is encouraging, but further high quality studies are needed to highlight the cross-sectional and longitudinal relationships between gait parameters and falls in older adults.

Recently, the interest of industry, government agencies and healthcare professionals in technology for aging people has increased. The challenge is whether technology may play a role in enhancing independence and quality of life and in reducing individual and societal costs of caring. Information and communication technologies, i.e. tools aimed at communicating and informing, assistive technologies designed to maintain older peoples' independence and increasing safety, and human-computer interaction technologies for supporting older people with motility and cognitive impairments as humanoid robots, exoskeletons, rehabilitation robots, service robots and companion-type are interdisciplinary topics both in research and in clinical practice. The most promising clinical applications of technologies are housing and safety to guarantee older people remaining in their own homes and communities, mobility and rehabilitation to improve mobility and gait and communication and quality of life by reducing isolation, improve management of medications and transportation. Many factors impair a broad use of technology in older age, including psychosocial and ethical issues, costs and fear of losing human interaction. A substantial lack of appropriate clinical trials to establish the clinical role of technologies to improve physical or cognitive performances and/or quality of life of subjects and their caregivers may suggest that the classical biomedical research model may not be the optimal choice to evaluate technologies in older people. In conclusion, successful technology development requires a great effort in interdisciplinary collaboration to integrate technologies into the existing health and social service systems with the aim to fit into the older adults' everyday life.

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.

Objective The objective of this study was to evaluate, among nursing home residents, the extent to which the various operational definitions of frailty predict mortality and falls at 1 year. Methods We studied 662 participants from the Sample of Elderly Nursing home Individuals: An Observational Research (SENIOR) cohort aged 83.2 ± 8.99 years, including 484 (72.5%) women and living in nursing homes. Among this cohort, 584 and 565 participants, respectively, were monitored over 12 months for mortality assessment and for occurrence of falls (ie, by mean of their medical records). Each patient was subjected to a clinical examination at baseline, during which many original clinical characteristics were collected. Stepwise regression analyses were carried out to predict mortality and falls. Results Among the participants included in the study, 93 (15.9%) died and 211 (37.3%) experienced a fall during the 1-year of follow-up. After adjustment, none of the definitions of frailty assessed predicted the 1-year occurrence of negative health outcomes. When comparing the clinical characteristics of deceased participants and those still alive, being a man (OR = 1.89; 95% CI: 1.19-3.01; P = .002) and being diagnosed with sarcopenia (OR = 1.7; 95% CI: 1.1-2.92; P = .03) were independent factors associated with 1-year mortality. Other independent factors that were significantly associated with the 1-year occurrence of falls were the results obtained with the Tinetti test (OR = 0.93; 95% CI: 0.87-0.98; P = .04), with the grip strength test (OR = 0.95; 95% CI: 0.90-0.98, P = .03), and with the isometric strength test of elbow extensors (OR = 0.93; 95%CI: 0.87-0.97; P = .04). Conclusions Within the operational definitions of frailty assessed, none is sufficiently sensitive to predict the occurrence of falls and deaths at 1 year among nursing home residents. Globally, the frequency of undesirable health outcomes seems to be higher among participants with lower muscle strength and mobility. Medical strategy or adapted physical activity, with the aim of improving specific isometric muscle strength and mobility could potentially, but significantly, reduce the occurrence of falls and even deaths.

Médéa Locquet,1 Charlotte Beaudart,1 Jean-Yves Reginster,1 Jean Petermans,2 Olivier Bruyère1 1Department of Public Health, Epidemiology and Health Economics, WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, University of Liège, 2Geriatric Department, CHU of Liège, Liège, Belgium Background: Sarcopenia leads to serious adverse health consequences. There is a dearth of screening tools for this condition, and performances of these instruments have rarely been evaluated. Our aim was to compare the performance of five screening tools for identifying elders at risk of sarcopenia against five diagnostic definitions.Subjects and methods: We gathered cross-sectional data of elders from the SarcoPhAge (“Sarco”penia and “Ph”ysical Impairment with Advancing “Age”) study. Lean mass was measured with X-ray absorptiometry, muscle strength with a dynamometer and physical performance with the Short Physical Performance Battery (SPPB) test. Performances of screening methods were described using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under the curve (AUC), according to five diagnostic definitions of sarcopenia. For each screening tool, optimal cutoff points were computed using two methods.Results: A total of 306 subjects (74.8±5.9years, 59.5% women) were included. The prevalence of sarcopenia varied from 5.7% to 16.7% depending on the definition. The best sensitivity (up to 100%) and the best NPV (up to 99.1%) were obtained with the screening test of Ishii et al, regardless of the definition applied. The highest AUC (up to 0.914) was also demonstrated by the instrument of Ishii et al. The most specific tool was the algorithm of the European Working Group on Sarcopenia in Older People (EWGSOP; up to 91.1%). All NPVs were above 87.0%, and all PPVs were below 51.0%. New cutoffs related to each screening instrument were also proposed to better discriminate sarcopenic individuals from non-sarcopenic individuals.Conclusion: Screening instruments for sarcopenia can be relevantly used in clinical practice to make sure to identify individuals who do not suffer from the syndrome. The screening test of Ishii et al showed better properties in terms of distinguishing those at risk of sarcopenia from those who were not at risk. Keywords: sarcopenia, screening, older individuals, sensitivity, specificity, ROC analysis

