Effects of physical exercise programs on sarcopenia management, dynapenia, and physical performance in the elderly : a systematic review of randomized clinical trials

Introduction. Sarcopenia is a prevalent condition in the elderly population, imposing a significant impact over their functional ability as well as their quality of life. Furthermore, it is associated with greater incidence of major geriatric outcomes, as reduced mobility, falls, loss of independence, cognitive impairment, and all-cause mortality. Physical Exercise Programs directed to improve muscle mass and its function may be key to reduce sarcopenia consequences. However, a significant heterogeneity is found in clinical trials, especially as a consequence of different exercise protocols applied to research subjects. Objectives. To access the effects of physical exercise programs compared to no exercise interventions to improve sarcopenia components and its determinants in sarcopenic elder individuals. Methods. A systematic review was conducted in the Pubmed database to identify randomized clinical trials (RCTs) which tested the effects of physical exercise programs to manage sarcopenia components in sarcopenic elder individuals. Two independent reviewers assessed the studies’ eligibility according to specified inclusion criteria in a four-step strategy. Data regarding population characteristics, muscle mass, muscle quality, muscle strength, and muscle function were extracted from each one of the included studies. Assessment of quality and individual studies risk of bias were assessed through Cochrane Risk of Bias Tool®. Assuming theoretical expected heterogeneity among studies, especially regarding different physical exercise programs and different outcome measurements, authors decided to be conservative and present study results in descriptive tables. Results. Search strategy retrieved 298 papers on PubMed database. )ree more were identified through manual search, being 301 studies revised for inclusion. 278 were excluded during title/abstract review. After further evaluation of 23 fulltexts, 5 RCTs were included. All 5 trials tested the efficacy of isolated exercise programs to improve sarcopenia components in the elderly compared to no physical intervention. Resistance training was the main intervention component in all included trials compared to inactive control groups (health education mainly). Physical training improved muscle strength, muscle quality, and muscle function compared to inactive control groups. Considering muscle mass, no differences were demonstrated. Data metaanalysis was not possible to be performed due to high heterogeneity among trials and small number of studies for each outcome comparison. Conclusion. Heterogeneity among trials and small number of RCTs limited robust conclusions and data metaanalysis. However, resistance training protocols can improve muscle strength and physical performance in elders previously diagnosed with sarcopenia, although its effect size and clinical impact are barely relevant

Bedside Ultrasound of Quadriceps to Predict Rehospitalization and Functional Decline in Hospitalized Elders

ObjectiveTo evaluate the capacity of total anterior thigh thickness, quadriceps muscle thickness, and quadriceps contractile index, all measured by bedside ultrasound, to predict rehospitalization, functional decline, and death in elderly patients 3 months after hospital discharge. To evaluate intra and interobserver reproducibility of the dominant thigh evaluation method by point of care ultrasound.MethodsCohort study of patients aged 65 years or more admitted to a medium complexity unit in a teaching hospital in southern Brazil. Comprehensive geriatric assessment and ultrasound evaluation of the dominant thigh of each participant were performed. After 3 months of hospital discharge, telephone contact was made to evaluate the outcomes of rehospitalization or death and functional decline—assessed by the 100 points Barthel scale and defined as a decrease of five or more points.Results100 participants were included. There was no statistically significant difference between intraobserver measurements in the GEE method analysis (p > 0.05), and the mean bias obtained in Bland–Altman plots was close to zero in all four analyses performed, suggesting good intra and interobserver agreement. There was a significant correlation between the echographic measurements (quadriceps thickness and contractile index) and gait speed, timed up and go, and handgrip tests. There was a significant association between contractile index (quadriceps thickness over total anterior thigh thickness multiplied by 100) lower than 60% and functional decline (relative risk 1.35; CI 95% 1.10–1.65; p = 0.003) as well as between the thickness of the quadriceps and rehospitalization or death, in both individuals with preserved walking capacity and in bedridden elders (relative risk 1.34; CI 95% 1.02–1.75; p = 0.04).ConclusionThe ultrasonographic method to evaluate thigh thickness was easily applicable and reproducible. The thickness of the quadriceps could predict rehospitalization or death, even in those patients without walking capacity—unable to perform gait speed and timed up and go tests. Additionally, the contractile index was associated with functional decline after 3 months of hospital discharge. This is a promising result, which highlights the bedside ultrasound of the quadriceps as a potential tool for the prognosis evaluation of bedridden hospitalized elderly patients

