Grip strength cut-points from the Swiss DO-HEALTH population

BACKGROUND: While grip strength (GS) is commonly assessed using a Dynamometer, the Martin Vigorimeter was proposed as an alternative method especially in older adults. However, its reference values for Swiss older adults are missing. We therefore aimed to derive sex- and age-specific GS cut-points for the dominant and non-dominant hand (DH; NDH) using the Martin Vigorimeter. Additionally, we aimed to identify clinically relevant weakness and assess convergent validity with key markers of physical function and sarcopenia in generally healthy Swiss older adults. METHODS: This cross-sectional analysis includes baseline data from Swiss participants enrolled in DO-HEALTH, a 3-year randomized controlled trial in community-dwelling adults age 70 + . For both DH and NDH, 4 different definitions of weakness to derive GS cut-points by sex and age category (≤ 75 vs. > 75 years) were used: i) GS below the median of the 1st quintile, ii) GS below the upper limit of the 1st quintile, iii) GS below 2-standard deviation (SD) of the sex- and age-specific mean in DO-HEALTH Swiss healthy agers (i.e. individuals without major chronic diseases, disabilities, cognitive impairment or mental health issues) and iv) GS below 2.5-SD of the sex- and age-specific mean in DO-HEALTH Swiss healthy agers. To assess the proposed cut-points' convergent validity, we assessed their association with gait speed, time to complete the 5 Times Sit-To-Stand (5TSTS) test, and present sarcopenia. RESULTS: In total, 976 participants had available GS at the DH (mean age 75.2, 62% women). According to the 4 weakness definitions, GS cut-points at the DH ranged from 29-42 and 25-39 kPa in younger and older women respectively, and from 51-69 and 31-50 kPa in younger and older men respectively. Overall, weakness prevalence ranged from 2.0% to 19.3%. Definitions of weakness using the median and the upper limit of the 1st GS quintile were most consistently associated with markers of physical performance. Weak participants were more likely to have lower gait speed, longer time to complete the 5TSTS, and sarcopenia, compared to participants without weakness. CONCLUSIONS: In generally healthy Swiss older adults, weakness defined by the median or the upper limit of the 1st GS quintile may serve as reference to identify clinically relevant weakness. Additional research is needed in less healthy populations in order to derive representative population-based cut-points

Evidenz körperlicher Trainings-programme zur Sturzprävention bei älteren Menschen

Es konnte gezeigt werden, dass körperliche Trainingsprogramme das Sturzrisiko bei zuhause lebenden Personen über 65 Jahre um 23–42% senken. Dies trifft vor allem auf Trainingsprogramme zu, die funktionelle Aspekte sowie Gleichgewicht und Krafttraining enthalten. Die optimale Stundenanzahl beträgt laut aktueller Studienlage mindestens drei pro Woche. Zunehmende Evidenz zeigt, dass Trainingsprogramme mit einem Fokus auf funktionelle Aspekte die Sturzhäufigkeit besonders effektiv senken. Unter funktionellem Training versteht man Übungen, die gezielt alltägliche Situationen nachstellen und unter Einbezug des eigenen Körpergewichts mit Gewichten oder anderen Hilfsmitteln ausgeführt werden. = Evidence of Physical Training Programs for Fall Prevention in Seniors Abstract. It has been shown that physical exercise reduced fall risk by 23-42% in community-dwelling adults aged 65+. This is particularly true for physical exercises with functional, balance and strength components. Growing evidence shows that functional training is particularly effective in reducing fall risk. Functional training is composed by exercises which reflect activities of daily life, supported by weights and other aids. Keywords: Alter 65+; Empfehlungen; Fall prevention; Sturzprävention; Trainingsprogramm; age 65+; community-dwelling; habitant en communauté; personnes âgées 65+; physical exercise; programme d’entraînement; prévention de chutes; recommandations; recommendations; zuhause lebende Personen

Gezielte Trainingstherapie zur Sekundärprävention von Stürzen und Hüftfrakturen

Over the last 20 years, some home based training studies have been published regarding post-treatment of hip fracture patients. The Zurich hip fracture study showed that a home program can be effective for «frail» seniors. Further studies must evaluate the value of low-cost home therapy in «frail» and «pre-frail» as a non-drug treatment strategy

Nutzen altersmedizinischer Abklärungen vor Operationen, Interventionen und onkologischen Therapien