Background The SarQoL® is a recently developed quality of life questionnaire specific to sarcopenia. Aim To compare the quality of life (QoL) of subjects identified as sarcopenic with that of non-sarcopenic subjects when using six different operational definitions of sarcopenia. Methods Participants of the SarcoPhAge study (Belgium) completed the SarQoL®. Among the six definitions used, two were based on low lean mass alone (Baumgartner, Delmonico), and four required both low muscle mass and decreased performance (Cruz-Jentoft, Studenski, Fielding, Morley). Physical assessments included measurements of muscle mass with dual energy X-ray absorptiometry, muscle strength with a handheld dynamometer and gait speed over a 4-m distance. Results A total of 387 subjects completed the SarQoL®. Prevalence of sarcopenia varied widely across the different definitions. Using the SarQoL®, a lower QoL was found for sarcopenic subjects compared to non-sarcopenic subjects when using the definitions of Cruz-Jentoft (56.3 ± 13.4 vs 68.0 ± 15.2, p

The ageing population ought to be celebrated as evidence for the efficacy of modern medicine, but the challenge that this demographic shift presents for 21st century healthcare systems, with increasing numbers of people living with multi-morbidity and frailty, cannot be ignored. There is therefore a need to ensure that all healthcare professionals grasp the basic principles of care of older people. In this paper, we make a case for the development of pan-European education and training standards for the field of geriatric medicine. Firstly, the challenges which face the implementation and delivery of geriatric medicine in a systematic way across Europe are described – these include, but are not limited to; variance in geriatric medicine practice across Europe, insecurity of the specialty in some countries and significant heterogeneity in geriatric medicine training programs across Europe. The opportunities for geriatric medicine are then presented and we consider how engendering core geriatric medicine competencies amongst nongeriatricians has potential to bridge existing gaps in service provision across Europe. Finally, we consider how work can proceed to teach sufficient numbers of doctors and health professionals in the core knowledge, skills and attitudes required to do this. To safeguard the future of the specialty across Europe, we contend that there is a need to strive towards harmonisation of post-graduate geriatric medicine training across Europe, through the establishment of pan-European education and training standards in the specialty.

Resume Le fardeau de maladies chroniques (surtout non transmissibles) est le defi majeur mondial de sante publique. La combinaison d’un developpement economique erratique, des systemes de sante inadaptes, manquant de capacites de diagnostic et therapeutique, provoque dans beaucoup de pays a ressources limitees dont la Republique democratique du Congo (RDC) une impossibilite a gerer l’ampleur actuelle de ces maladies. A cela s’ajoute la pauvrete repandue et les defis environnementaux. Dans ce contexte, le besoin des services de soins palliatifs (SP) pour des patients en fin de vie est enorme et indeniable. La formation et l’information des decideurs politiques, des soignants et familles sont necessaires dans cette transition sanitaire. Les SP pourraient etre la solution d’un accompagnement avec dignite, ameliorant la qualite de vie des malades chroniques. Cet article presente et analyse l’ampleur de ces maladies chroniques et cherche a faire un plaidoyer pour implementer ces soins dans les pratiques medicales a Kinshasa. Trois raisons principales (transition epidemiologique, manque de formation de soignants des approches palliatives et de priorite par les decideurs politiques de ces maladies chroniques) devraient motiver tous les acteurs (partenaires, politiques, soignants et familles) a implementer ces soins dans les pratiques medicales et de faire que ces maladies ne soient pas negligees en Afrique subsaharienne.

