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Wolfgang Kemmler,1 Simon von Stengel,1 Matthias Kohl,2 Nicolas Rohleder,3 Thomas Bertsch,4 Cornel C Sieber,5 Ellen Freiberger,5 Robert Kob5 1Institute of Medical Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; 2Faculty of Medical and Life Science, University of Furtwangen, Schwenningen, Germany; 3Institute of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; 4Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, General Hospital Nuremberg, Paracelsus Medical University, Nuremberg, Germany; 5Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, GermanyCorrespondence: Robert KobInstitute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstr. 60, Nuremberg 90408, GermanyTel +49 911 5302-96624Fax +49 911 5302-96151Email Robert.Kob@fau.dePurpose: Whole-body electromyostimulation (WB-EMS) especially in combination with a high-protein supplementation has been established as an efficient treatment against sarcopenia. However, there are several case reports of rhabdomyolysis after WB-EMS application. Thus, we asked if this training could potentially lead to deteriorations of the cardiac as well as the renal function.Materials and Methods: One hundred sarcopenic obese men aged 70 years and older were randomly balanced (1-1-1) and allocated to one of the three study arms. During 16 weeks of intervention, these groups either performed WB-EMS and took a protein supplement (WB-EMS&P), solely received the protein supplement (Protein) or served as control group (CG). WB-EMS consisted of 1.5× 20 min (85 Hz, 350 μs, 4 s of strain to 4 s of rest) applied with moderate-to-high intensity while moving. We further generated a daily protein intake of 1.7– 1.8 g/kg/body mass per day. At baseline and 8– 10 days after completion of the intervention, blood was drawn and biomarkers of muscle, cardiac and renal health were assessed.Results: Hereby, we found slight but significant elevations of creatine kinase (CK) levels in the WB-EMS group pointing to minor damages of the skeletal muscle (140 U/l [81– 210], p < 0.001). This was accompanied by a significant, low-grade increase of creatine kinase–muscle brain (CK-MB, 0.43 ng/mL [− 0.29– 0.96], p < 0.01) and high-sensitivity troponin T (hsTnT, 0.001 ng/mL. [0.000– 0.003], p < 0.001) but without a higher risk of developing heart failure according to N-terminal prohormone of brain natriuretic peptide (NT-proBNP, − 5.7 pg/mL [− 38.8– 24.6], p = 0.17). Estimated glomerular filtration rate (eGFR) was impaired neither by the high-protein supplementation alone nor in combination with WB-EMS (CG 76.0 mL/min/1.73 m2 [71.9– 82.2] vs Protein 73.2 mL/min/1.73 m2 [63.0– 78.9] vs WB-EMS&P 74.6 mL/min/1.73 m2 [62.8– 84.1], p = 0.478).Conclusion: In conclusion, even in the vulnerable group of sarcopenic obese seniors, the combination of WB-EMS with a high-protein intake revealed no short-term, negative impact on the eGFR, but potential consequences for the cardiovascular system need to be addressed in future studies.Keywords: electromyostimulation, high protein, sarcopenic obesity, rhabdomyolysis, CK-MB, hsTnT, cystatin C

Samuel Schülein,1 Cornel Christian Sieber,2,3 Karl-Günter Gaßmann,1,2 Martin Ritt2,4 1Geriatrics Centre Erlangen, Malteser Waldkrankenhaus St. Marien, Erlangen, Germany; 2Institute for Biomedicine of Aging (IBA), Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Nürnberg, Germany; 3Department of Internal Medicine, Kantonsspital Winterthur, Winterthur, Switzerland; 4Department of Internal Medicine III, Klinikum Neumarkt, Kliniken des Landkreises Neumarkt i. d. OPf, Neumarkt, GermanyCorrespondence: Martin RittInstitute for Biomedicine of Ageing (IBA), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Kobergerstraße 60, Nürnberg D-90408, GermanyTel +49 9181 420 3076Fax +49 9181 420 3077Email Martin.Ritt@klinikum.neumarkt.deObjective: An analysis of the relationships between static equilibrium parameters and frailty status and/or severity across four different frailty measures.Design: Cross-sectional analysis.Setting: Geriatric wards of a general hospital.Participants: One hundred twenty-three geriatric inpatients comprising 70 women (56.5%) and 53 men (42.7%) with an age range of 68– 95 years.Methods: The variation in the center of pressure (CoP), ie, the length of sway, the area of sway, and the mean speed, was assessed for different positions/tasks: 1) wide standing with eyes open (WSEO); 2) wide standing with eyes closed (WSEC); 3) narrow standing with eyes open (NSEO) and 4) narrow standing with eyes closed (NSEC), using a force plate. Frailty status and/or frailty severity were evaluated using the frailty phenotype (FP), the clinical frailty scale (CFS), the 14-item frailty index based on a comprehensive geriatric assessment (FI-CGA), and a 47-item frailty index (FI).Results: WSEO length of sway (FP, CFS, FI-CGA, FI), WSEO area of sway (FP, CFS, FI-CGA, FI), and WSEO mean speed (FP, CFS, FI-CGA, FI), WSEC length of sway (FP, FI-CGA, FI), WSEC area of sway (FP, FI-CGA, FI) and WSEC mean speed (FI-CGA, FI), NSEO length of sway (FP, FI-CGA, FI), NSEO area of sway (FP, CFS, FI-CGA, FI), and NSEO mean speed (FP, CFS, FI-CGA, FI), NSEC length of sway (FI-CGA, FI), NSEC area of sway (FI-CGA, FI) and NSEC mean speed (FI-CGA, FI) were associated with the frailty status and/or severity across the four different frailty instruments (all p < 0.05, respectively).Conclusion: Greater fluctuations in CoP with increasing frailty status and/or severity were a uniform finding across various major frailty instruments.Keywords: frailty instruments, balance quality parameters, older people

