Epidemiology of Sarcopenia and Frailty

Sarcopenia and frailty are common in older persons and pose particular challenges for health and social care systems especially in the context of global population ageing. Sarcopenia, the loss of skeletal muscle mass, strength and function with age is associated with adverse individual physical and metabolic changes contributing to morbidity and mortality. The health and socioeconomic implications of sarcopenia are also considerable. Sarcopenia is a core component of physical frailty that together impact negatively on an individual’s capability to live independently. Frailty is a biological syndrome of low reserve and resistance to stressors resulting from cumulative declines across multiple physiological systems that collectively predispose an individual to adverse outcomes. Frailty develops along a continuum from independence through to death as physiological reserves progressively diminish an individual’s capacity to recover from an acute insult or illness. Managing sarcopenia and frailty involves the multidisciplinary led completion of a comprehensive care plan that is patient centred, responsive to the needs of the patient and adaptable therefore enabling an individual to maintain their independence

Mortality, bone density and grip strength: lessons from the past and hope for the future?

Lay Summary: What does this mean for patients? Low grip strength is important in the diagnosis of sarcopenia (loss of muscle mass and strength with age) and low bone density is used to define osteoporosis. Both sarcopenia and osteoporosis are common conditions among older people and are related to increased risk of poor health. In this study we examined grip strength and bone density in relation to the risk of death using data from older UK men and women from the Hertfordshire Cohort Study (aged 59–73 years at the start of the study). Lower grip strength was related to an increased risk of death (any cause) and death due to cardiovascular causes. In contrast, the relationships between bone density and risk of death (any cause) and death due to cardiovascular causes were weak. Relationships between muscle strength and risk of death were much stronger than the relationships between bone density and risk of death. This may reflect better treatment of low bone density, compared with low muscle strength, in this group of older people. This suggests that advances in the treatment of low muscle strength are required

A feasibility study of implementing grip strength measurement into routine hospital practice (GRImP): study protocol.

BACKGROUND: Handgrip strength is a non-invasive marker of muscle strength, and low grip strength in hospital inpatients is associated with poor healthcare outcomes including longer length of stay, increased functional limitations, and mortality. Measuring grip strength is simple and inexpensive. However, grip strength measurement is not routinely used in clinical practice. The aim of this study is to evaluate the feasibility of implementing grip strength measurement into routine clinical practice. METHODS/DESIGN: This feasibility study is a mixed methods design combining qualitative, quantitative, and economic elements and is based on the acute medical wards for older people in one hospital. The study consists of three phases: phase 1 will define current baseline practice for the identification of inpatients at high risk of poor healthcare outcomes, their nutrition, and mobility care through interviews and focus groups with staff as well as a review of patients' clinical records. Phase 2 will focus on the feasibility of developing and implementing a training programme using Normalisation Process Theory to enable nursing and medical staff to measure and interpret grip strength values. Following the training, grip strength will be measured routinely for older patients as part of admission procedures with the use of a care plan for those with low grip strength. Finally, phase 3 will evaluate the acceptability of grip strength measurement, its adoption, coverage, and basic costs using interviews and focus groups with staff and patients, and re-examination of clinical records. DISCUSSION: The results of this study will inform the translation of grip strength measurement from a research tool into clinical practice to improve the identification of older inpatients at risk of poor healthcare outcomes. TRIAL REGISTRATION: Clinicaltrials.gov NCTO2447445

Implementation of grip strength measurement in medicine for older people wards as part of routine admission assessment: identifying facilitators and barriers using a theory-led intervention.