Background Chronic illnesses are a major public health problem in low-income countries. In the Democratic Republic of the Congo (DRC), few data are available, especially in palliative care. In this context, the present study aimed at describing the patterns of diseases in Kinshasa hospitals as well as risk factors associated with patients’ evolving status and length of hospital stay. Methods A prospective study was conducted in ten hospitals of Kinshasa, over a 1-year period. A total of 2699 patients with a chronic condition (non-communicable diseases (NCD) and/or AIDS) were consecutively enrolled in the study between January and December, 2013. Results Out of 2699 patients studied, 36.9% were suffering from cardiovascular diseases, 29.7% from comorbidity and 17.5% from AIDS. 27.5% of patients died while hospitalized, and 67.4% were lost to follow-up. The risk factors independently associated with death in hospitals were AIDS (adjusted OR = 2.2) and age over 65 years old (adjusted OR = 1.7). Peri-urban and rural areas were significantly associated with a mean adjusted hospital stay longer than 3 days. The length of stay (LOS) was shorter for women and patients living in urban areas. Patients survived for a median of 10 days (range 7–20 days). Conclusions This study reveals the high proportion of patients suffering from advanced chronic diseases, including cardiovascular diseases, AIDS and comorbidity. It demonstrates the need for palliative care (PC) in medical practices in Kinshasa, the capital of the Democratic Republic of the Congo.

Gait patterns of healthy aging are needed to allow a comparison with pathological situations. However, little data is available. To present gait pattern of healthy older specially selected to be “healthy walkers”. Fifty-seven older people benefited from a geriatric assessment including clinical and functional evaluations to include only those without gait disorders. Gait data were simultaneously recorded using a tri-axial accelerometer placed on the waist and four 3D position markers placed on the feet at the level of the heel and the toe. Volunteers walked at comfortable self-selected speed (CW), fast self-selected speed (FW), and finally in dual task walking condition (DTW). The extracted gait parameters were: gait speed, stride length, stride frequency, regularity and symmetry, swing, stance and double support time and ratio and minimum toe clearance. Gait speed and stride length were normalized to the right leg length. Fifty-seven older people with a mean age of 69.7 ± 4.2 years old (range from 65 to 82 years) were included. Data were analyzed according to the gender and according to the age (

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).

WOS: 000462615200022, PubMed ID: 30423032, the European Union of Medical Specialists (UEMS-GMS) recommendations for training in Geriatric Medicine were published in 1993. The practice of Geriatric Medicine has developed considerably since then and it has therefore become necessary to update these recommendations. under the auspices of the UEMS-GMS, the European Geriatric Medicine Society (EuGMS) and the European Academy of Medicine of Ageing (EAMA), a group of experts, representing all member states of the respective bodies developed a new framework for education and training of specialists in Geriatric Medicine using a modified Delphi technique. Thirty-two expert panel members from 30 different countries participated in the process comprising three Delphi rounds for consensus. The process was led by five facilitators. the final recommendations include four different domains: General Considerations on the structure and aim of the syllabus as well as quality indicators for training (6 sub-items), Knowledge in patient care (36 sub-items), Additional Skills and Attitude required for a Geriatrician (9 sub-items) and a domain on Assessment of postgraduate education: which items are important for the transnational comparison process (1 item). the current publication describes the development of the new recommendations endorsed by UEMS-GMS, EuGMS and EAMA as minimum training requirements to become a geriatrician at specialist level in EU member states., EUGMS, The project was supported by EUGMS by a restricted grant in 2017, which was used to support the administrative work during the Delphi procedure.

Background A specific self-administrated health-related quality of life questionnaire for sarcopenia, the Sarcopenia and Quality Of Life (SarQoL®), has been recently developed. This questionnaire is composed of 55 items translated into 22 questions and organized into seven domains of quality of life. The objective of the present work is to evaluate the psychometric properties (discriminative power, validity, reliability, floor and ceiling effects) of the SarQoL® questionnaire. Methods Sarcopenic subjects were recruited in an outpatient clinic in Liege, Belgium and were diagnosed according to the algorithm developed by the European Working Group on Sarcopenia in Older People. We compared the score of the SarQoL® between sarcopenic and non-sarcopenic subjects using a logistic regression after adjustment for potential confounding variables. Internal consistency reliability was determined using Cronbach's alpha coefficient; construct validity was assessed using convergent and divergent validities. Test–retest reliability was verified after a two-week interval using the intra-class correlation coefficient (ICC). At last, floor and ceiling effects were also tested. Results A total of 296 subjects with a median age of 73.3 (68.9–78.6) years were recruited for this study. Among them, 43 were diagnosed sarcopenic. After adjustment for potential confounding factors, the total score and the scores of the different dimensions of the SarQoL® questionnaire were significantly lower for sarcopenic than for non-sarcopenic subjects (54.7 (45.9–66.3) for sarcopenic vs. 67.8 (57.3 – 79.0) for non sarcopenic, OR 0.93 (95%CI 0.90–0.96)). Regarding internal consistency, the Cronbach's alpha coefficient was 0.87. The SarQoL® questionnaire data showed good correlation with some domains of the Short-Form 36 (SF-36) and the EuroQoL 5-dimension (EQ-5D) questionnaires and with the mobility test. An excellent agreement between the test and the retest was found with an ICC of 0.91 (95% CI 0.82–0.95). At last, neither floor nor ceiling effects were detected. Conclusions The SarQoL® questionnaire is valid, consistent, and reliable and can therefore be recommended for clinical and research purposes. However, its sensitivity to change needs to be assessed in future longitudinal studies.