Daniel Schoene,1,2 Claudia Heller,1 Yan N Aung,1 Cornel C Sieber,1,3 Wolfgang Kemmler,2 Ellen Freiberger11Institute for Biomedicine of Aging, Friedrich-Alexander University Erlangen-Nürnberg, Nuremberg, Germany; 2Institute of Medical Physics, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany; 3Department of General Internal and Geriatric Medicine, Hospital of the Order of St. John of God Regensburg, Regensburg, GermanyAbstract: Maintaining or improving quality of life (QoL) is a key outcome of clinical interventions in older people. Fear of falling (FoF) is associated with activity restriction as well as with poorer physical and cognitive functions and may be an important contributor to a diminished QoL. The objectives of this systematic review were to determine i) the effect of FoF on QoL in older people, ii) whether the association between these two constructs depends on the use of specific conceptualizations and measurement instruments, and iii) the role of fall events as mediating factor in this relationship. Four electronic databases (PubMed, EMBASE, CINAHL, and Cochrane Library) were searched from their inceptions to February 2018. Thirty mostly cross-sectional studies in nearly 30.000 people (weighted mean age 75.6 years (SD =6.1); 73% women) were included. FoF was associated with QoL in most studies, and this association appeared to be independent of the conceptualization of FoF. Moreover, this relationship was independent of falls people experienced which seemed to have a lower impact. FoF should be considered not only as by-product of falls and targeted interventions in parts different from those to reduce falls are likely required. Studies are needed showing that reducing FoF will lead to increased QoL.Keywords: fear of falling, falls efficacy, quality of life, accidental falls, aged, function

Jakob Jäger,1,2 Cornel Christian Sieber,1,3 Karl-Günter Gaßmann,1,2 Martin Ritt1,2 1Institute for Biomedicine of Ageing (IBA), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), D-90408 Nürnberg, Germany; 2Department of Internal Medicine III (Medicine of Ageing), Geriatrics Center Erlangen, Malteser Hospital Erlangen, D-91054 Erlangen, Germany; 3Department of General Internal Medicine and Geriatrics, Hospital of the Order of St John of God, D-93049 Regensburg, Germany Background: We aimed to evaluate the abilities of a 21-item frailty index based on laboratory blood and urine tests (FI-Lab21) assessed at different points in time, ie, at admission to hospital (FI-Lab21admission) and before discharge from hospital (FI-Lab21discharge), and the change of the FI-Lab21 during the hospital stay to predict 6-month and 1-year mortality in hospitalized geriatric patients. Methods: Five hundred hospitalized geriatric patients aged ≥65 years were included in this analysis. Follow-up data were acquired after a period of 6 months and 1 year. Results: The FI-Lab21admission and FI-Lab21discharge scores were 0.33±0.15 and 0.31±0.14, respectively (P

