Inflammatory markers and incident frailty in men and women:the English Longitudinal Study of Ageing

Cross-sectional studies show that higher blood concentrations of inflammatory markers tend to be more common in frail older people, but longitudinal evidence that these inflammatory markers are risk factors for frailty is sparse and inconsistent. We investigated the prospective relation between baseline concentrations of the inflammatory markers C-reactive protein (CRP) and fibrinogen and risk of incident frailty in 2,146 men and women aged 60 to over 90 years from the English Longitudinal Study of Ageing. The relationship between CRP and fibrinogen and risk of incident frailty differed significantly by sex (p for interaction terms <0.05). In age-adjusted logistic regression analyses, for a standard deviation (SD) increase in CRP or fibrinogen, odds ratios (95 % confidence intervals) for incident frailty in women were 1.69 (1.32, 2.17) and 1.39 (1.12, 1.72), respectively. Further adjustment for other potential confounding factors attenuated both these estimates. For an SD increase in CRP and fibrinogen, the fully-adjusted odds ratio (95 % confidence interval) for incident frailty in women was 1.27 (0.96, 1.69) and 1.31 (1.04, 1.67), respectively. Having a high concentration of both inflammatory markers was more strongly predictive of incident frailty than having a high concentration of either marker alone. In men, there were no significant associations between any of the inflammatory markers and risk of incident frailty. High concentrations of the inflammatory markers CRP and fibrinogen are more strongly predictive of incident frailty in women than in men. Further research is needed to understand the mechanisms underlying this sex difference

Papel de los profesionales de la atención primaria en el manejo de la sarcopenia

La sarcopenia fue definida por primera vez en 1989 por Irwin H. Rosenberg como la pérdida involuntaria de masa y fuerza muscular asociado a la edad.Con posterioridad, varios han sido los esfuerzos para llegar a una definición y a unos criterios diagnósticos, y no fue hasta el año 2010 cuando el European Working Group on Sarcopenia in Older People (EWGSOP), que incluía representantes de la Sociedad Europea de Medicina Geriátrica, de la Sociedad Europea de Nutrición Clínica y Metabolismo, de la Asociación Internacional de Gerontología y Geriatría-Región Europea y de la Asociación Internacional de Nutrición y Envejecimiento, que por consenso, llegó a definir a la sarcopenia como «un síndrome caracterizado por una progresiva y generalizada pérdida de masa y fuerza muscular esquelética con riesgo de resultados negativos como discapacidad física, peor calidad de vida y muerte».La sarcopenia es común en la población anciana, con una prevalencia entre el 9 y el 18% en mayores de 64 años y entre el 11 y el 50% en personas mayores de 80 años.El impacto sanitario que tiene la sarcopenia es importante y no tan solo en términos de morbilidad, discapacidad y mortalidad, sino también en relación con el gasto sanitario. Así, en el año 2000 en Estados Unidos se estimó unos costes directos relacionados con la sarcopenia de 18,5 mil millones de dólares.Entre los factores de riesgo asociados con la presencia de sarcopenia, hay que destacar la edad avanzada. Con el envejecimiento, como proceso biológico natural, hay una pérdida de masa y fuerza muscular como resultado de una interacción de varios factores: cambios intrínsecos en el músculo (disminución del número de fibras musculares, preferentemente del tipo II y daño en el ADN mitocondrial), cambios en el sistema nervioso central (disminución del número de motoneuronas alfa del asta anterior de la médula espinal) y cambios hormonales (descenso de hormonas anabolizantes como testosterona, estrógenos, descensos en la hormona de crecimiento y aumento de distintas interleukinas). Otros factores asociados son el género, los bajos niveles de actividad física, una nutrición inadecuada, la presencia de comorbilidades y el bajo peso al nacer.La sarcopenia juega un papel determinante en la fisiopatología de la fragilidad, predispone a las caídas, al deterioro funcional, a la discapacidad, al uso de recursos hospitalarios y sociales, a una peor calidad de vida y, finalmente, a la muerte.El tratamiento de la sarcopenia se basa fundamentalmente en el ejercicio físico (ejercicios de resistencia) y la nutrición (mejorando el consumo diario de proteínas). En la actualidad, existe un creciente interés por diferentes intervenciones farmacológicas, pero la evidencia actual sobre el beneficio de algunos fármacos específicos es limitada5.La sarcopenia tanto por su impacto clínico, social o económico es objeto de debate y estudio por diferentes profesionales sanitarios, particularmente por aquellos procedentes de los ámbitos de la investigación y de la geriatría, pero, ¿cuál es el papel de los profesionales de la atención primaria? ¿Por qué no estamos más presentes en los foros científicos de discusión sobre la sarcopenia?Las consecuencias de la sarcopenia en personas mayores son graves y los profesionales de la atención primaria nos encontramos en un lugar privilegiado para la detección, evaluación y tratamiento de estos pacientes. Por ejemplo, no es infrecuente encontrarnos en el día a día de las consultas de atención primaria a pacientes que presentan dificultades para las actividades de la vida diaria, historia recurrente de caídas, hospitalizaciones recientes o la presencia de enfermedades crónicas asociadas a una pérdida de fuerza y masa muscular.La EWGSOP ha desarrollado un algoritmo diagnóstico basado en la velocidad de la marcha, con un punto de corte de más de 0,8 m/s y la fuerza de aprehensión como identificador de riesgo de la sarcopenia. Ambas herramientas son sencillas, coste-efectivas y de fácil aplicación en la atención primaria, aunque el acceso, por ejemplo, a la absorciometría por energía dual de rayos X (DXA) para evaluar la masa muscular puede ser más problemático.Con el objetivo de prevenir o retrasar la aparición de la sarcopenia, los profesionales de la atención primaria tenemos un papel clave, en primer lugar, deberíamos considerar siempre su posibilidad y como consecuencia de ello, iniciar y desarrollar estrategias terapéuticas basadas en fomentar cambios en aquellos estilos de vida no saludables, en promover la práctica del ejercicio físico (fundamentalmente ejercicios de resistencia que mejoran la masa y fuerza muscular, el equilibrio y la resistencia) y establecer estrategias dietéticas adecuadas a su edad (adecuada ingesta diaria de proteínas).Así mismo, tampoco deberíamos renunciar a participar o liderar proyectos de investigación sobre la sarcopenia con el objetivo de encontrar formas eficaces de prevenir y manejar este problema desde la atención primaria