The aim of this study was to assess the relationship between frailty and a large number of indicators related to physical and muscular performance as well as quality of life. This is an analysis of data collected at baseline in the Sample of Elderly Nursing home Individuals: an Observational Research (SENIOR) cohort including nursing home residents. Subjects are volunteer, oriented and able to walk (walking assistance allowed) nursing home residents in Belgium. A large number of demographic and clinical characteristics, including physical and muscular performance, were collected from each patient. The prevalence of frailty in this population was assessed using Fried’s definition. In total, 662 subjects are included in this analysis. The mean age of the sample is 83.2 ± 8.99 years, and 484 (73.1 %) are women. In this population of nursing home residents, the prevalence of frailty is 25.1 %, pre-frailty, 59.8 % and robustness, 15.1 %. Compared to non-frail subjects, frail subjects have lower physical and muscular performances and a lower quality of life. Frailty, according to Fried’s definition, seems to be associated with several clinical indicators suggesting a higher level of disability and an increased propensity to develop major clinical consequences. Follow-up data of the SENIOR cohort will be helpful in confirming these findings, establishing cause–effect relationships and identifying the most predictive components of physical frailty for adverse outcomes in nursing homes.

The importance of a health problem is based on its current and expected prevalence, its clinical and economic consequences, the social status of people affected by the problem and the availability of an effective treatment. In this paper, we review the main current literature on sarcopenia in order to assess whether this geriatric syndrome could be considered as a major public health problem. Our review highlights that based on its prevalence, its clinical consequences, the limitations of the current available treatments as well as on the fact that many frail patients are affected by this geriatric syndrome, sarcopenia should be considered as a health priority by all interested parties in order to reduce its burden.

Ageing increases the risk and severity of infectious diseases, especially when chronic diseases are present. Healthcare providers generally view vaccination as a childhood intervention and consider vaccination of the elderly not to be sufficiently effective due to immunosenescence. However, the burden of frequent vaccine-preventable diseases, such as influenza, pneumococcal disease and herpes zoster, increases with age, so that the perceived lower vaccine effectiveness should be considered in the context of this higher burden. Vaccination can prevent infection and mortality hospitalization and functional decline, and their consequences thereby having a positive impact. The use of medications will be reduced (e.g. antibiotics, analgesics) and therefore the iatrogenic risk would be lower. This contributes to an improved quality of life and to successful ageing. Many countries recommend influenza and pneumococcal vaccination in the elderly and, more recently, some recommend the live-attenuated herpes zoster vaccine. However, better guidelines and recommendations, especially for frail individuals are needed. Protection may be improved by offering vaccination to younger, fitter individuals, before they become frail. In addition, offering vaccination to caregivers and others who are in contact with the elderly could also improve protection. Many studies have demonstrated that influenza, pneumococcal and herpes zoster vaccinations in the elderly are cost-effective and can even be cost-saving. Healthcare providers and public health decision-makers need to understand more fully the value of vaccination and to consider it as an important preventive tool in the promotion of successful ageing.

A total of 119 GPs participated to a survey aimed to assess the profile and determinants of vitamin D supplementation prescription in nursing homes. Among the respondent GPs, 65 (54.6 %) systematically prescribe vitamin D to their institutionalized patients and the 54 (45.4 %) others prescribe only sometimes. The aim of this study is to assess the profile and determinants of vitamin D supplementation prescription in nursing homes. General practitioners (GPs) having at least one patient in a nursing home in Liege, Belgium, were asked to complete the survey. A total of 119 GPs participated in the survey. Among the respondent GPs, 65 (54.6 %) systematically prescribe vitamin D to their institutionalized patients and the 54 (45.4 %) others prescribe only sometimes. The main reasons for prescribing vitamin D cited by GPs who do so systematically are as follows: because they believe nursing home residents are mostly deficient in vitamin D status (92.1 %), because they believe that vitamin D supplementation prevents osteoporotic fractures (77.8 %), and because vitamin D supplementation is recommended by various scientific societies (38.1 %). GPs who only prescribe vitamin D supplementation in some patients mainly do so following a diagnosis of osteoporosis (82.4 %), on the basis the 25(OH)D level (78.4 %), in the case of history of fracture (54.9 %) or after a recent fracture (43.4 %). Surprisingly, 16 physicians (31.4 %) only prescribe vitamin D when they think of it. Interestingly, while 40.7 % of GPs always prescribe the same dose of vitamin D, the remaining 59.3 % prescribe a dose that will mainly depend on the results of the 25(OH)D level (94.0 %), the patient’s bone health (49.3 %), or history of fracture (43.3 %). More than half of GPs systematically prescribe vitamin D to their patients living in nursing homes. The other GPs usually prescribe vitamin D following the result of the vitamin D status or after a diagnosis of osteoporosis.

