Sarcopenia and post-hospital outcomes in older adults: a longitudinal study

Introduction Sarcopenia poses a significant problem for older adults, yet very little is known about this medical condition in the hospital setting. The aims of this hospital-based study were to determine: (i) the prevalence of sarcopenia; (ii) factors associated with sarcopenia; and (iii) the association of sarcopenia with adverse clinical outcomes post-hospitalisation. Methods This is a longitudinal analysis of consecutive patients aged ≥70 years admitted to a Geriatric Management and Evaluation Unit (GEMU) ward. Sarcopenia was classified using the European Working Group on Sarcopenia in Older People (EWGSOP) algorithm, which included: handgrip strength, gait speed, and muscle mass using Bioelectrical Impedance Analysis (BIA). Outcomes were assessed at 12-months post-hospital discharge, and included both mortality and admission to a hospital Emergency Department (ED). Kaplan-Meier methods were used to estimate survival, with Cox proportion hazard models then applied. All regression analyses controlled for age, sex, and co-morbidity. Results 172 patients (72% female) with a mean (SD) age of 85.2 (6.4) years were included. Sarcopenia was present in 69 (40.1%) of patients. Patients with sarcopenia were twice as likely to die in the 12-months post-hospitalisation (HR, 95% CI = 2.23, 1.15–4.34), but did not have an increased likelihood of ED admission. Conclusions Sarcopenia showed an independent association with 12-month post-hospital mortality in older adults. With the new recognition of sarcopenia as a medical condition with its own unique ICD-10-CM code, awareness and diagnosis of sarcopenia in clinical settings is paramount

Actions to be taken for improving functional prognosis in dementia

The growing incidence of dementia has led to an increased need for specialized care and higher health and social costs. Functional decline is the main cause of dementia complications. Per definition, dementia diagnosis and severity stratification require a certain degree of functional impairment [1]. Therefore, it is important to determine strategies to prevent functional deterioration in both, general population and especially people with dementia. The number of older adults with some degree of disability will triple by 2050 due to the increase in the aging population and the prevalence of age-related diseases that lead to functional impairment [2]. Therefore, functional impairment and disability in old people are increasingly becoming a major public health concern. Furthermore, functional impairment severely impairs quality of life and consumes a large proportion of the public health resources, creating an important burden for health care systems. It is well known that functional loss and disability in dementia are the main consequences of cognitive decline. Therefore, most of the efforts in dementia management have been directed to stop or reverse cognitive decline. However, functional loss and disability are also the consequence of other conditions that are common in old age and comorbid with dementia, such as frailty, sarcopenia, malnutrition, falls, pulmonary or cardiovascular diseases, polypharmacy, depression, and neuropsychiatric symptoms (NPS) [3].Q3Q2The growing incidence of dementia has led to an increased need for specialized care and higher health and social costs. Functional decline is the main cause of dementia complications. Per definition, dementia diagnosis and severity stratification require a certain degree of functional impairment [1]. Therefore, it is important to determine strategies to prevent functional deterioration in both, general population and especially people with dementia. The number of older adults with some degree of disability will triple by 2050 due to the increase in the aging population and the prevalence of age-related diseases that lead to functional impairment [2]. Therefore, functional impairment and disability in old people are increasingly becoming a major public health concern. Furthermore, functional impairment severely impairs quality of life and consumes a large proportion of the public health resources, creating an important burden for health care systems. It is well known that functional loss and disability in dementia are the main consequences of cognitive decline. Therefore, most of the efforts in dementia management have been directed to stop or reverse cognitive decline. However, functional loss and disability are also the consequence of other conditions that are common in old age and comorbid with dementia, such as frailty, sarcopenia, malnutrition, falls, pulmonary or cardiovascular diseases, polypharmacy, depression, and neuropsychiatric symptoms (NPS) [3].https://orcid.org/0000-0001-5680-7880https://scholar.google.com/citations?view_op=search_authors&mauthors=carlos+alberto+cano-gutierrez&hl=es&oi=aohttps://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0000054895&lang=esRevista Nacional - Indexad