Type 2 deiodinase Thr92Ala polymorphism is not associated with cognitive impairment in older adults : a cross-sectional study

Background: Type 2 Deiodinase (DIO2) converts thyroxine (T4) into the active hormone triiodothyronine (T3). Thr92Ala DIO2 polymorphism has been associated with reduced conversion of T4 into T3 and central nervous system hypothyroidism. However, how Thr92Ala DIO2 polymorphism affects cognitive function is still unclear. Objective: To assess the association between Thr92Ala DIO2 polymorphism and cognitive performance in older adults. Design: Cross-sectional study. Setting: University-based tertiary hospital in Brazil. Patients: > 65-year-old with no limiting clinical disease. Interventions: All participants answered a standard questionnaire before undergoing thyroid function laboratory evaluation and genotyping of the Thr92Ala DIO2 polymorphism. Main Outcomes: Cognitive impairment measured by the Word List Memory task from the Consortium to Establish a Registry for Alzheimer’s Disease Neuropsychological Battery (CERAD-NB) and the Brief Cognitive Screening Battery (BCSB). Results: A hundred individuals were included. Clinical and laboratory characteristics were similar among DIO2 genotypes (all p > 0.05). No differences were found in the Word List Memory, recall, or recognition tests of the CERAD-NB assuming a recessive model for the Ala/Ala vs. Thr/Ala-Thr/Thr genotypes. Results of Clock Drawing Test, Animal Fluency Test, Mini-Mental State Exam, and Figure Memory Test of the BCSB were similar between groups. Conclusions: These findings suggest that Thr92Ala DIO2 polymorphism is not associated with relevant cognitive impairment in older adults

DELIRIUM+ as a mnemonic device to optimize delirium-related teaching and clinical care

Delirium, a common neurocognitive disorder among hospitalized older adults, depends on an interrelationship between precipitating and predisposing factors. Adequate prevention, detection, and management are directly related to knowledge of these factors. Due to a lack of education, delirium is underdiagnosed and the time taken to identify and react to the condition is suboptimal. Based on an open review of the literature, the main precipitating factors were compiled into the acronym DELIRIUM, in Portuguese. A second acronym MAIS (meaning 'plus') was compiled from important behaviors for preventing and treating delirium. Thus, the mnemonic device DELIRIUM+ stands for: Discomfort, Electrolytes/metabolism, Locale/environment, Infections, urinary/fecal Retention; and acute clinical complIcations; Uremia; Medications + (Mobility, Assistant/companion, Interactions, and Sleep/psychotropic substances]. This mnemonic device can encourage teaching and care aimed at the prevention, detection, and management of delirium. Ideally, the clinical impact of this mnemonic device should be tested in research to validate its implementation.</p

Proposição do Mnemônico DELIRIUM+ para Otimização do Ensino e Assistência Clínica Relacionadas ao Delirium - Material Suplementar

Material suplementar referente ao artigo: Proposição do Mnemônico DELIRIUM+ para Otimização do Ensino e Assistência Clínica Relacionadas ao DeliriumTabela 1: Categorias e fatores precipitantes de deliriumTabela 2: Sub-mnemônico MAIS</p

Bedside Ultrasound of Quadriceps to Predict Rehospitalization and Functional Decline in Hospitalized Elders