To assess the occurrence of 3 major adverse outcomes of sarcopenia (ie, physical disabilities, institutionalizations and deaths) observed over a 3-year follow-up in older adults and compare the risk of these outcomes using 5 definitions of sarcopenia.The study is a part of the ongoing SarcoPhAge (for Sarcopenia and Physical Impairment with advancing Age) longitudinal project.The SarcoPhAge study follows 534 community-dwelling older adults.Sarcopenia was defined as low muscle mass plus a decreased muscle function. Data on adverse outcomes were collected yearly during the annual follow-up or with a phone call. The association between baseline sarcopenia and the occurrence of undesirable outcomes was tested using the Cox proportional hazards model or a logistic regression model.A total of 534 subjects were recruited into this prospective cohort (73.5 ± 6.2 years, 60.5% female). After 3 years, 33 participants were lost to follow-up. If no association between baseline sarcopenia and physical disabilities or institutionalizations was highlighted, a higher number of deaths occurred in individuals diagnosed with sarcopenia than in those who were not diagnosed (16.2% vs 4.6%, P value.001). The probability of death within 3 years when presenting with sarcopenia showed an approximately 3-fold increase compared to subjects without sarcopenia.Over a 3-year period, sarcopenia at baseline was associated with an increased risk of mortality. There were some variations in the ability of different definitions of sarcopenia to predict outcomes.

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 consequences of sarcopenia on quality are difficult to evaluate and consequently are quite poorly studied. The few studies assessing the quality of life in sarcopenic subjects currently use generic quality of life questionnaires such as SF-36 and EQ-5D. The SarcoPhAge study, conducted on a cohort developed in Liège including 534 subjects of 65 years or older, suggested that sarcopenic subjects present a significant worse quality of life in the domains of physical function compared to non-sarcopenic subjects. Generic tools do not cover exhaustively all the areas of potential dysfunction concerned in this geriatric syndrome. Yet, there is no specific and validated quality of life questionnaire for sarcopenia. It would be useful to have at our disposal a sarcopenia specific quality of life questionnaire to assess not only the prospective quality of life of sarcopenic subjects but also to assess the efficacy and the relevance of new therapeutic and preventive strategies developed in the field of sarcopenia.

Introduction The SarcoPhAge project is an ongoing longitudinal study following community-dwelling elderly subjects with the objective to assess some health and functional consequences of sarcopenia. The sarcopenia diagnosis algorithm developed by the European Working Group on Sarcopenia in Older People (EWGSOP) and used in the present study needs further validation through cross-sectional and longitudinal studies. The aim of the present study is to assess, using this algorithm, the prevalence of sarcopenia and the clinical components linked to this geriatric syndrome. Methods Participants were community dwelling subjects aged 65 years or older. To diagnose sarcopenia, we applied the definition of the EWGSOP. Muscle mass was measured by dual-energy X-ray absorptiometry, muscle strength by a hydraulic dynamometer and physical performance by the SPPB test. Large amounts of socio-demographic, anamnestic and clinical data were collected in all subjects. Results over one year 534 subjects were recruited for this study (60.5% of women, mean age of 73.5 ± 6.16 years), among whom 73 subjects were diagnosed sarcopenic, which represents a global prevalence of 13.7%. Prevalence was 11.8% in men and 14.9% in women. Sarcopenic subjects were older; had a lower Body Mass Index, lower calf, waist, wrist and arm circumferences; presented more cognitive impairments (Mini-Mental State Examination), more comorbidities; were more often malnourished; and consumed more drugs. After adjustment for age, BMI, cognitive status, nutritional status, number of comorbidities and number of drugs, sarcopenic subjects had a worse physical health-related quality of life (SF-36) for the domain of physical functioning, were at higher risk of falls (Timed Up and Go test), were more frail (Fried), presented more often tiredness for the achievement of activities of daily living (Mobility-test), presented less fat mass and obviously less lean mass. Sarcopenic women were also more dependent for housekeeping and handling finances (Lawton scale) than non-sarcopenic ones. Conclusion Sarcopenia seems to be associated with many harmful clinical components making this geriatric syndrome a real public health burden. Follow-up data of the SarcoPhAge study will be helpful to assess the outcomes of sarcopenia based on the EWGSOP diagnosis algorithm and its different proposed cut-offs.