COPD In Costa Rican Elder Older Adults and Its Association with Sarcopenia

Background: Sarcopenia is associated with to multiples comorbidities, including moreover those with some degree of inflammation. Chronic inflammatory states generate hypercatabolism and replacement of lean muscle mass for adipose tissue, decreasing muscle strength, power and function leading to disability and dependence. Here we study COPD as an important chronic inflammatory disease Strong associations have been reported between COPD and sarcopenia. The aim of this study is to evaluate the associations of COPD and sarcopenia with clinical outcomes, pulmonary function and health status and mortality. Methods: Data was taken of the CRELES- retirement cohort survey, a longitudinal study taken place in Costa Rica with a representative sample of 2820 elder adults born before 1945. Starting in 2010 with a second wave starting in 2012. The variable ‘presence of sarcopenia in patients with COPD’ was used to identify associations with independent variables (sociodemographic factors, self-rated health, comorbidities, functional status, cognitive status, pulmonary function, hospitalizations and mortality). Results: From a total of 2,827 60-year or older adults, 9.83% (n=278) were categorized as sarcopenic. A total of 18.09% referred as having a lung disease, from which 24.82% had sarcopenia (p=0.002). When grouping with sarcopenia and lung disease status, 74.24% did not had any of the conditions, 15.56% had just lung disease without sarcopenia, 7.67% had only sarcopenia without having lung disease and 2.53% had both conditions. The only group that had a higher risk of mortality was that having both conditions, with a hazard ratio of 1.81 (95% CI 1.27–2.58, p=0.001), after adjusting for age and sex. Conclusions: Older adults with lung disease have a significant higher prevalence of sarcopenia and a higher risk of mortality, than either any of the conditions alone. Special care to older adults with lung disease is important in order to detect sarcopenia and emphasize on those interventions that could impact this condition along with the regular treatment of the lung disease. This in turn could ameliorate prognosis of older adults with both conditions.Completo150-150Background: Sarcopenia is associated with to multiples comorbidities, including moreover those with some degree of inflammation. Chronic inflammatory states generate hypercatabolism and replacement of lean muscle mass for adipose tissue, decreasing muscle strength, power and function leading to disability and dependence. Here we study COPD as an important chronic inflammatory disease Strong associations have been reported between COPD and sarcopenia. The aim of this study is to evaluate the associations of COPD and sarcopenia with clinical outcomes, pulmonary function and health status and mortality. Methods: Data was taken of the CRELES- retirement cohort survey, a longitudinal study taken place in Costa Rica with a representative sample of 2820 elder adults born before 1945. Starting in 2010 with a second wave starting in 2012. The variable ‘presence of sarcopenia in patients with COPD’ was used to identify associations with independent variables (sociodemographic factors, self-rated health, comorbidities, functional status, cognitive status, pulmonary function, hospitalizations and mortality). Results: From a total of 2,827 60-year or older adults, 9.83% (n=278) were categorized as sarcopenic. A total of 18.09% referred as having a lung disease, from which 24.82% had sarcopenia (p=0.002). When grouping with sarcopenia and lung disease status, 74.24% did not had any of the conditions, 15.56% had just lung disease without sarcopenia, 7.67% had only sarcopenia without having lung disease and 2.53% had both conditions. The only group that had a higher risk of mortality was that having both conditions, with a hazard ratio of 1.81 (95% CI 1.27–2.58, p=0.001), after adjusting for age and sex. Conclusions: Older adults with lung disease have a significant higher prevalence of sarcopenia and a higher risk of mortality, than either any of the conditions alone. Special care to older adults with lung disease is important in order to detect sarcopenia and emphasize on those interventions that could impact this condition along with the regular treatment of the lung disease. This in turn could ameliorate prognosis of older adults with both conditions

Thyroid stimulating hormone levels and geriatric syndromes : secondary nested case–control study of the Mexican Health and Aging Study