Martin Ritt,1,2 Jakob Jäger,2 Julia Isabel Ritt,2 Cornel Christian Sieber,1,3 Karl-Günter Gaßmann1,2 1Institute for Biomedicine of Ageing (IBA), Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Nuremberg, Germany; 2Department of Internal Medicine III (Medicine of Ageing), Geriatrics Center Erlangen, Hospital of the Congregation of St Francis Sisters of Vierzehnheiligen, Erlangen, Germany; 3Department of General Internal Medicine and Geriatrics, Hospital of the Order of St John of God, Regensburg, Germany Background: Uncomplicated frailty instruments are desirable for use in a busy clinical setting. The aim of this study was to operationalize a frailty index (FI) from routine blood and urine tests, and to evaluate the properties of this FI compared to other frailty instruments.Materials and methods: We conducted a secondary analysis of a prospective cohort study on 306 patients aged ≥65 years hospitalized on geriatric wards. An FI comprising 22 routine blood parameters and one standard urine parameter (FI-Lab), a 50-item FI based on a comprehensive geriatric assessment (FI-CGA), a combined FI (FI-combined [items from the FI-Lab + others from the FI-CGA]), the Clinical Frailty Scale, rule-based frailty definition, and frailty phenotype were operationalized from data obtained during patients’ hospital stays (ie, before discharge [baseline examination]). Follow-up data were obtained up to 1 year after the baseline examination.Results: The mean FI-Lab score was 0.34±15, with an upper limit of 0.74. The FI-Lab was correlated with all the other frailty instruments (all P

Martin Ritt,1,2 Julia Isabel Ritt,2 Cornel Christian Sieber,1,3 Karl-Günter Gaßmann1,2 1Institute for Biomedicine of Ageing (IBA), Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Nürnberg, 2Department of Internal Medicine III (Medicine of Ageing), Geriatrics Centre Erlangen, Hospital of the Congregation of St Francis Sisters of Vierzehnheiligen, Erlangen, 3Department of Internal Medicine and Geriatrics, Hospital of the Order of St John of God, Regensburg, Germany Background: Studies evaluating and comparing the power of frailty, comorbidity, and disability instruments, together and in parallel, for predicting mortality are limited.Objective: This study aimed to evaluate and compare the measures of frailty, comorbidity, and disability in predicting 1-year mortality in geriatric inpatients.Design: Prospective cohort study.Patients and setting: A total of 307 inpatients aged ≥65 years in geriatric wards of a general hospital participated in the study.Measurements: The patients were evaluated in relation to different frailty, comorbidity, and disability instruments during their hospital stays. These included three frailty (the seven-category Clinical Frailty Scale [CFS-7], a 41-item frailty index [FI], and the FRAIL scale), two comorbidity (the Cumulative Illness Rating Scale for Geriatrics [CIRS-G] and the comorbidity domain of the FI [Comorbidity-D-FI]), and two disability instruments (disability in basic activities of daily living [ADL-Katz] and the instrumental and basic activities of daily living domains of the FI [IADL/ADL-D-FI]). The patients were followed-up over 1 year.Results: Using FI, CIRS-G, Comorbidity-D-FI, and ADL-Katz, this study identified a patient group with a high (≥50%) 1-year mortality rate in all of the patients and the two patient subgroups (ie, patients aged 65–82 years and ≥83 years). The CFS-7, FI, FRAIL scale, CIRS-G, Comorbidity-D-FI, and IADL/ADL-D-FI (analyzed as full scales) revealed useful discriminative accuracy for 1-year mortality (ie, an area under the curve >0.7) in all the patients and the two patient subgroups (all P

Rainer Wirth,1,2 Rainer Dziewas,3 Anne Marie Beck,4 Pere Clavé,5 Shaheen Hamdy,6 Hans Juergen Heppner,7,8 Susan Langmore,9 Andreas Herbert Leischker,10 Rosemary Martino,11 Petra Pluschinski,12 Alexander Rösler,13 Reza Shaker,14 Tobias Warnecke,3 Cornel Christian Sieber,2,15 Dorothee Volkert2 1Department for Internal Medicine and Geriatrics, St Marien-Hospital Borken, Borken, Germany; 2Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany; 3Department of Neurology, University Hospital Münster, Münster, Germany; 4Department of Nutrition and Health, Faculty of Health and Technology, Metropolitan University College, Copenhagen, Denmark; 5Centro de Investigación Biomédica en Red de enfermadades Hepáticas y Digestivas (CIBERehd), Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain; 6Centre for Gastrointestinal Sciences, Institute of Inflammation and Repair, University of Manchester, Salford Royal Hospital, Salford, UK; 7Department of Geriatrics, Witten- Herdecke University, 8Helios Clinic Schwelm, Schwelm, Germany; 9Department of Speech, Language and Hearing Sciences, Boston University School of Medicine, Boston, MA, USA; 10Department of Geriatrics, Alexianer Hospital Krefeld, Krefeld, Germany; 11Department of Speech-Language Pathology, University of Toronto, Toronto, Canada; 12Department of Phoniatrics and Pediatric Audiology, University of Marburg, Marburg, Germany; 13Department of Geriatrics, Marien Hospital Hamburg, Hamburg, Germany; 14Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI, USA; 15Department of General Internal Medicine and Geriatrics, St John of God Hospital Regensburg, Regensburg, Germany Abstract: Oropharyngeal dysphagia (OD) is a highly prevalent and growing condition in the older population. Although OD may cause very severe complications, it is often not detected, explored, and treated. Older patients are frequently unaware of their swallowing dysfunction which is one of the reasons why the consequences of OD, ie, aspiration, dehydration, and malnutrition, are regularly not attributed to dysphagia. Older patients are particularly vulnerable to dysphagia because multiple age-related changes increase the risk of dysphagia. Physicians in charge of older patients should be aware that malnutrition, dehydration, and pneumonia are frequently caused by (unrecognized) dysphagia. The diagnosis is particularly difficult in the case of silent aspiration. In addition to numerous screening tools, videofluoroscopy was the traditional gold standard of diagnosing OD. Recently, the fiberoptic endoscopic evaluation of swallowing is increasingly utilized because it has several advantages. Besides making a diagnosis, fiberoptic endoscopic evaluation of swallowing is applied to evaluate the effectiveness of therapeutic maneuvers and texture modification of food and liquids. In addition to swallowing training and nutritional interventions, newer rehabilitation approaches of stimulation techniques are showing promise and may significantly impact future treatment strategies. Keywords: aspiration, dehydration, dysphagia, geriatric, malnutrition, older