Previous literature demonstrates the interest of gait analysis to predict cognitive decline in old people. This pilot study aims to determine if gait speed or gait variability is a marker able to early identify, among mild cognitive impairment (MCI) subjects, those at risk to develop Alzheimer’s disease (AD) in the future. 13 MCI subjects were included in 2007. Their gait parameters (walking speed, stride length and gait frequency, regularity and symmetry) were measured in 2007 and 2008 in simple task (ST) and in dual task (DT) using a triaxial accelerometer (Locometrix®). Among the 13 MCI subjects included in 2007, 10 were assessed in 2008. So, 23 (13 in 2007 + 10 in 2008) gait tests were collected. In 2011, MCI people were considered as “MCI+” when they developed AD (between baseline and 2011) and as “MCI−” if they did not. Among the 23 gait tests, 15 were from MCI+ (9 gait tests in 2007 and 6 in 2008) and 8 from MCI− (4 gait tests in 2007 and 4 gait tests in 2008). Mann–Whitney non-parametric U test was used to compare gait parameters of MCI+ and MCI−. Gait speed, symmetry and regularity were lower in MCI+ than in MCI−. Despite the small sample size, the results presented in this original pilot study are in line as the infrequent previous literature related to this topic. The authors discuss lacks and strengths of this work. These results suggest that both gait speed and gait variability could be markers to early identify MCI at risk to develop AD.

BACKGROUND Gait impairment seems to be a risk factor for falls and mortality. Because gait change cannot be determined easily with classical clinical tests, some authors have suggested that it might be useful to use a gait-analysis system among elderly community-dwelling people. OBJECTIVE The main objective of the present study was to determine the predictive value of a quantitative evaluation of the gait characteristics in nursing home residents for the occurrence of falls and death performed using a tri-axial accelerometer (Locometrix®). MATERIAL AND METHODS One hundred elderly nursing home residents (80 women and 20 men, mean age 86.4 ± 6.04 years) were included in this study with the aim to follow them for 2 years. Deaths and falls were systematically recorded. A quantitative evaluation of a 10-second walk was performed with a tri-axial accelerometer (Locometrix®). Demographic data (i.e age, sex, body mass index) and clinical data (i.e. fall risk evaluated by the Tinetti test) were also recorded. RESULTS During the two years of follow-up, 27 patients died. After adjustment on all potential confounding variables, only body mass index was significantly associated with the risk of mortality with an odds ratio of 0.86 (95% CI: 0.77-0.96, p=0.04). At the end of the study period, 440 falls had occurred (mean: 4.44 ± 6.79 falls per patient) but no single factors were independently associated with fall incidence. CONCLUSION Our results show that a quantitative gait analysis performed using a tri-axial accelerometer is not predictive of long-term falls and mortality among nursing home residents.

BACKGROUND: the impact of sarcopenia on quality of life is currently assessed by generic tools. However, these tools may not detect subtle effects of this specific condition on quality of life. OBJECTIVE: the aim of this study was to develop a sarcopenia-specific quality of life questionnaire (SarQoL, Sarcopenia Quality of Life) designed for community-dwelling elderly subjects aged 65 years and older. SETTINGS: participants were recruited in an outpatient clinic in Liège, Belgium. SUBJECTS: sarcopenic subjects aged 65 years or older. METHODS: the study was articulated in the following four stages: (i) Item generation-based on literature review, sarcopenic subjects' opinion, experts' opinion, focus groups; (ii) Item reduction-based on sarcopenic subjects' and experts' preferences; (iii) Questionnaire generation-developed during an expert meeting; (iv) Pretest of the questionnaire-based on sarcopenic subjects' opinion. RESULTS: the final version of the questionnaire consists of 55 items translated into 22 questions rated on a 4-point Likert scale. These items are organised into seven domains of dysfunction: Physical and mental health, Locomotion, Body composition, Functionality, Activities of daily living, Leisure activities and Fears. In view of the pretest, the SarQoL is easy to complete, independently, in ∼10 min. CONCLUSIONS: the first version of the SarQoL, a specific quality of life questionnaire for sarcopenic subjects, has been developed and has been shown to be comprehensible by the target population. Investigations are now required to test the psychometric properties (internal consistency, test-retest reliability, divergent and convergent validity, discriminant validity, floor and ceiling effects) of this questionnaire.

