Prevalence of sarcopenia and associated factors in older adults attending a day hospital service in Ireland

Purpose: Sarcopenia is a muscle disease that is linked to the effects of ageing, chronic diseases, physical inactivity, and poor nutrition. In Ireland, there is a lack of readily available information on sarcopenia in older adults. The aim of this study was to describe the prevalence and associated factors of sarcopenia in community-dwelling older adults attending a day hospital service in Ireland, using the European Working Group of Sarcopenia in Older People (EWGSOP) guidelines.Methods: An observational cross-sectional study was conducted, where a consecutive series of older adults attending a day hospital service were invited to participate. The measure of primary interest was the diagnosis of sarcopenia using the EWGSOP 2019 guidelines. We also collected other Comprehensive Geriatric Assessment measures including cognition, nutrition, frailty and physical activity.Results: A total of 134 participants took part in the study. The mean age was 81.7 (SD ± 7.1). Sixty-one percent (N = 82) were female. The prevalence of sarcopenia ranged from 27 to 37% depending on the assessment tool used to assess muscle strength. Sarcopenia was associated with older age, frailty, reduced nutritional state, poor physical performance and reduced anthropometric measures, irrespective of how muscle strength was measured. Independently associated factors differed depending on muscle strength test, except for older age.Conclusion: The prevalence of sarcopenia in the day hospital ranged from 27 to 37%. The assessment tool used to assess muscle strength influenced both the prevalence and associated factors of sarcopenia, suggesting scope for further research.</p

Using accelerometers in the assessment of sarcopenia in older adults attending a day hospital service in Ireland

Objectives: The aim of this study was to describe the associations between sarcopenia and variables derived from wrist accelerometry in community-dwelling older adults attending a day hospital service in Ireland. Methods: An observational cross-sectional study was carried out using a consecutive series of older adults attending a day hospital service. Sarcopenia was diagnosed using the latest European Working Group of Sarcopenia in Older People guidelines. Accelerometers were worn by each participant for a 7-day period on their non-dominant wrist. Results: Thirty-eight out of forty-one participants (93%) met the accelerometer wear time criterion and were included in statistical analyses. Included participants had a mean age of 81.1 years (standard deviation 6.2). Both sarcopenia (Grip) and sarcopenia (Lower limb) were associated with increased time spent in low physical activity and reduced average of Kcals per hour. Only sarcopenia (Lower limb) was associated with increased time in sedentary behaviour as well as reduced number of steps taken in a week. Conclusions: Accelerometer data can be used in an older day hospital population to track physical activity levels and sedentary behaviours. The assessment tool used to assess muscle strength and the cut-off criteria for physical activity behaviour influences the association with sarcopenia.</p

Does the shoe really fit? Characterising ill-fitting footwear among community dwelling older adults: an observational cross-sectional study

Background: Falls in older people are common and can result in loss of confidence, fear of falling, restriction in activity and loss of independence. Causes of falls are multi-factorial. There is a paucity of research assessing the footwear characteristics among older people who are at high risk of falls, internationally and in the Irish setting. The aim of this study was to examine the proportion of older adults attending a geriatric day hospital in Ireland who were wearing incorrectly sized shoes. Methods: A consecutive sample of 111 older adults aged 60 years and over attending a geriatric day hospital in a large Irish teaching hospital was recruited. Demographic data including age, mobility, medications, co-habitation status, footwear worn at home and falls history were recorded. Shoe size and foot length were measured in millimetres using an internal shoe gauge and SATRA shoe size stick, respectively. Participants' self-reported shoe size was recorded. Footwear was assessed using the Footwear Assessment Form (FAF). A Timed Up and Go (TUG) score was recorded. Functional independence was assessed using the Nottingham Extended Activities of Daily Living (NEADL) Scale. The primary outcome of interest in this study was selected as having footwear within the suggested range (10 to 15 mm) on at least one foot. Participants who met this definition were compared to those with ill-fitting footwear on both feet using Chi-square tests, T-tests or Mann-Whitney U tests. Results: The mean difference between shoe length and foot length was 18.6 mm (SD: 9.6 mm). Overall, 72% of participants were wearing footwear that did not fit correctly on both feet, 90% had shoes with smooth, partly worn or fully worn sole treading and 67% reported wearing slippers at home. Participant age, TUG score and NEADL score were not associated with ill-fitting footwear. Conclusions: Wearing incorrectly fitting shoes and shoes with unsafe features was common among older adults attending geriatric day services in this study. A large number of participants reported wearing slippers at home.</p

Does the shoe really fit? Characterising ill-fitting footwear among community-dwelling older adults attending geriatric services: an observational cross-sectional study