Wolfgang Kemmler,1 Marc Teschler,1 Sabine Goisser,2 Michael Bebenek,1 Simon von Stengel,1 Leo Cornelius Bollheimer,2,3 Cornel C Sieber,2,3 Ellen Freiberger2 1Institute of Medical Physics, University of Erlangen-Nürnberg, Erlangen, Germany; 2Institute for Biomedicine of Aging, University Erlangen-Nürnberg, Nürnberg, Germany; 3Department of General Internal Medicine and Geriatrics, St John of God Hospital, Regensburg, GermanyBackground: Although sarcopenia represents a challenging burden for health care systems around the world, its prevalence in the elderly population varies widely. The primary aim of the study was to determine the prevalence of sarcopenia in community-dwelling (CD) German women aged 70 years and older; the secondary aim was to assess the effect of osteoarthritis (OA) on sarcopenia prevalence in this cohort.Methods: A total of 689 Caucasian females 18–35 years old and 1,325 CD females 70 years+ living in Northern Bavaria, Germany, were assessed during the initial phase of the FORMoSA research project. Anthropometry, total and regional muscle mass, were assessed by segmental multifrequency Bioelectrical Impedance Analysis. Further 10 m walking speed and handgrip strength were evaluated to apply the European Working Group on Sarcopenia in Older People definition of sarcopenia. Covariates were determined by questionnaires and interviews.Results: Applying the algorithm of the European Working Group on Sarcopenia in Older People of two standard deviations below the mean value for appendicular skeletal muscle mass of a reference cohort of the young cohort (5.66 kg/m2), low gait speed (≤0.8 m/s), and low grip strength (

Sabine Goisser,1 Wolfgang Kemmler,2 Simone Porzel,3 Dorothee Volkert,1 Cornel Christian Sieber,1,4 Leo Cornelius Bollheimer,1,4 Ellen Freiberger1 1Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Nuremberg, 2Institute of Medical Physics (IMP), Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, 3Nutricia GmbH, Danone Medical Nutrition, Erlangen, 4Department of Internal Medicine and Geriatrics, St John of God Hospital (Barmherzige Brüder), Regensburg, Germany Abstract: One of the many threats to independent life is the age-related loss of muscle mass and muscle function commonly referred to as sarcopenia. Another important health risk in old age leading to functional decline is obesity. Obesity prevalence in older persons is increasing, and like sarcopenia, severe obesity has been consistently associated with several negative health outcomes, disabilities, falls, and mobility limitations. Both sarcopenia and obesity pose a health risk for older persons per se, but in combination, they synergistically increase the risk for negative health outcomes and an earlier onset of disability. This combination of sarcopenia and obesity is commonly referred to as sarcopenic obesity. The present narrative review reports the current knowledge on the effects of complex interventions containing nutrition and exercise interventions in community-dwelling older persons with sarcopenic obesity. To date, several complex interventions with different outcomes have been conducted and have shown promise in counteracting either sarcopenia or obesity, but only a few studies have addressed the complex syndrome of sarcopenic obesity. Strong evidence exists on exercise interventions in sarcopenia, especially on strength training, and for obese older persons, strength exercise in combination with a dietary weight loss intervention demonstrated positive effects on muscle function and body fat. The differences in study protocols and target populations make it impossible at the moment to extract data for a meta-analysis or give state-of-the-art recommendations based on reliable evidence. A conclusion that can be drawn from this narrative review is that more exercise programs containing strength and aerobic exercise in combination with dietary interventions including a supervised weight loss program and/or protein supplements should be conducted in order to investigate possible positive effects on sarcopenic obesity. Keywords: sarcopenia, obesity, mobility, nutrition, weight loss diets, exercise, review, function