The aim of this study was to compare energy and protein content of the served food with the actual intake from the food consumed by nursing home residents. This study also aimed to compare food intake and dietary allowances. This is a cross sectional study. This study was performed in nursing homes. Residents of these 2 nursing homes were eligible for the study if they agreed to participate and if they meet the selection criteria (to be older than 65 years and have a regular texture diet). Nutrient content of the served food and real food consumption was calculated for all meals during a 5-day period by precise weighting method. Difference between consumed and served dietary content was evaluated by the Chi² test. Seventy-four Belgian nursing home residents (75% of women, 85.8 ± 7.04 years on average) were included in this study. These subjects had a mean body mass index of 24.9 ± 4.83 kg/m². The mean energy content of the served food was 1783.3 ± 125.7 kcal per day. However, residents did not eat the whole of the meals and the actual energy content of the consumed food was significantly less (1552.4 ± 342.1 kcal per day; p

Background: Perceptions of families who take care of patients suffering from advanced illness are rarely considered in Kinshasa medical practices; nevertheless, these families are the main actors involved in such care. The objective of this present study was to illustrate, in a Congolese context, the perceptions of families on the care of patients suffering from advanced illness, and to identify the possible aids provided by healthcare facilities. Methods: A qualitative study was performed among focus groups in six hospitals in Kinshasa. Each group included eight members. Results: We gathered factors that could negatively influence the care of a patient suffering from advanced disease. Such factors included: scarcity of and inaccessibility to painkillers, economic resilience, poor quality treatment, lack of psychological counselling, seeking alternative solutions and poor communication between caregivers and patients. In contrast, the study also showed that relatives caring for these patients often receive support from the wider family and from cult members. Conclusions: This study focuses on the miscommunication between healthcare workers and patients, poor management in advanced illness as well as a lack of psychological support from caregivers. The findings can serve as basis for further research in palliative care.

Older adults often resort to self-medication to relieve symptoms of their current illnesses; however, the risks of this practice are multiplied in old age. In particular, this age group is more vulnerable to adverse drug events because of the physiological changes that occur due to senescence. The aim of the study was to obtain an overview of the adverse health events related to self-medication among subjects aged 60 years and over through a systematic review of the literature. A study of relevant articles was conducted among databases (MEDLINE, PsycINFO, and EBM Reviews–Cochrane Database of Systematic Reviews). Eligibility criteria were established and applied by two investigators to include suitable studies. The results and outcomes of interest were detailed in a descriptive report. The electronic search identified 4096 references, and the full texts of 74 were reviewed, of which four were retained in the analysis: three had a cross-sectional design and one prospectively followed elderly subjects. The first study showed a 26.7% prevalence of adverse drug reactions (ADRs) among elders, the second study found a 75% prevalence of side effects, and, finally, a prospective study showed an ADR incidence of 4.5% among self-medicated elders. These studies showed that adverse health events related to self-medication are relatively frequently reported. They also highlighted that analgesics and anti-inflammatory drugs are the most self-medicated products, while vitamins and dietary supplements also appear to be frequently self-administered, but by older individuals. Studies on self-medication in the elderly and its adverse health effects are clearly lacking. There is a need to perform prospective studies on this topic to gain a clear understanding of the extent of this problem and to enhance the awareness of health professionals to better inform seniors.

There is growing evidence that vitamin D plays a role on several tissues including skeletal muscle.The aim was to summarize with a meta-analysis, the effects of vitamin D supplementation on muscle function.A systematic research of randomized controlled trials, performed between 1966 and January 2014 has been conducted on Medline, Cochrane Database of Systematics Reviews, Cochrane Central Register of Controlled and completed by a manual review of the literature and congressional abstracts.All forms and doses of vitamin D supplementation, with or without calcium supplementation, compared with placebo or control were included. Out of the 225 potentially relevant articles, 30 randomized controlled trials involving 5615 individuals (mean age: 61.1 years) met the inclusion criteria.Data were extracted by two independent reviewers.Results revealed a small but significant positive effect of vitamin D supplementation on global muscle strength with a standardized mean difference (SMD) of 0.17 (P = .02). No significant effect was found on muscle mass (SMD 0.058; P = .52) or muscle power (SMD 0.057; P = .657). Results on muscle strength were significantly more important with people who presented a 25-hydroxyvitamin D level30 nmol/L. Supplementation seems also more effective on people aged 65 years or older compared to younger subjects (SMD 0.25; 95% CI 0.01 to 0.48 vs SMD 0.03; 95% CI -0.08 to 0.14).Vitamin D supplementation has a small positive impact on muscle strength, but additional studies are needed to define optimal treatment modalities, including dose, mode of administration, and duration.