Prevalence and risk factors for falls in men and women:The English Longitudinal Study of Ageing

Backgroundfalls are a major cause of disability and death in older people. Women are more likely to fall than men, but little is known about whether risk factors for falls differ between the sexes. We used data from the English Longitudinal Study of Ageing to investigate the prevalence of falls by sex and to examine cross-sectionally sex-specific associations between a range of potential risk factors and likelihood of falling.Methodsparticipants were 4,301 men and women aged 60 and over who had taken part in the 2012–13 survey of the English Longitudinal Study of Ageing. They provided information about sociodemographic, lifestyle and behavioural and medical factors, had their physical and cognitive function assessed and responded to a question about whether they had fallen down in the last two years.Resultsin multivariable logistic regression models, severe pain and diagnosis of at least one chronic disease were independently associated with falls in both sexes. Sex-specific risk factors were incontinence (odds ratio (OR), 1.48; 95% CI, 1.19, 1.85) and frailty (OR 1.69, 95% CI 1.06, 2.69) in women, and older age (OR 1.02, 95% CI 1.04, 1.07), high levels of depressive symptoms (OR 1.33, 95% CI 1.05, 1.68), and being unable to perform a standing balance test (OR 3.32, 95% CI 2.09, 5.29) in men.Conclusionalthough we found some homogeneity between the sexes in the risk factors that were associated with falls, the existence of several sex-specific risk factors suggests that gender should be taken into account in designing fall-prevention strategies

Comparing associations of handgrip strength and chair stand performance with all-cause mortality—implications for defining probable sarcopenia: the Tromsø Study 2015–2020