Community-acquired pneumonia is a common disease of the elderly and involves a high mortality risk. Demographic developments are creating new challenges for acute medical treatment strategies in geriatric patients with their underlying multimorbidity. In addition to the diagnostic parameters recorded on hospital admission, such as white cell count and C-reactive protein, procalcitonin, more than the risk scores CRB- and CURB-65 evaluated to date, appears to be a promising parameter for assessing the severity of pneumonia in elderly patients to allow early detection of severe courses and initiation of suitable treatment. The decisive factor is the dynamic course of the procalcitonin values over 3 consecutive days, as demonstrated in this case series. [ABSTRACT FROM AUTHOR]

Chronic diseases as well as aging are frequently associated with deterioration of nutritional status, loss muscle mass and function (i.e. sarcopenia), impaired quality of life and increased risk for morbidity and mortality. Although simple and effective tools for the accurate screening, diagnosis and treatment of malnutrition have been developed during the recent years, its prevalence still remains disappointingly high and its impact on morbidity, mortality and quality of life clinically significant. Based on these premises, the Special Interest Group (SIG) on cachexia-anorexia in chronic wasting diseases was created within ESPEN with the aim of developing and spreading the knowledge on the basic and clinical aspects of cachexia and anorexia as well as of increasing the awareness of cachexia among health professionals and care givers. The definition, the assessment and the staging of cachexia, were identified as a priority by the SIG. This consensus paper reports the definition of cachexia, pre-cachexia and sarcopenia as well as the criteria for the differentiation between cachexia and other conditions associated with sarcopenia, which have been developed in cooperation with the ESPEN SIG on nutrition in geriatrics. [ABSTRACT FROM AUTHOR]

Background: Although the percentage of obese nursing home residents is increasing, few longitudinal studies have reported on functionality and mortality in this subpopulation. The aim of the present study was to explore functionality and mortality in obese nursing home residents during a 1-year follow-up and to compare these results with those of residents within the normal and low BMI range. Methods: Two hundred residents (147 female, 53 male, mean age 85.6 ± 7.8 years) from 2 Nuremberg nursing homes were included. Body weight and height were measured in all participants. BMI was calculated and categorized as low (<20 kg/m2), normal (20–30 kg/m2), and high (>30 kg/m2). Handgrip strength, timed “up and go” test, and Barthel''s Activities of Daily Living were applied as functional parameters. All measurements were done at baseline and after a 1-year follow-up. Results: At baseline, the prevalence of obesity was 23.5%, whereas low BMI values were present in 8.5% of the residents. After 1 year, there was no significant decline of functionality in the obese group, whereas functional parameters deteriorated significantly in study participants with normal BMI. One-year mortality was lowest in the obese (12.8%), with no deaths in residents with BMI of 35 kg/m2 or higher. Mortality was highest in residents with low BMI (58.8%). Conclusion: In nursing home residents, obesity is associated with increased survival and stable functionality. These observations may therefore be regarded as an expression of “risk factor paradox” in this specific population of older individuals. [ABSTRACT FROM AUTHOR]

