From Sarcopenia to Frailty: The Pathophysiological Basis and Potential Target Molecules of Intervention

Skeletal muscle is not only an endocrine organ but also one of core components of muscloskeletal system. Sarcopenia refers to a decline in the skeletal muscle mass and function. The former involves the size and number of changes in two types of myofibers, lower satellite cell density, and regeneration ability. The latter shows a loss of muscle strength. Frailty is a geriatric syndrome with multisystem impairment associated with increased vulnerability to stressors. Sarcopenia increases the risk of frailty and may be one of the major causes of physical frailty phenotype. Sarcopenia is also potentially associated with cognitive frailty phenotype. Aging might be the common underlying pathophysiology of sarcopenia and frailty. Therefore, there are some potential target molecules in aging-related signaling pathways that might be associated with sarcopenia and frailty. Nevertheless, sarcopenia can mediate metabolism and promote accelerate systemic aging, frailty, and age-related diseases by myokines in an endocrine manner. Lifestyle interventions (resistance exercise and dietary restriction) of gerontoscience are effective in the prevention of sarcopenia. Some pharmacological agents are registered in different phases of clinical trials for sarcopenia intervention. Phytochemicals, mTOR inhibitors, metformin and acarbose, NAD precursors, and sirtuin activators demonstrated that multiple target antiaging effects might also have preventive and therapeutic perspectives on sarcopenia and frailty

The Complexity of Frailty: Psychological Mechanism and Therapeutic Interventions in Old People - A Narrative Review

Aging is a complex and dynamic process. Senses become less sophisticated and negative life events increase. These factors combined with medical conditions contribute to develop a degenerative functional autonomy of the elderly. This clinical condition is known as frailty. However, there is a difference in the way people live their silver years in terms of happiness and their sense of autonomy. Both being and feeling frail represent two different drives of cognitive representations concerning how the elderly live their lives. In addition, other factors such as cognitive stimulation, assistive technology and physical activity can support frail people to achieve independence. This chapter aims to provide an overview on how the psychological environment may affect frailty, suggesting a possible role of new technology’s solutions and physical activity as therapeutic interventions

Non-Pharmacological Approaches in the Treatment of Dementia

Currently, a pharmacological disease-modifying treatment for dementia is not available, but different non-pharmacological approaches appear to be useful. In this chapter, we describe traditional treatments such as cognitive and emotion-oriented interventions, sensory and multi-sensory stimulation interventions and also potentially alternative interesting options such as behavioural therapy, animal-assisted therapy, home-adaptation therapy and assistive technologies to support patient with dementia. Many non-pharmacological treatments have reported benefits in multiple research studies, but there is a need for further Randomized controlled trials (RCTs) with an adequate sample size to improve the strength of evidence in order to apply these approaches

Sarcopenia: Technological Advances in Measurement and Rehabilitation

Sarcopenia is an important recently defined disease affecting people aged ≥65 years all over the world. Improving the assessment of loss of muscle mass is becoming mandatory. In this regard, various new technologies have been advanced. Although the gold standard is represented by magnetic resonance imaging (MRI) or magnetic resonance spectroscopy (MRS), computed tomography (CT) or dual-energy X-ray absorptiometry (DXA), followed by biological impedance analysis (BIA) compared with DXA, there are numerous correlations between sarcopenia and health domain of everyday life that must be investigated and addressed, trying to obtain the best possible outcome in the older population. In this review, we focused on all types of new technologies assessing loss of muscle mass, frailty, independence, walking, capacity to get dressed, and loss of balance or sleepiness in older people and that could improve the diagnosis of sarcopenia or the rehabilitation of sarcopenic patients to prevent possible accidents. Different technologies have been proposed to investigate the factors promoting the loss of muscle mass and weakness. Despite the standard EWGSOP 2019 guidelines defining a specific methodology for the diagnosis of sarcopenia, not all domains and devices were included, and new frontiers of prevention have been explored

Old Age and Women’s Identity

Female identity is a dynamic concept, and it has been a very discussed issue by contemporary cultural critic. How does old age affect identity construction and perception in elderly woman? Has feminine gender an impact in subjective well-being? Psychological changes of midlife women have been as conflicting as the idea that society has about them. Personality changes after young adulthood in women is a controversial matter. Erikson proposed that women might not develop identities in early adulthood as men do. In fact, he argued that women develop them later, in the context of an intimate relationship. Moreover, identity development appears to have important consequences for midlife well-being. For example, Vandewater et al. found that women’s midlife well-being was facilitated by earlier attainment of a well-articulated identity. In these situations accomplishment of developmentally earlier tasks (identity formation) sets the stage for later psychological health. Our work sheds additional light on how women live this period of life in terms of happiness and purpose of life