BACKGROUND: Low grip strength in older inpatients is associated with poor healthcare outcomes including longer length of stay and mortality. Measuring grip strength is simple and inexpensive. However, it is not routinely used in clinical practice. We aimed to evaluate the implementation of grip strength measurement into routine clinical practice. METHODS: This implementation study was a mixed methods study based in five acute medical wards for older people in one UK hospital. Intervention design and implementation evaluation were based on Normalization Process Theory (NPT). A training program was developed and delivered to enable staff to measure grip strength and use a care plan for patients with low grip strength. Routine implementation and monitoring was assessed using the "implementation outcome variables" proposed by WHO: adoption, coverage, acceptability, fidelity, and costs analysis. Enablers and barriers of implementation were identified. RESULTS: One hundred fifty-five nursing staff were trained, 63% in just 3 weeks. Adoption and monthly coverage of grip strength measurement varied between 25 and 80% patients across wards. 81% of female patients and 75% of male patients assessed had low grip strength (< 27 kg for men and < 16 kg for women). Staff and patients found grip measurement easy, cheap and potentially beneficial in identifying high-risk patients. The total cost of implementation across five wards over 12 months was less than £2302. Using NPT, interviews identified enablers and barriers. Enablers included: highly motivated ward champions, managerial support, engagement strategies, shared commitment, and integration into staff and ward daily routines. Barriers included lack of managerial and staff support, and high turnover of staff, managers and champions. CONCLUSIONS: Training a large number of nurses to routinely implement grip strength measurement of older patients was feasible, acceptable and inexpensive. Champions' motivation, managerial support, and shared staff commitment were important for the uptake and normalisation of grip strength measurement. A high percentage of older patients were identified to be at risk of poor healthcare outcomes and would benefit from nutritional and exercise interventions. Measuring grip strength in these patients could provide an opportunity to identify those with normal grip strength for fast tracking through admission to discharge thereby reducing length of stay. TRIAL REGISTRATION: Clinicaltrials.gov NCTO2447445 . Registered May 18, 2015

Can routine clinical data identify older patients at risk of poor healthcare outcomes on admission to hospital?

OBJECTIVE: Older patients who are at risk of poor healthcare outcomes should be recognised early during hospital admission to allow appropriate interventions. It is unclear whether routinely collected data can identify high-risk patients. The aim of this study was to define current practice with regard to the identification of older patients at high risk of poor healthcare outcomes on admission to hospital. RESULTS: Interviews/focus groups were conducted to establish the views of 22 healthcare staff across five acute medicine for older people wards in one hospital including seven nurses, four dieticians, seven doctors, and four therapists. In addition, a random sample of 60 patients' clinical records were reviewed to characterise the older patients, identify risk assessments performed routinely on admission, and describe usual care. We found that staff relied on their clinical judgment to identify high risk patients which was influenced by a number of factors such as reasons for admission, staff familiarity with patients, patients' general condition, visible frailty, and patients' ability to manage at home. "Therapy assessment" and patients' engagement with therapy were also reported to be important in recognising high-risk patients. However, staff recognised that making clinical judgments was often difficult and that it might occur several days after admission potentially delaying specific interventions. Routine risk assessments carried out on admission to identify single healthcare needs included risk of malnutrition (completed for 85% patients), falls risk (95%), moving and handling assessments (85%), and pressure ulcer risk assessments (88%). These were not used collectively to highlight patients at risk of poor healthcare outcomes. Thus, patients at risk of poor healthcare outcomes were not explicitly identified on admission using routinely collected data. There is a need for an early identification of these patients using a valid measure alongside staff clinical judgment to allow timely interventions to improve healthcare outcomes

Altered H19/miR‐675 expression in skeletal muscle is associated with low muscle mass in community‐dwelling older adults