Background: Maintenance of physical function, mobility, and independent living are important goals for older adults. However, concerns about falling (CaF) play a central role in the vicious cycle of CaF, inflammation, loss of muscle mass, and decreasing physical function ultimately resulting in negative health outcomes. CaF, like other states of chronic stress and anxiety, can be considered as enduring adverse stimuli affecting the stress systems and the inflammatory system. Therefore, the aim of this study is to investigate whether a reduction of CaF leads to a reduction of stress and therefore possibly reduces chronic low-grade inflammation. Understanding the role and directionality of the effects of inflammation on CaF increases our understanding of age-related loss of mobility and physical function., Methods: In this study, community-dwelling older adults, aged 70 years and older, will be randomly assigned to either a 4-month, multi-component intervention with exercise training and cognitive-behavioral components or to a sham control group with light stretching exercises, cognitive training, and educational health lectures. For the operationalization of specific CaF, the Falls Efficacy Scale-International will be used. Stress and related psychological symptoms will be monitored using established self-reports and by measuring salivary cortisol. Concentrations of C-reactive protein, interleukin 6, interleukin 10, and tumor-necrosis-factor-alpha, as well as gene expression of selected inflammatory transcripts, will be used as surrogate parameters of the inflammatory status at baseline, after the 4-month intervention and 8-month follow-up., Discussion: This study will be the first to test whether CaF are related with stress system activity or reactivity or with markers of inflammation in the context of a multi-component intervention with exercise training and cognitive-behavioral components addressing CaF. The reduction of specific CaF or general psychological symptoms should reverse alterations in stress systems, and / or slow down low-grade inflammation. Changes in activity, as well as psychological and biological pathways leading from CaF to muscle loss will be measured, to disentangle the individual contribution to sarcopenia, and to provide an additional pathway to break or slow-down the vicious cycle of CaF and sarcopenia., Trial Registration: German Clinical Trials Register (DRKS): DRKS00029171 . Registered 22 July 2022., (© 2024. The Author(s).)

Background: Type 2 diabetes mellitus (DM) in older people is a heterogeneous condition that exhibits differential characteristics in comparison with younger adults. DM increases the risk of disability, is associated with dementia and loss of function, and cognition may often be interrelated and more pronounced in older patients with DM than in those without., Aims: Our aim was to evaluate the incidence of functional and/or cognitive impairment in older adults with and without DM, and its associated factors in DM participants., Methods: A 2-year prospective analysis was conducted in a European multicenter prospective cohort (SCOPE study). Older community-dwelling adults (aged ≥ 75 years) underwent a comprehensive geriatric assessment. New functional and/or cognitive decline was explored., Results: Of 1611 participants, 335 (22.0%) had DM at baseline. The percentage of participants scoring at least one ADL impairment and/or cognitive impairment (MMSE < 24) was similar in both groups (9.6%). Factors associated with any new disability in participants with DM in the multivariate analysis were female sex (OR 3.28, 95% CI 1.42-7.56), history of stroke (OR 4.58, 95% CI 1.64-12.7), and greater IADL dependency (OR 1.08 95% CI 1.02-1.15)., Discussion: Association between DM and cognitive or functional decline in outpatients of 75 years and older was not found, but factors such as female gender, history of stroke, and IADL dependency could be related., Conclusion: Decline in functional and cognitive status of community-dwelling older adults with DM was similar to participants without DM in a short period of 2 years of follow-up, though several clinical factors may increase its risk in this population., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: Older cyclists are in great risk of being injured or killed in a traffic-related accident and their needs should find more consideration in safety guidelines, urban planning, and future intervention programs., Objective: The aim for this cross-sectional analysis was to comprehensively explore characteristics of community-dwelling cyclists aged 65 years and older with a self-perceived need to increase cycle competence., Methods: 118 older adults (mean age 73.3 ± 5.2 years, 61% women) performed a standardized cycle course representing specific cycling skills. Additionally, health and functional assessments were carried out and characteristics regarding demographic, health, falls, bicycle equipment/type and cycling biography/behavior were obtained., Results: The majority (67.8%) of this community-dwelling adults reported being unsafe when cycling and 41.3% had a bicycle fall in the past year. More than half of the participants showed at least one limitation in each of the measured cycling skills. Women significantly had more frequent limitations in four of the cycling skills measured (p ≤ 0.001) compared to men. While no significant differences were found for falls, health and functional characteristics, women and men differed significantly in terms of bicycle type, equipment, and perceived safety (p < 0.001)., Conclusion: Limitations in cycling should be compensated by preventive bicycle training and a safe cycling infrastructure. Bicycle fit, the wearing of bicycle helmets and promotion of a sense of security while cycling can further reduce accident risk and must find recognition in safety guidelines. In addition, educational initiatives have to dismantle gender-related bicycle stereotypes., (© 2023. The Author(s).)