Q3Q3Abstract Purpose To determine the incidence of geriatric syndromes (GS) in community dwelling older adults with subclinical hypothyroidism. Methods This is an analysis from the Mexican Health and Aging Study, of a subsample of 2089 subjects with TSH determination. From this last subsample, we included 1628 individuals with TSH levels in the subclinical range (4.5–10 µU/ml). Results The multivariate analysis showed that when comparing data obtained from the 2012 wave with the 2015 wave results, there was a signifcant incidence of some GS such as falls (OR 1.79, CI 1.16–2.77, p=0.0116), fatigue (OR 2.17, CI 1.40–3.38, p=0.0348) and depression (OR 1.70, CI 1.06–2.71, p=0.0246) among the subclinical hypothyroidism group. Conclusion This study showed a greater incidence of GS in subjects 50 years and older with sub-clinical hypothyroidism, when compared to those with normal thyroid function. Keywords Thyroid stimulating hormone · Aging · Geriatric syndromes · Chronic disease · Subclinical hypothyroidismhttps://orcid.org/0000-0002-1652-5042https://scholar.google.com/citations?user=qUwLuswAAAAJ&hl=es&oi=aohttps://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0000136038Revista Internacional - Indexad

The Social Vulnerability Index, Mortality and Disability in Mexican Middle-Aged and Older Adults

The social vulnerability index (SVI) independently predicts mortality and others adverse outcomes across different populations. There is no evidence that the SVI can predict adverse outcomes in individuals living in countries with high social vulnerability such as Latin America. The aim of this study was to analyze the association of the SVI with mortality and disability in Mexican middle-aged and older adults. This is a longitudinal study with a follow-up of 47 months, the Mexican Health and Aging Study, including people over the age of 40 years. A SVI was calculated using 42 items stratified in three categories low (0.47) vulnerability. We examined the association of SVI with three-year mortality and incident disability. Cox and logistic regression models were fitted to test these associations. We included 14,217 participants (58.4% women) with a mean age of 63.9 years (+/- SD 10.1). The mean SVI was of 0.42 (+/- SD 0.12). Mortality rate at three years was 6% (n = 809) and incident disability was 13.2% (n = 1367). SVI was independently associated with mortality, with a HR of 1.4 (95% CI 1.1-1.8, p < 0.001) for the highest category of the SVI compared to the lowest. Regarding disability, the OR was 1.3 (95% CI 1.1-1.5, p = 0.026) when comparing the highest and the lowest levels of the SVI. The SVI was independently associated with mortality and disability. Our findings support previous evidence on the SVI and builds on how this association persists even in those individuals with underlying contextual social vulnerability

Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study

Background: Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. Methods: For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. Findings: Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. Interpretation: Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life

Frailty in Older Adults with Mild Dementia: Dementia with Lewy Bodies and Alzheimer’s Disease

Introduction: The aim of the study is to describe the frequency of frailty in people with a new diagnosis of mild dementia due to Alzheimer’s disease (AD) and dementia with Lewy bodies (DLB). Methods: This is a secondary analysis of the Dementia Study of Western Norway (Demvest). For this study, we analysed a sample of 186 patients, 116 with AD and 70 with DLB. Subjects were included at a time in which mild dementia was diagnosed according to consensus criteria after comprehensive standardized assessment. Frailty was evaluated retrospectively using a frailty index generated from existing data. The cut-off value used to classify an older adult as frail was 0.25. Results: The prevalence of frailty was 25.81% (n = 48). In the DLB group, 37.14% (n = 26) were classified as frail, compared to 18.97% (n = 22) of those with AD (p < 0.001). The adjusted multivariate analysis revealed an OR of 2.45 (1.15–5.23) for being frail in those with DLB when using AD as the reference group. Conclusion: Frailty was higher than expected in both types of dementia. The prevalence of frailty was higher in those with DLB compared to AD. This new finding underscores the need for a multi-systems approach in both dementias, with a particular focus on DLB

Two-Way bridge between muscular dysfunction and cognitive impairment : secondary analyses of SABE - Bogota study