Inadequate vitamin D status is associated with secondary hyperparathyroidism and increased bone turnover and bone loss, which in turn increases fracture risk. The objective of this study is to assess the prevalence of inadequate vitamin D status in European women aged over 80 years. Assessments of serum 25-hydroxyvitamin D levels (25(OH)D) were performed on 8532 European women with osteoporosis or osteopenia of which 1984 were aged over 80 years. European countries included in the study were: France, Belgium, Denmark, Italy, Poland, Hungary, United Kingdom, Spain and Germany. Two cut-offs of 25(OH)D inadequacy were fixed

Introduction Given their major health consequences in the elderly, identifying people at risk of fall is a major challenge faced by clinicians. A lot of studies have confirmed the relationships between gait parameters and falls incidence. However, accurate tools to predict individual risk among independent older adults without a history of falls are lacking. Objective This study aimed to apply a supervised learning algorithm to a data set recorded in a two-year longitudinal study, in order to build a classification tree that could discern subsequent fallers based on their gait patterns. Methods A total of 105 adults aged >65 years, living independently at home and without a recent fall history were included in a two-year longitudinal study. All underwent physical and functional assessment. Gait speed, stride length, frequency, symmetry and regularity, and minimum toe clearance were recorded in comfortable, fast and dual task walking conditions in a standardized laboratory environment. Fall events were recorded using personal falls diaries. A supervised machine learning algorithm (J48) has been applied to the data recorded at inclusion in order to obtain a classification tree able to identify future fallers. Results Based on fall information from 96 volunteers, a classification tree correctly identifying 80% of future fallers based on gait patterns, gender, and stiffness, was obtained, with accuracy of 84%, sensitivity of 80%, specificity of 87%, a positive predictive value of 78%, and a negative predictive value of 88%. Discussion While the performances of the classification tree warrant further confirmation, it is the first predictive tool based on gait parameters that are identified (not clustered) allowing its use by other research teams. Conclusion This original longitudinal pilot study using a supervised machine learning algorithm, shows that gait parameters and clinical data can be used to identify future fallers among independent older adults.

BACKGROUND: Sarcopenia is increasingly recognized as a correlate of ageing and is associated with increased likelihood of adverse outcomes including falls, fractures, frailty and mortality. Several tools have been recommended to assess muscle mass, muscle strength and physical performance in clinical trials. Whilst these tools have proven to be accurate and reliable in investigational settings, many are not easily applied to daily practice. METHODS: 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 afterwards organized for the whole group to make amendments and discuss further recommendations. RESULTS: This paper proposes some user-friendly and inexpensive methods that can be used to assess sarcopenia in real-life settings. Healthcare providers, particularly in primary care, should consider an assessment of sarcopenia in individuals at increased risk; suggested tools for assessing risk include the Red Flag Method, the SARC-F questionnaire, the SMI method or different prediction equations. Management of sarcopenia should primarily be patient centered and involve the combination of both resistance and endurance based activity programmes with or without dietary interventions. Development of a number of pharmacological interventions is also in progress. CONCLUSIONS: Assessment of sarcopenia in individuals with risk factors, symptoms and/or conditions exposing them to the risk of disability will become particularly important in the near future. ispartof: BMC Geriatrics vol:16 issue:1 pages:170-179 ispartof: location:England status: published

This research aimed to assess the correlation between isometric muscle strength of the lower limb and motor skills. This is a cross sectional study performed among volunteer nursing home residents included in the SENIOR (Sample of Elderly Nursing home Individuals: an Observational Research) cohort. The present analysis focused on isometric muscle strength of 6 lower limb muscle groups (i.e. knee extensors, knee flexors, hip abductors, hip extensors, ankle flexors and ankle extensors), assessed using a validated hand-held dynamometer (i.e. the MicroFET2 device), and motor skills evaluated using the Tinetti test, the Timed Up and Go test, the Short Physical Performance Battery test (SPPB) and the walking speed. The relationship between all these parameters was tested by means of a multiple correlation, adjusted on age, sex and body mass index. 450 nursing home residents (69.8% of women) with a mean age of 83.1±9.4 years were included in this study. Our results showed a significant inverse correlation between lower limb muscle strength and the time required to perform the TUG test or gait speed, except for ankle flexors and ankle extensors. The relationship between the Tinetti test or the SPPB score, and lower limb muscle strength was significant, except for ankle flexors and ankle extensors. In conclusion, a positive association between lower limb muscle strength of the four main muscle groups and motor skills of the elderly nursing residents was found in this research. Therefore, special attention should be given to these muscle groups during rehabilitation programs.