Ältere und hochbetagte Patient_innen haben ein erhöhtes Risiko für Komplikationen und nachteilige Behandlungsverläufe bei Operationen, Interventionen und onkologischen Therapien. Gleichzeitig sollte diese Gruppe nicht anhand des chronologischen Alters von potenziell nutzenbringenden medizinischen Verfahren per se ausgeschlossen werden. Geriatrische Syndrome und erhöhte Vulnerabilität durch eine altersmedizinische Abklärung rechtzeitig zu identifizieren wird zunehmend wichtiger und wird in den Richtlinien der Fachgesellschaften mehrerer Spezialdisziplinen bereits heute empfohlen. Nach einer geriatrischen Abklärung sollte jedoch idealerweise ein proaktives Co-Management im Sinn einer integrierten Versorgung erfolgen. Die Etablierung von interdisziplinären Behandlungspfaden für ältere Spitalpatient_innen kann dazu beitragen, Behandlungsergebnisse signifikant zu verbessern. Dieser Ansatz kann neben verbesserten patientenbezogenen Ergebnissen und ansteigenden Qualitätsindikatoren auch positive gesundheitsökonomische Effekte bieten. // Benefit of a Geriatric Evaluation before Operations, Interventions and Oncological Therapies Abstract: Older patients face an increased risk of complications and adverse outcomes during and after operations, interventions, and intense oncological therapies. At the same time, this patient group should not be excluded per se from potentially beneficial medical procedures based on chronological age alone. The timely identification of geriatric syndromes and increased vulnerability by means of comprehensive geriatric assessment is becoming increasingly important and is already recommended in the guidelines of professional societies of several medical disciplines. Nonetheless, the geriatric assessment should ideally be followed by proactive co-management in the sense of integrated care. The establishment of interdisciplinary and integrated care pathways for older hospital patients can contribute to significantly improved treatment outcomes. In addition to better patient-related outcomes and rising quality indicators, this approach may also offer positive health economic effects

Are patients with cognitive impairment fit to fly? Current evidence and practical recommendations

Background The worldwide prevalence of dementia is increasing and represents a major public health concern. In the last decades, air travel services have undergone an impressive expansion and one of ten passengers is aged 65 years and older. While air travel can be stressful at all ages and health conditions, older individuals with cognitive impairment carry a greater risk for air-travel-related complications. Consequently, demands to general practitioners for assessing their older patient’s fitness to fly are increasing. Methods We conducted a search of the literature in PubMed on the impact of in-flight environmental changes on passengers with cognitive impairment and possible resulting complications. This set the base for a discussion on pharmacological and non-pharmacological interventions aimed at preventing in-flight complications in this vulnerable population. Results While our research strategy identified a total of 11 articles related to older age and air travel, only three focused on passengers with cognitive impairment. Our literature review showed that the airplane environment may lead to a large spectrum of symptoms in passengers of all age groups. However, passengers with cognitive impairment due to neurodegenerative diseases are at increased risk for experiencing the most extreme symptoms such as acute confusional state. Non-pharmacological and pharmacological interventions at different stages of the travel process (before, during and after) can help prevent complications in this vulnerable population. Conclusion The decision to let a patient with cognitive impairment fly requires a solid understanding of the in-flight environmental changes and their impact on older patients with cognitive impairment. Moreover, a sound weighing of the risks and benefits while considering different aspects of the patient’s history is demanded. In this regard, the role of the treating physicians and caregivers is essential along with the support of the medical department of the airline

Speed of sound ultrasound: a pilot study on a novel technique to identify sarcopenia in seniors

OBJECTIVES To measure speed of sound (SoS) with a novel hand-held ultrasound technique as a quantitative indicator for muscle loss and fatty muscular degeneration. METHODS Both calf muscles of 11 healthy, young females (mean age 29 years), and 10 elderly females (mean age 82 years) were prospectively examined with a standard ultrasound machine. A flat Plexiglas® reflector, on the opposite side of the probe with the calf in between, was used as timing reference for SoS (m/s) and ΔSoS (variation of SoS, m/s). Handgrip strength (kPA), Tegner activity scores, and 5-point comfort score (1 = comfortable to 5 = never again) were also assessed. Ultrasound parameters (muscle/adipose thickness, echo intensity) were measured for comparison. RESULTS Both calves were assessed in less than two minutes. All measurements were successful. The elderly females showed significantly lower SoS (1516 m/s, SD17) compared to the young adults (1545 m/s, SD10; p < 0.01). The ΔSoS of elderly females was significantly higher (12.2 m/s, SD3.6) than for young females (6.4 m/s, SD1.5; p < 0.01). Significant correlations of SoS with hand grip strength (r = 0.644) and Tegner activity score (r = 0.709) were found, of similar magnitude as the correlation of hand grip strength with Tegner activity score (r = 0.794). The average comfort score of the elderly was 1.1 and for the young adults 1.4. SoS senior/young classification (AUC = 0.936) was superior to conventional US parameters. CONCLUSIONS There were significant differences of SoS and ΔSoS between young and elderly females. Measurements were fast and well tolerated. The novel technique shows potential for sarcopenia quantification using a standard ultrasound machine. KEY POINTS • Speed of sound ultrasound: a novel technique to identify sarcopenia in seniors. • Measurements were fast and well tolerated using a standard ultrasound machine. • The novel technique shows potential for sarcopenia quantification