Background/objectives: The Protein Screener 55 + (Pro55 + ) is a brief food questionnaire to screen older community-dwelling adults for low protein intake. The result is the predicted probability of protein intake <1.0 g/kg adjusted body weight (aBW)/d ranging from 0-1. For purposes of cross-cultural validation, we translated the Pro55+ into German and tested its discriminative accuracy in detecting low protein intake of older community-dwelling people in Germany., Subjects/methods: After translation and pilot-testing, the Pro55+ and the reference standard (3-day dietary record) were completed by 144 participants (81.6 ± 3.9 years, 61.8% female). Discriminative properties were tested by receiver operating characteristic curves and by calculating sensitivity and specificity for different cut-offs of predicted probability (>0.3/>0.5/>0.7) using <1.0 or <0.8 g/kg aBW/d to define low protein intake., Results: Protein intake was <1.0 g/kg aBW/d in 39.6% of the sample and <0.8 g/kg aBW/d in 17.4%. Area under the curve was 62.0% (95%CI 52.6-71.5) and 68.8% (58.1-79.4), respectively. Specificity was 82-90% using probability cut-offs of 0.5 and 0.7 for both protein thresholds. Sensitivity was poor for protein threshold of 1.0 g/kg aBW/d regardless of the used probability cut-offs. For protein threshold of <0.8 g/kg aBW/d, sensitivity was 88.0% (71.8-96.9) using a probability cut-off of 0.09., Conclusion: The overall discriminative accuracy of the German Pro55+ to identify older community-dwelling people with low protein intake was poor. However, applying different probability cut-offs allows increasing specificity and sensitivity for 0.8 g/kg aBW/d to levels justifying the use for certain purposes e.g. excluding individuals with adequate protein intake. Further validation is needed., (© 2023. The Author(s).)

Background: The risk of older adults being injured or killed in a bicycle accident increases significantly due to the age-related decline of physical function. Therefore, targeted interventions for older adults to improve safe cycling competence (CC) are urgently needed., Methods: The "Safer Cycling in Older Age" (SiFAr) randomized controlled trial investigated if a progressive multi-component training program related to cycling improves CC of older adults. Between June 2020 and May 2022, 127 community-dwelling persons living in the area Nürnberg-Fürth-Erlangen, Germany aged 65 years and older were recruited, who are either (1) beginners with the e-bike or (2) feeling self-reported unsteadiness when cycling or (3) uptaking cycling after a longer break. Participants were either randomized 1:1 to an intervention group (IG; cycling exercise program, 8 sessions within 3 months) or an active control group (aCG; health recommendations). The CC as primary outcome was tested not blinded in a standardized cycle course prior and after the intervention period and after 6-9 months, which consists of variant tasks requiring skills related to daily traffic situations. Regression analyses with difference of errors in the cycling course as dependent variable and group as independent variable adjusted for covariates (gender, number of errors at baseline, bicycle type, age and cycled distance) were performed., Results: 96 participants (73.4 ± 5.1 years; 59.4% female) were analyzed for primary outcome. Compared to the aCG (n = 49), the IG (n = 47) made an average of 2.37 fewer errors in the cycle course after the 3 months intervention period (p = 0.004). People with more errors at baseline had higher potential for improvement (B=-0.38; p < 0.001). Women on average made 2.31 (p = 0.016) more errors than men, even after intervention. All other confounders had no significant effect on the difference in errors. The intervention effect was very stable until 6-9 months after the intervention (B=-3.07, p = 0.003), but decreased with a higher age at baseline in the adjusted model (B = 0.21, p = 0.0499)., Conclusion: The SiFAr program increases cycling skills among older adults with self-perceived needs for improvement in CC and could easily be made available to a broad public due to its standardized structure and a train-the-trainer approach., Trial Registration: This study was registered with clinicaltrials.gov: NCT04362514 (27/04/2020), https://clinicaltrials.gov/ct2/show/NCT04362514 ., (© 2023. The Author(s).)

The neutrophil-to-lymphocyte ratio (NLR) is a marker for systemic inflammation. Since inflammation plays a relevant role in vascular aging, the aim of this study was to investigate whether NLR is associated with blood pressure profiles in older adults. This study was performed within the framework of the SCOPE study including 2461 outpatients aged 75 years and over. Mean blood pressure values, namely systolic blood pressure (SBP), diastolic blood pressure (DBP) and pulse pressure (PP) were investigated across tertiles of NLR. Change in blood pressure levels in 2 years of follow-up were compared across categories of baseline NLR. Data of 2397 individuals were used, of which 1854 individuals had hypertension. Mean values of blood pressure did not differ across categories of baseline NLR in individuals without hypertension. Individuals with hypertension with a high-range NLR had lower SBP and PP when compared to those in low-range NLR (mean difference SBP -2.94 mmHg, p = 0.032 and PP -2.55 mmHg, p = 0.030). Mean change in blood pressure in 2 years did only slightly differ in non-clinically relevant ranges, when compared across tertiles of baseline NLR. NLR as a marker of inflammaging was not associated with unfavorable blood pressure profiles in older individuals with or without hypertension.