Background Widely adopted criteria suggest using either low handgrip strength or poor chair stand performance to identify probable sarcopenia. However, there are limited direct comparisons of these measures in relation to important clinical endpoints. We aimed to compare associations between these two measures of probable sarcopenia and all-cause mortality. Methods Analyses included 7838 community-dwelling participants (55% women) aged 40–84 years from the seventh survey of the Tromsø Study (2015–2016), with handgrip strength assessed using a Jamar + Digital Dynamometer and a five-repetition chair stand test (5-CST) also undertaken. We generated sex-specific T-scores and categorised these as “not low”, “low”, and “very low” handgrip strength or 5-CST performance. Cox Proportional Hazard regression models were used to investigate associations between these two categorised performance scores and time to death (up to November 2020 ascertained from the Norwegian Cause of Death registry), adjusted for potential confounders including lifestyle factors and specific diseases. Results A total of 233 deaths occurred (median follow-up 4.7 years) with 1- and 5-year mortality rates at 3.1 (95% confidence interval [CI] 2.1, 4.6) and 6.3 (95% CI 5.5, 7.2) per 1000 person-years, respectively. There was poor agreement between the handgrip strength and 5-CST categories for men (Cohen’s kappa [κ] = 0.19) or women (κ = 0.20). Fully adjusted models including handgrip strength and 5-CST performance mutually adjusted for each other, showed higher mortality rates among participants with low (hazard ratio [HR] 1.22, 95% CI 0.87, 1.71) and very low (HR 1.68, 95% CI 1.02, 2.75) handgrip strength compared with the not low category. Similar associations, although stronger, were seen for low (HR 1.88, 95% CI 1.38, 2.56) and very low (HR 2.64, 95% CI 1.73, 4.03) 5-CST performance compared with the not low category. Conclusions We found poor agreement between T-score categories for handgrip strength and 5-CST performance and independent associations with mortality. Our findings suggest that these tests identify different people at risk when case-finding probable sarcopenia. As discussions on an international consensus for sarcopenia definitions proceed, testing both handgrip strength and chair stand performance should be recommended rather than viewing these as interchangeable assessments

Personality and risk of frailty:The English longitudinal study of ageing

There is evidence that the personality traits conscientiousness, extraversion and neuroticism are associated with health behaviours and with risk of various health outcomes. We hypothesised that people who are lower in conscientiousness or extraversion or higher in neuroticism may be at greater risk of frailty in later life.We used general linear models to examine the prospective relation between personality, assessed using the Midlife Development Inventory, and change in frailty, modelled by a frailty index, in 5314 men and women aged 60 to over 90 years from the English Longitudinal Study of Ageing.Men and women with higher levels of neuroticism or lower levels of extraversion or conscientiousness had an increased frailty index score at follow-up. After adjustment for potential confounding or mediating variables, including frailty index score at baseline, the frailty index score at follow-up-which potentially ranges from 0 to 1-was higher by 0.035 (95 % confidence interval 0.018, 0.052) for a standard deviation increase in neuroticism and lower by 0.061 (0.031, 0.091) or 0.045 (0.020, 0.071) for a standard deviation increase in extraversion or conscientiousness, respectively. There was some evidence that the association between extraversion and frailty may be due to reverse causation whereby poorer health affected responses to items in the personality inventory.Higher levels of neuroticism or lower levels of conscientiousness or extraversion may be risk factors for the onset or progression of frailty. Future studies need to replicate these observations in other populations and explore the mechanisms underlying these associations

The developmental origins of sarcopenia: using peripheral quantitative computed tomography to assess muscle size in older people

Background: a number of studies have shown strong graded positive relationships between size at birth, grip strength, and estimates of muscle mass in older people. However no studies to date have included direct measures of muscle size. Methods: we studied 313 men and 318 women born in Hertfordshire, United Kingdom between 1931 and 1939 who were still resident there and had historical records of growth in early life. Information on lifestyle was collected. and participants underwent peripheral quantitative computed tomography to directly measure forearm and calf muscle size. Results: birth weight was positively related to forearm muscle area in the men (r = 0.24. p &lt; .0001) and women (r = 0.17, p = .003). There were similar but weaker associations between birth weight and calf muscle area in the men (r = 0.13, p = .03) and in the women (r = 0.17, p = .004). These relationships were all attenuated by adjustment for adult size. Conclusion: we present first evidence that directly measured muscle size in older men and women is associated with size at birth. This may reflect tracking of muscle size and is important because it suggests that benefit may be gained from taking a life course approach both to understanding the etiology of sarcopenia and to developing effective interventions<br/

Recruitment strategies for sarcopenia trials – lessons from the LACE randomised controlled trial