Abstract: Background and objective: Muscular dysfunction and cognitive impairment are both disabling states, affecting especially the elderly. Thus, are important subjects of research. Our goal is to describe the association between these two entities in the elderly. Methods: This is a secondary analysis from the SABE 2012 Bogota survey, which is a cross-sectional study. We define muscular dysfunction as an abnormal result in gait speed and/or handgrip strength tasks. Cognitive impairment was defined as an abnormal result in Mini Mental State Examination. Other independent variables were measured. Results: A total of 1,564 older adults were included in the analysis. Cognitive impairment showed statistically significant association with both low handgrip strength (OR: 2.25; CI 1.52 – 3.33) and low gait speed (OR: 2.76; CI 1.83 – 4.15) in the adjusted model. Conclusion: In older adults, muscular dysfunction is associated with cognitive impairment. New studies should address the causality and temporality of this relationship.Completo2-3Abstract: Background and objective: Muscular dysfunction and cognitive impairment are both disabling states, affecting especially the elderly. Thus, are important subjects of research. Our goal is to describe the association between these two entities in the elderly. Methods: This is a secondary analysis from the SABE 2012 Bogota survey, which is a cross-sectional study. We define muscular dysfunction as an abnormal result in gait speed and/or handgrip strength tasks. Cognitive impairment was defined as an abnormal result in Mini Mental State Examination. Other independent variables were measured. Results: A total of 1,564 older adults were included in the analysis. Cognitive impairment showed statistically significant association with both low handgrip strength (OR: 2.25; CI 1.52 – 3.33) and low gait speed (OR: 2.76; CI 1.83 – 4.15) in the adjusted model. Conclusion: In older adults, muscular dysfunction is associated with cognitive impairment. New studies should address the causality and temporality of this relationship

Frailty prevalence and associated factors in the Mexican health and aging study: a comparison of the frailty index and the phenotype

Frailty is a relatively new phenomenon described mainly in the older population. There are a number of different tools that aim at categorizing an older adult as frail. Two of the main tools for this purpose are the Fried's frailty phenotype (FFP) and the frailty index (FI). The aim of this report is to determine the prevalence of frailty and associated factors using both FFP and the FI.Secondary analysis of 1108 individuals aged 60 or older is participating in the third (2012) wave from the Mexican Health and Aging Study (MHAS). The FFP and the FI were constructed and a set of variables from different domains were used to explore associations. Domains included were: socio-demographic, health-related, and psychological factors. Regarding prevalence, concordance was tested with a kappa statistic. To test significant associations when classifying with each of the tools, multiple logistic regression models were fitted.Mean (SD) age was 69.8 (7.6) years, and 54.6% (n=606) were women. The prevalence of frailty with FFP was 24.9% (n=276) while with FI 27.5% (n=305). Kappa statistics for concordance between tools was 0.34 (

Frailty in Older Adults with Mild Dementia: Dementia with Lewy Bodies and Alzheimer’s Disease

Introduction: The aim of the study is to describe the frequency of frailty in people with a new diagnosis of mild dementia due to Alzheimer’s disease (AD) and dementia with Lewy bodies (DLB). Methods: This is a secondary analysis of the Dementia Study of Western Norway (Demvest). For this study, we analysed a sample of 186 patients, 116 with AD and 70 with DLB. Subjects were included at a time in which mild dementia was diagnosed according to consensus criteria after comprehensive standardized assessment. Frailty was evaluated retrospectively using a frailty index generated from existing data. The cut-off value used to classify an older adult as frail was 0.25. Results: The prevalence of frailty was 25.81% (n = 48). In the DLB group, 37.14% (n = 26) were classified as frail, compared to 18.97% (n = 22) of those with AD (p < 0.001). The adjusted multivariate analysis revealed an OR of 2.45 (1.15–5.23) for being frail in those with DLB when using AD as the reference group. Conclusion: Frailty was higher than expected in both types of dementia. The prevalence of frailty was higher in those with DLB compared to AD. This new finding underscores the need for a multi-systems approach in both dementias, with a particular focus on DLB