Objectives: Frailty is common in nursing home (NH) residents, but its prevalence in German institutions is unknown. Valid and easy-to-use screening tools are needed to identify frail residents. We used the FRAIL-NH scale and the Clinical Frailty Scale (CFS) to (1) obtain the prevalence of frailty, (2) investigate the agreement between both instruments, and (3) evaluate their predictive validity for adverse health events in German NH residents., Design: Prospective cohort study., Setting and Participants: German NH residents (n = 246, age 84 ± 8 years, 67% female)., Methods: Frailty status was categorized according to FRAIL-NH (nonfrail, frail, most frail) and CFS (not frail, mild to moderately frail, severely frail). Agreement between instruments was examined by Spearman correlation, an area under the receiver operating characteristic curve (AUC) with 95% CI, and sensitivity and specificity using the "most frail" category of FRAIL-NH as reference standard. Adverse health events (death, hospital admissions, falls) were recorded for 12 months, and multivariate cox and logistic regression models calculated., Results: According to FRAIL-NH, 71.1% were most frail, 26.4% frail, and 2.5% nonfrail. According to CFS, 66.3% were severely frail, 26.8% mild to moderately frail, and 6.9% not frail. Both scales correlated significantly (r = 0.78; R 2  = 60%). The AUC was 0.92 (95% CI 0.88-0.96). Using a CFS cutoff of 7 points, sensitivity was 0.90 and specificity 0.92. The frailest groups according to both instruments had an increased risk of death [FRAIL-NH hazard ratio (HR) 2.19, 95% CI 1.21-3.99; CFS HR 2.56, 95% CI 1.43-4.58] and hospital admission [FRAIL-NH odds ratio (OR) 1.95, 95% CI 1.06-3.58; CFS OR 1.79, 95% CI 1.01-3.20] compared to less frail residents. The FRAIL-NH predicted recurrent faller status (OR 2.57, 95% CI 1.23-5.39)., Conclusions and Implications: Frailty is highly prevalent in German NH residents. Both instruments show good agreement despite different approaches and are able to predict adverse health outcomes. Based on our findings and because of its simple administration, CFS may be an alternative to FRAIL-NH for assessing frailty in NHs., (Copyright © 2022 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Obesity and sarcopenic obesity (SO) are characterized by excess body fat with or without low muscle mass affecting bio-psycho-social health, functioning, and subsequently quality of life in older adults. We mapped outcomes addressed in randomized controlled trials (RCTs) on lifestyle interventions in community-dwelling older people with (sarcopenic) obesity. Systematic searches in Medline, Embase, Cochrane Central, CINAHL, PsycInfo, Web of Science were conducted. Two reviewers independently performed screening and extracted data on outcomes, outcome domains, assessment methods, units, and measurement time. A bubble chart and heat maps were generated to visually display results. Fifty-four RCTs (7 in SO) reporting 464 outcomes in the outcome domains: physical function (n = 42), body composition/anthropometry (n = 120), biomarkers (n = 190), physiological (n = 30), psychological (n = 47), quality of life (n = 14), pain (n = 4), sleep (n = 2), medications (n = 3), and risk of adverse health events (n = 5) were included. Heterogeneity in terms of outcome definition, assessment methods, measurement units, and measurement times was found. Psychological and quality of life domains were investigated in a minority of studies. There is almost no information beyond 52 weeks. This evidence map is the first step of a harmonization process to improve comparability of RCTs in older people with (sarcopenic) obesity and facilitate the derivation of evidence-based clinical decisions., (© 2022 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of World Obesity Federation.)

Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

Purpose: Individualised interventions are recommended to tackle malnutrition in older adults, but approaches for nursing home (NH) residents are scarce. This study investigated the effects of an individualised nutritional intervention in NH residents with (risk of) malnutrition., Methods: In a pre-post study, 6 weeks (w) of usual care were followed by 6w of intervention. The intervention consisted of up to three supplement modules (sweet and savoury protein creams and protein-energy drink, single or combined) and, if required, reshaped texture-modified meals (RTMM)., Results: Fifty residents completed the study (84 ± 8 years, 74% female). One-third (32%) received RTMM. Additional 258 ± 167 kcal/day and 23 ± 15 g protein/day were offered. Mean daily energy intake increased by 207 (95%CI 47-368, p = 0.005) kcal and protein intake by 14 (7-21, p < 0.001) g (w12 vs w1). Quality of life (QoL) increased in the subscale "care relationship" (+ 9 (3-15) points, p = 0.002, w12 vs w6). Body weight, handgrip strength, and other QoL subscales did not change., Conclusion: Our intervention improved dietary intake and one QoL subscale in NH residents with (risk of) malnutrition. As a next step, randomized controlled trials are needed to investigate the impact of individualised interventions more comprehensively., (© 2021. The Author(s).)