Background: Sarcopenia is rarely diagnosed and is not recorded electronically in routine clinical care, posing challenges to trial recruitment. We describe the performance of four components of a strategy to efficiently recruit participants with sarcopenia to a trial of perindopril and/or leucine for sarcopenia: primary care vs. hospital recruitment, a comparison of central vs. local telephone pre-screening, performance of a questionnaire on physical function conducted as part of the pre-screening telephone call, and performance of bioimpedance measurement to identify low muscle mass. Methods: Hospital-based recruitment took place through inpatient and outpatient geriatric medicine services. Local research nurses reviewed medical notes and approached potentially eligible patients. Primary care recruitment reviewed primary care lists from collaborating practices, sending mailshots to patients aged 70 and over who were not taking angiotensin-converting enzyme inhibitors. Telephone pre-screening was conducted either by research nurses at each site or centrally by Tayside Clinical Trials Unit. The 10-point SARC-F questionnaire was used for pre-screening. De-identified recruitment information was held on a central electronic tracking system and analysed using SPSS. Bioimpedance was measured using the Akern BIA 101 system, with the Sergi equation used to estimate lean mass. Results: Fourteen UK sites recruited to the trial. The 1202 sets of notes in hospital-based care were reviewed at these sites; 7 participants (0.6% of total notes screened) were randomized. From primary care, 13 808 invitations were sent; 138 (1.0% of total invited) were randomized. 633/2987 primary care respondents were pre-screened centrally; the mean number of calls per respondent was 2.3. For 10 sites where central and local pre-screening could be compared, the conversion rate from pre-screening to randomization was 18/588 (3.1%) for centralized calls, compared with 73/1814 (4.0%) for local pre-screening calls (P = 0.29). A weak relationship was seen between higher (worse) SARC-F score at screening and lower likelihood of progression to randomization (r = −0.08, P = 0.03). Muscle mass estimates generated using the Sergi equation were systematically biased, and a recalibrated equation for bioimpedance-estimated muscle mass was derived. Conclusions: Primary care recruitment led to higher response rates and overall numbers randomized than hospital-based recruitment. Centralized pre-screening saved local research nurses' time but did not improve conversion to randomization. SARC-F did not help to target screening activity in this sarcopenia trial, and a recalibration of the equation for estimating muscle mass from bioimpedance measures may improve accuracy of the screening process

Sleep disturbance and the older worker:Findings from the Health and Employment After Fifty study

Objectives: The aim of this study was to characterize the descriptive epidemiology of insomnia in midlife and explore the relative importance of different occupational risk factors for insomnia among older workers.Methods: A questionnaire was mailed to all adults aged 50–64 years registered with 24 English general practices. Insomnia was defined as having at least one of four problems with sleep severely in the past three months. Subjects were also asked about employment conditions, feelings concerning work, and their health. Associations were assessed by logistic regression and population attributable fractions (PAF) calculated.Results: Analysis was based on 8067 respondents (5470 in paid work), 18.8% of whom reported insomnia. It was more common among women, smokers, obese individuals, those living alone, and those in financial hardship, and less prevalent among the educated, those in South-East England, and those with friendships and leisure-time pursuits. Occupational risk factors included unemployment, shift working, lack of control and support at work, job insecurity, job dissatisfaction and several of its determinants (lacking a sense of achievement, feeling unappreciated, having difficult work colleagues, feeling unfairly criticized). Population burden of insomnia was associated more strongly with difficulties in coping with work demands, job insecurity, difficult colleagues, and lack of friendships at work [population attributable fraction (PAF) 15–33%] than shift work and lack of autonomy or support (PAF 5–7%). It was strongly associated with seven measures of poorer self-assessed health.Conclusions: Employment policies aimed at tackling insomnia among older workers may benefit from focusing particularly on job–person fit, job security and relationships in the workplace.<br/

Global variation in grip strength: a systematic review and meta-analysis of normative data.

Background: weak grip strength is a key component of sarcopenia and is associated with subsequent disability and mortality. We have recently established life course normative data for grip strength in Great Britain, but it is unclear whether the cut 209 Global variation in grip strength points we derived for weak grip strength are suitable for use in other settings. Our objective was to investigate differences in grip strength by world region using our data as a reference standard. Methods: we searched MEDLINE and EMBASE for reporting age- and gender-stratified normative data for grip strength. We extracted each item of normative data and converted it on to a Z-score scale relative to our British centiles. We performed meta-regression to pool the Z-scores and compare them by world region. Findings: our search returned 806 abstracts. Sixty papers met inclusion criteria and reported on 63 different samples. Seven UN regions were represented, although most samples (n = 44) were based in developed regions. We extracted 726 normative data items relating to 96,537 grip strength observations. Normative data from developed regions were broadly similar to our British centiles, with a pooled Z-score 0.12 SDs (95% CI: 0.07, 0.17) above the corresponding British centiles. By comparison, normative data from developing regions were clearly lower, with a pooled Z-score of −0.85 SDs (95% CI: −0.94, −0.76). Interpretation: our findings support the use of our British grip strength centiles and their associated cut points in consensus definitions for sarcopenia and frailty across developed regions, but highlight the need for different cut points in developing region