Reference values and clinical predictors of bone strength for HR-pQCT-based distal radius and tibia strength assessments in women and men.

Reference values for radius and tibia strength using multiple-stack high-resolution peripheral quantitative computed tomography (HR-pQCT) with homogenized finite element analysis are presented in order to derive critical values improving risk prediction models of osteoporosis. Gender and femoral neck areal bone mineral density (aBMD) were independent predictors of bone strength. INTRODUCTION The purpose was to obtain reference values for radius and tibia bone strength computed by using the homogenized finite element analysis (hFE) using multiple stacks with a HR-pQCT. METHODS Male and female healthy participants aged 20-39 years were recruited at the University Hospital of Bern. They underwent interview and clinical examination including hand grip, gait speed and DXA of the hip. The nondominant forearm and tibia were scanned with a double and a triple-stack protocol, respectively, using HR-pQCT (XCT II, SCANCO Medical AG). Bone strength was estimated by using the hFE analysis, and reference values were calculated using quantile regression. Multivariable analyses were performed to identify clinical predictors of bone strength. RESULTS Overall, 46 women and 41 men were recruited with mean ages of 25.1 (sd 5.0) and 26.2 (sd 5.2) years. Sex-specific reference values for bone strength were established. Men had significantly higher strength for radius (mean (sd) 6640 (1800) N vs. 4110 (1200) N; p < 0.001) and tibia (18,200 (4220) N vs. 11,970 (3150) N; p < 0.001) than women. In the two multivariable regression models with and without total hip aBMD, the addition of neck hip aBMD significantly improved the model (p < 0.001). No clinical predictors of bone strength other than gender and aBMD were identified. CONCLUSION Reference values for radius and tibia strength using multiple HR-pQCT stacks with hFE analysis are presented and provide the basis to help refining accurate risk prediction models. Femoral neck aBMD and gender were significant predictors of bone strength

Performance of a Novel Handheld Bioelectrical Impedance Device for Assessing Muscle Mass in Older Inpatients.

OBJECTIVES To investigate practicality and repeatability of a handheld compared to a state-of-the-art multisegmental bioelectrical impedance analysis (BIA) device to facilitate screening of sarcopenia in older inpatients. DESIGN AND SETTING Cross-sectional study in a geriatric rehabilitation hospital. PARTICIPANTS 207 inpatients aged 70+. MEASUREMENTS In a first phase, appendicular skeletal muscle mass index (ASMI) was measured using the handheld Biody xpertZm II BIA device (n=100). In a second phase, ASMI was obtained using the multisegmental Biacorpus RX 4004M device (n=107). Repeatability of BIA devices was compared in subgroups of patients (handheld BIA device: n=36, multisegmental BIA device: n=46) by intra-class correlation (ICC) and Bland-Altman plots. RESULTS Overall, measurement failure was seen in 31 patients (31%) tested with the handheld BIA device compared to one patient (0.9%) using the multisegmental BIA device (p<0.001). Main reasons for measurement failure were inability of patients to adopt the position necessary to use the handheld BIA device and device failure. The mean difference of two ASMI measurements in the same patient was 0.32 (sd 0.85) using the handheld BIA device compared to 0.02 kg/m2 (sd 0.07) using the multisegmental device (adjusted mean difference between both groups -0.35, 95% confidence interval (CI) -0.61 to -0.09 kg/m2). Congruently, Bland-Altman plots showed poor agreement with the handheld compared to the multisegmental BIA device. CONCLUSION The handheld BIA device is neither a practical nor reliable device for assessing muscle mass in older rehabilitation inpatients

Predictive Abilities of the Frailty Phenotype and the Swiss Frailty Network and Repository Frailty Index for Non-Home Discharge and Functional Decline in Hospitalized Geriatric Patients