Objective: To evaluate the capacity of total anterior thigh thickness, quadriceps muscle thickness, and quadriceps contractile index, all measured by bedside ultrasound, to predict rehospitalization, functional decline, and death in elderly patients 3 months after hospital discharge. To evaluate intra and interobserver reproducibility of the dominant thigh evaluation method by point of care ultrasound. Methods: Cohort study of patients aged 65 years or more admitted to a medium complexity unit in a teaching hospital in southern Brazil. Comprehensive geriatric assessment and ultrasound evaluation of the dominant thigh of each participant were performed. After 3 months of hospital discharge, telephone contact was made to evaluate the outcomes of rehospitalization or death and functional decline—assessed by the 100 points Barthel scale and defined as a decrease of five or more points. Results: 100 participants were included. There was no statistically significant difference between intraobserver measurements in the GEE method analysis (p > 0.05), and the mean bias obtained in Bland–Altman plots was close to zero in all four analyses performed, suggesting good intra and interobserver agreement. There was a significant correlation between the echographic measurements (quadriceps thickness and contractile index) and gait speed, timed up and go, and handgrip tests. There was a significant association between contractile index (quadriceps thickness over total anterior thigh thickness multiplied by 100) lower than 60% and functional decline (relative risk 1.35; CI 95% 1.10–1.65; p = 0.003) as well as between the thickness of the quadriceps and rehospitalization or death, in both individuals with preserved walking capacity and in bedridden elders (relative risk 1.34; CI 95% 1.02–1.75; p = 0.04). Conclusion: The ultrasonographic method to evaluate thigh thickness was easily applicable and reproducible. The thickness of the quadriceps could predict rehospitalization or death, even in those patients without walking capacity—unable to perform gait speed and timed up and go tests. Additionally, the contractile index was associated with functional decline after 3 months of hospital discharge. This is a promising result, which highlights the bedside ultrasound of the quadriceps as a potential tool for the prognosis evaluation of bedridden hospitalized elderly patients

Bedside ultrasound of quadriceps to predict rehospitalization and functional decline in hospitalized elders

Objective: To evaluate the capacity of total anterior thigh thickness, quadriceps muscle thickness, and quadriceps contractile index, all measured by bedside ultrasound, to predict rehospitalization, functional decline, and death in elderly patients 3 months after hospital discharge. To evaluate intra and interobserver reproducibility of the dominant thigh evaluation method by point of care ultrasound. Methods: Cohort study of patients aged 65 years or more admitted to a medium complexity unit in a teaching hospital in southern Brazil. Comprehensive geriatric assessment and ultrasound evaluation of the dominant thigh of each participant were performed. After 3 months of hospital discharge, telephone contact was made to evaluate the outcomes of rehospitalization or death and functional decline—assessed by the 100 points Barthel scale and defined as a decrease of five or more points. Results: 100 participants were included. There was no statistically significant difference between intraobserver measurements in the GEE method analysis (p > 0.05), and the mean bias obtained in Bland–Altman plots was close to zero in all four analyses performed, suggesting good intra and interobserver agreement. There was a significant correlation between the echographic measurements (quadriceps thickness and contractile index) and gait speed, timed up and go, and handgrip tests. There was a significant association between contractile index (quadriceps thickness over total anterior thigh thickness multiplied by 100) lower than 60% and functional decline (relative risk 1.35; CI 95% 1.10–1.65; p = 0.003) as well as between the thickness of the quadriceps and rehospitalization or death, in both individuals with preserved walking capacity and in bedridden elders (relative risk 1.34; CI 95% 1.02–1.75; p = 0.04). Conclusion: The ultrasonographic method to evaluate thigh thickness was easily applicable and reproducible. The thickness of the quadriceps could predict rehospitalization or death, even in those patients without walking capacity—unable to perform gait speed and timed up and go tests. Additionally, the contractile index was associated with functional decline after 3 months of hospital discharge. This is a promising result, which highlights the bedside ultrasound of the quadriceps as a potential tool for the prognosis evaluation of bedridden hospitalized elderly patients