Association of polypharmacy with cognitive impairment in older trauma patients: a cross-sectional study

Introduction: Few if any studies have been conducted to date on the association between polypharmacy and cognitive impairment among older trauma patients. Therefore, we investigated whether polypharmacy is associated with cognitive impairment in trauma patients aged ≥70 years. Methods: This is a cross-sectional study of patients aged ≥70 years hospitalised due to a trauma-related injury. Cognitive impairment was defined as a Mini-Mental State Examination (MMSE) score ≤24 points. Medications were coded according to the Anatomical Therapeutic Chemical classification. Three exposures were examined: polypharmacy (≥5 medications), excessive polypharmacy (≥10 medications), and number of medications. Separate logistic regression models adjusted for age, sex, body mass index (BMI), education, smoking, independent living, frailty, multimorbidity, depression, and type of trauma were used to test the association between the three exposures and cognitive impairment. Results: A total of 198 patients were included (mean age 80.2; 64.7% women and 35.4% men), of which 148 (74.8%) had polypharmacy and 63 (31.8%) had excessive polypharmacy. The prevalence of cognitive impairment was 34.3% overall, 37.2% in the polypharmacy group and 50.8% in the excessive polypharmacy group. More than 80% of participants were taking at least one analgesic. Overall, polypharmacy was not statistically significantly associated with cognitive impairment (odds ratio (OR) 1.20 [95% confidence interval (CI) 0.46 to 3.11]). However, patients in the excessive polypharmacy group were more than two times more likely to have cognitive impairment (OR 2.88 [95% CI 1.31 to 6.37]) even after adjustments for relevant confounders. Similarly, the number of medications was associated with greater odds of cognitive impairment (OR 1.15 [95% CI 1.04 to 1.28]) after adjustments for the same relevant confounders. Conclusion: Cognitive impairment is common among older trauma patients, particularly among those in the excessive polypharmacy group. Polypharmacy was not associated with cognitive impairment. Excessive polypharmacy and number of medications, on the other hand, were associated with greater odds of cognitive impairment in older trauma patients

Association of depression with malnutrition, grip strength and impaired cognitive function among senior trauma patients

BACKGROUND: Depression is common among senior adults, yet understudied among trauma patients. The purpose of this study was to assess the prevalence of depressive symptoms among seniors hospitalized in acute trauma care, to compare patients with depressive symptoms vs. those without, and to evaluate whether depression symptoms affects discharge destination. METHODS: This cross-sectional and prospective analysis was conducted among community-dwelling patients ≥70 years old, hospitalized at the Senior Trauma Center of the University Hospital Zurich, Switzerland. We used the Geriatric Depression Scale (GDS-15) to assess presence of depressive symptoms. Using a cutoff value of 5 points, we compared age- and gender-adjusted characteristics of patients with and without depressive symptoms. Multinomial logistic regression models were used to estimate the odds of returning home vs. not adjusting for age, gender, nutritional status, cognitive function and others. RESULTS: Of the 273 seniors enrolled, 104 (38.1%) were men and the mean age was 79.4 (SD = 6.5) years. We identified 52 (19.0%) patients with depressive symptoms. These patients were more likely to be older (p = 0.04), at risk for malnutrition (p<0.0001), at least pre-frail (p = 0.005), and have decreased cognitive function (p = 0.001). They were also more than twice as likely to be discharged to acute geriatric care compared to home (OR = 2.28 (CI = 1.12-4.68)). LIMITATIONS: Depressive symptoms were assessed during acute care without data before hospitalization. CONCLUSIONS: Senior trauma patients with depressive symptoms during acute care were more likely to be at higher risk of malnutrition, have cognitive decline and are more likely to receive additional geriatric care