Background: Despite increasing knowledge of the pathogenesis of muscle ageing, the molecular mechanisms are poorly understood. Based on an expression analysis of muscle biopsies from older Caucasian men, we undertook an in-depth analysis of the expression of the long non-coding RNA, H19, to identify molecular mechanisms that may contribute to the loss of muscle mass with age. Methods: We carried out transcriptome analysis of vastus lateralis muscle biopsies from 40 healthy Caucasian men aged 68–76 years from the Hertfordshire Sarcopenia Study (HSS) with respect to appendicular lean mass adjusted for height (ALMi). Validation and replication was carried out using qRT-PCR in 130 independent male and female participants aged 73–83 years recruited into an extension of the HSS (HSSe). DNA methylation was assessed using pyrosequencing. Results: Lower ALMi was associated with higher muscle H19 expression (r2 = 0.177, P < 0.001). The microRNAs, miR-675-5p/3p encoded by exon 1 of H19, were positively correlated with H19 expression (Pearson r = 0.192 and 0.182, respectively, P < 0.03), and miR-675-5p expression negatively associated with ALMi (r2 = 0.629, P = 0.005). The methylation of CpGs within the H19 imprinting control region (ICR) were negatively correlated with H19 expression (Pearson r = −0.211 to −0.245, P ≤ 0.05). Moreover, RNA and protein levels of SMAD1 and 5, targets of miR-675-3p, were negatively associated with miR-675-3p (r2 = 0.792 and 0.760, respectively) and miR-675-5p (r2 = 0.584 and 0.723, respectively) expression, and SMAD1 and 5 RNA levels positively associated with greater type II fibre size (r2 = 0.184 and 0.246, respectively, P < 0.05). Conclusions: Increased expression profiles of H19/miR-675-5p/3p and lower expression of the anabolic SMAD1/5 effectors of bone morphogenetic protein (BMP) signalling are associated with low muscle mass in older individuals

Development of a UK core dataset for geriatric medicine research: : a position statement and results from a Delphi consensus process

Funding AS and MW are funded by the Newcastle National Institute for Health (NIHR) Biomedical Research Centre, which also funded the initial meeting of academic clinicians in geriatric medicine during the Delphi process. The views expressed in this article are those of the authors and not necessarily those of the NIHR, the NHS, or the Department of Health. Acknowledgements The authors acknowledge the contributions of members of the UK Geriatric Medicine Core Dataset Extended Working Group.Peer reviewedPublisher PD

Tumour necrosis factor and PI3-kinase control oestrogen receptor alpha protein level and its transrepression function

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2410160

Understanding how we age: insights into inflammaging

Inflammaging is characterized by the upregulation of the inflammatory response that occurs with advancing age; its roots are strongly embedded in evolutionary theory.Inflammaging is believed to be a consequence of a remodelling of the innate and acquired immune system, resulting in chronic inflammatory cytokine production.Complex interrelated genetic, environmental and age-related factors determine an individual’s vulnerability or resilience to inflammaging. These factors include polymorphisms to the promoter regions of cytokines, cytokine receptors and antagonists, age-related decreases in autophagy and increased adiposity. Anti-inflammaging describes the upregulation of the hypothalamic-pituitary axis in response to inflammaging, leading to higher levels of cortisol, which in turn may be detrimental, contributing to less successful ageing and frailty. This may be countered by the adrenal steroid dehydroepiandrosterone, which itself declines with age, leaving certain individuals more vulnerable. Inflammaging and anti-inflammaging have both been linked with a number of age-related outcomes, including chronic morbidity, functional decline and mortality. This important area of research offers unique insights into the ageing process and the potential for screening and targeted interventions

Mortality, bone density and grip strength: lessons from the past and hope for the future?

Objectives: therapeutic advances in management of osteoporosis and sarcopenia have occurred at different rates over the last two decades; here we examined associations between grip strength and bone mineral density (BMD) with subsequent all-cause and cause-specific mortality in a UK community-dwelling cohort.Methods: data from 495 men and 414 women from the Hertfordshire Cohort Study were analysed. Grip strength was assessed by grip dynamometry; femoral neck BMD was ascertained using DXA; deaths were recorded from baseline (1998–2004) until 31st December 2018. Grip strength and BMD in relation to mortality outcomes (all-cause, cardiovascular-related, cancer-related, and mortality due to other causes) were examined using Cox regression with adjustment for age and sex.Results: mean (SD) baseline age of participants was 64.3 (2.5) and 65.9 (2.6) years in men and women respectively. Lower grip strength was associated with increased risk of all-cause mortality (hazard ratio (95% CI): 1.30 (1.06,1.58), p = 0.010) and cardiovascular-related mortality (1.75 (1.20,2.55), p = 0.004). In contrast, BMD was not associated with any of the mortality outcomes (p &gt; 0.1) for all associations.Conclusion: we report strong relationships between grip strength and mortality in comparison with BMD. We hypothesize that this may reflect better recognition and treatment of low BMD in this cohort