Background: Falls in older people are common and can result in loss of confidence, fear of falling, restriction in activity and loss of independence. Causes of falls are multi-factorial. There is a paucity of research assessing the footwear characteristics among older people who are at high risk of falls, internationally and in the Irish setting. The aim of this study was to examine the proportion of older adults attending a geriatric day hospital in Ireland who were wearing incorrectly sized shoes. Methods: A consecutive sample of 111 older adults aged 60 years and over attending a geriatric day hospital in a large Irish teaching hospital was recruited. Demographic data including age, mobility, medications, co-habitation status, footwear worn at home and falls history were recorded. Shoe size and foot length were measured in millimetres using an internal shoe gauge and SATRA shoe size stick, respectively. Participants' self-reported shoe size was recorded. Footwear was assessed using the Footwear Assessment Form (FAF). A Timed Up and Go (TUG) score was recorded. Functional independence was assessed using the Nottingham Extended Activities of Daily Living (NEADL) Scale. The primary outcome of interest in this study was selected as having footwear within the suggested range (10 to 15 mm) on at least one foot. Participants who met this definition were compared to those with ill-fitting footwear on both feet using Chi-square tests, T-tests or Mann-Whitney U tests. Results: The mean difference between shoe length and foot length was 18.6 mm (SD: 9.6 mm). Overall, 72% of participants were wearing footwear that did not fit correctly on both feet, 90% had shoes with smooth, partly worn or fully worn sole treading and 67% reported wearing slippers at home. Participant age, TUG score and NEADL score were not associated with ill-fitting footwear. Conclusions: Wearing incorrectly fitting shoes and shoes with unsafe features was common among older adults attending geriatric day services in this study. A large number of participants reported wearing slippers at home.</p

The association between proton pump inhibitors and hyperparathyroidism: a potential mechanism for increased fracture—results of a large observational cohort study

Summary Proton pump inhibitors (PPIs) are associated with increased risk of osteoporotic fracture; however, the mechanism is unclear. PPI users taking calcium supplements were more likely to have hyperparathyroidism compared to non-users (OR 1.56, CI 1.08–2.23, p=0.018). This highlights the importance of monitoring PPI use, especially in older adults.Purpose Proton pump inhibitors (PPIs) are associated with increased risk of osteoporotic fracture. Hyperparathyroidism may be implicated, but few studies have considered this relationship. This study evaluated the relationship between PPI use and hyperparathyroidism in older adults.Methods Participants were from the TUDA study, a large cross-sectional cohort of older Irish adults. Participants with an estimated glomerular fltration rate (eGFR)2.5 mmol/l were excluded to avoid hyperpar-athyroidism due to chronic renal disease and primary hyperparathyroidism. Hyperparathyroidism was defned as a parathyroid hormone (PTH)>65 pg/ml. Multivariate regression models were used to analyse the relationship between PPI use and hyperparathyroidism.Results A total of 4139 participants met the inclusion criteria, of whom 37.8% (n=1563) were taking PPI medication. PPI use was identifed in 41.4% of calcium supplement users and 35.4% of non-calcium supplement users. Overall, compared to non-users of PPIs, those taking PPIs were older (74.8 vs 72.9 years, pDiscussion The results are consistent with the hypothesis of PPIs reducing calcium absorption, leading to a rise in PTH which could mediate increased fracture risk. No relationship of PPI use with hyperparathyroidism was observed in non-users of calcium supplements, possibly owing to lower dietary calcium intake. These results highlight the importance of monitoring PPI use, especially in older adults at risk of fracture.</p

Home FIRsT: interdisciplinary geriatric assessment and disposition outcomes in the Emergency Department

Background: Older people in the Emergency Department (ED) are clinically heterogenous and some presentations may be better suited to alternative out-of-hospital pathways. A new interdisciplinary comprehensive geriatric assessment (CGA) team (Home FIRsT) was embedded in our acute hospital's ED in 2017.Aim: To evaluate if routinely collected CGA metrics were associated with ED disposition outcomes.Design: Retrospective observational study.Methods: We included all first patients seen by Home FIRsT between 7th May and 19th October 2018. Collected measures were sociodemographic, baseline frailty (Clinical Frailty Scale), major diagnostic categories, illness acuity (Manchester Triage Score) and cognitive impairment/delirium (4AT). Multivariate binary logistic regression models were computed to predict ED disposition outcomes: hospital admission; discharge to GP and/or community services; discharge to specialist geriatric outpatients; discharge to the Geriatric Day Hospital.Results: In the study period, there were 1,045 Home FIRsT assessments (mean age 80.1 years). For hospital admission, strong independent predictors were acute illness severity (OR 2.01, 95% CI 1.50-2.70, PConclusions: Routinely collected CGA metrics are useful to predict ED disposition. The ability of baseline frailty to predict ED outcomes needs to be considered together with acute illness severity and delirium.</p