Virtual Round care model in a Covid-19 Geriatric sub intensive unit

Introduction. Telepresence provides clinicians the ability to monitor patients as well to communicate with all the members of the healthcare staff.  Covid-19 Units cope with high complexity in providing care and an integration amount the care team and the patients’ relatives should be carried out to obtained successful outcomes and preventing complication. Virtual rounding (VR) has been successfully applied to cope with this task in the last 2000 years in medical units.  Covid-19 patients due to safety rules may be prone to isolation and lack of communication with their family. Purpose. The aim of our study was to evaluate the effect of structured virtual round protocol in a geriatric Covid-19 unit on anxiety and depression for the patients and their relatives. Methodology. All the patients admitted to the geriatric Covid-19 unit from 1 February 2021 to 30 April were studied. Inclusion criteria to the study were the followings: no severe cognitive impairment (MMSE =>24) or neuro sensorial deficits; informed consent to participate to the study. Forty-nine 49 (75% of patients) met the inclusion criteria. All the subject who were found to be eligible to the study underwent a VR standard protocol of care. VR was consisted with: 1) a video call with a tablet device conducted by a psychologist that established a cooperative communication between the health care staff (nurses and MD, their relatives) at the bed sides; 2) a video call with the patient’s relatives in which it was clearly explained the standard care and the role of each healthcare member was also included. Anxiety and depression levels were assessed for the patients at baseline after the end of the protocol by the Hospital Anxiety and Depression Scale (HADS). Patients’ relatives were investigated for depression at baseline and after the end of the protocol by the Beck Depression Inventory- Primary Care (BDI-PC). The Beck Depression Inventory for primary care has seven items with each item rated on a 4-point scale (0–3). It is scored by summing ratings for each item (range 0–21). Items are symptoms of sadness, pessimism, past failure, loss of pleasure, self-dislike, self-criticalness, and suicidal thoughts and wishes. The Hospital Anxiety and Depression Scale (HADS) is a self- assessment scale found to be a reliable instrument for detecting states of depression and anxiety. The anxiety and depressive sub-scales are also valid measures of severity of the emotional disorder. The questionnaire comprises seven questions for anxiety and seven questions for depression, and takes 2–5min to complete. For both scales, scores less than 7 indicate non- cases, 8-10 mild, 11-14 moderate, 15-21 severe. JMP software by SAS (v.16) was used for the statistical analysis. Results. The present study included forty-nine 49 patients (67% male), mean age of 69.9 ±14.7 years with one relative for each patient. The average mean of the hospitalization for each patients was 17.6 ± 5.7 days The mean VR duration time was 60±5.5 minutes. VR showed a significant decrease in both Anxiety and depression for patients: (HADS Depression baseline 10.6 ±3.1 vs 6.9 ±2.7 end p<0.01) (HADS Anxiety baseline 10.2 ±3.4 vs 6.8 ±3.0 end p<0.01). VR has also reduced depression in the relatives of patients (BDI-PC 3.6 ±2.4 vs 1.9 ±1.9 p<0.01). Discussion. VR has reduced anxiety and depression in patients hospitalized in a sub-intensive COVID 19 unit and it also has been found to be effective in decreasing depression in the relatives of these patients Limitation. However, the study has some possible limitations considering its small size and that it was mono centric Conclusions. Our data confirm the efficacy of VR in the sub-intensive care setting. This evidence supports the key role of a multidisciplinary team, focusing on the importance of social and psychological support during the hospital stay.   More studies will be consequently necessary to better validate the importance of VR as a standard care tool in intensive/sub- intensive care units for the elderly patient

Agile Co-Creation for Robots and Aging (ACCRA) Project

__Introduction__ Worldwide population is getting older. The older persons want to stay independent and wish to increase their engagement in social activities to tackle loneliness, depression, and isolation. Starting from these assumptions, we developed the ACCRA project (Agile Co-Creation for Robots and Aging) with the aim to enable the development of advanced ICT Robotics-based solutions for extending active and healthy aging in daily life by defining, developing and demonstrating an agile co-creation development process. __Methods__ ACCRA robotics solutions will be designed and developed to be tested in three different domains: mobility, daily life, socialization support in four countries (i.e., France, Netherlands, Italy, and Japan). The proposed approach identifies four different phases: (1) needs analysis, (2) agile co-creation, (3) experimentation, and (4) sustainability analysis. Currently, the first two phases were almost completed. For the needs phase, we have used the following recruitment criteria: (1) for mobility: age ≥ 60 years, the and presence of mobility issues assessed by Older Mobility Scale (EMS) with a score > 13; (2) for daily life: age ≥ 60 years, and the presence of difficulties engaging in housework assessed by Autonomie Gérontologie Groupes Iso-Ressources (AGGIR) with a GIR score ≥ 4; (3) for socialization support: age ≥ 60 years, and the absence or mild level of cognitive impairment assessed by Mini Mental State Examination (MMSE) with a score ≥ 24. __Results__ The needs analysis and first co-creation sessions focus attention on the experience of older in the four countries. Preliminary results showed how, in all the pilot sites, many expectations were raised from older, formal and informal caregivers about the application of the technology into their life. Minor concerns existed about privacy, real efficacy and modularity in a real-world environment. Overall, a good attitude was recorded towards the use of technologies to support life and promote independent living. Moreover, the older engaged in our studies showed a great interest to be actively involved in the developing phase of something built based on their needs. __Conclusions__ The availability of new solutions to increase independence and quality of life in a sustainable manner appears to be mandatory in the actual society considering the actual socio-economic situation over the industrial countries