BACKGROUND: Frailty is increasingly applied as a measure to predict clinical outcomes, but data on the predictive abilities of frailty measures for non-home discharge and functional decline in acutely hospitalized geriatric patients are scarce. OBJECTIVES: The aim of this study was to investigate the predictive ability of the frailty phenotype and a frailty index currently validated as part of the ongoing Swiss Frailty Network and Repository Study based on clinical admission data for non-home discharge and functional decline in acutely hospitalized older patients. DESIGN: Prospective cohort study. SETTING AND PARTICIPANTS: Data were analyzed from 334 consecutive hospitalized patients of a tertiary acute care geriatric inpatient clinic admitted between August 2020 and March 2021. MEASUREMENTS: We assessed frailty using 1) the frailty phenotype and 2) the Swiss Frailty Network and Repository Study (SFNR) frailty index based on routinely available clinical admission data. Predictive abilities of both frailty measures were analyzed for the clinical outcomes of non-home discharge and functional decline using multivariate logistic regression models and receiver operating characteristic curves (ROC). RESULTS: Mean age was 82.8 (SD 7.2) years and 55.4% were women. Overall, 170 (53.1%) were frail based on the frailty phenotype and 220 (65.9%) based on the frailty index. Frail patients based on the frailty phenotype were more likely to be discharged non-home (55 (32.4%) vs. 26 (17.3%); adjusted OR 2.4 (95% CI, 1.4, 5.1)). Similarly, frail patients based on the frailty index were more likely to be discharged non-home compared to non-frail patients (76 (34.6%) vs. 9 (7.9%); adjusted OR, 5.5 (95% CI, 2.6, 11.5)). Both, the frailty phenotype and the frailty index were similarly associated with functional decline (adjusted OR 2.7 (95% CI, 1.5, 4.9); adjusted OR 2.8 (95% CI 1.4, 5.5)). ROC analyses showed best discriminatory accuracy for the frailty index for non-home discharge (area under the curve 0.76). CONCLUSIONS: Frailty using the SFNR-frailty index and the frailty phenotype is a promising measure for prediction of non-home discharge and functional decline in acutely hospitalized geriatric patients. Further study is needed to define the most valid frailty measure

Predictive Abilities of the Frailty Phenotype and the Swiss Frailty Network and Repository Frailty Index for Non-Home Discharge and Functional Decline in Hospitalized Geriatric Patients

Background: Frailty is increasingly applied as a measure to predict clinical outcomes, but data on the predictive abilities of frailty measures for non-home discharge and functional decline in acutely hospitalized geriatric patients are scarce. Objectives: The aim of this study was to investigate the predictive ability of the frailty phenotype and a frailty index currently validated as part of the ongoing Swiss Frailty Network and Repository Study based on clinical admission data for non-home discharge and functional decline in acutely hospitalized older patients. Design: Prospective cohort study. Setting and participants: Data were analyzed from 334 consecutive hospitalized patients of a tertiary acute care geriatric inpatient clinic admitted between August 2020 and March 2021. Measurements: We assessed frailty using 1) the frailty phenotype and 2) the Swiss Frailty Network and Repository Study (SFNR) frailty index based on routinely available clinical admission data. Predictive abilities of both frailty measures were analyzed for the clinical outcomes of non-home discharge and functional decline using multivariate logistic regression models and receiver operating characteristic curves (ROC). Results: Mean age was 82.8 (SD 7.2) years and 55.4% were women. Overall, 170 (53.1%) were frail based on the frailty phenotype and 220 (65.9%) based on the frailty index. Frail patients based on the frailty phenotype were more likely to be discharged non-home (55 (32.4%) vs. 26 (17.3%); adjusted OR 2.4 (95% CI, 1.4, 5.1)). Similarly, frail patients based on the frailty index were more likely to be discharged non-home compared to non-frail patients (76 (34.6%) vs. 9 (7.9%); adjusted OR, 5.5 (95% CI, 2.6, 11.5)). Both, the frailty phenotype and the frailty index were similarly associated with functional decline (adjusted OR 2.7 (95% CI, 1.5, 4.9); adjusted OR 2.8 (95% CI 1.4, 5.5)). ROC analyses showed best discriminatory accuracy for the frailty index for non-home discharge (area under the curve 0.76). Conclusions: Frailty using the SFNR-frailty index and the frailty phenotype is a promising measure for prediction of non-home discharge and functional decline in acutely hospitalized geriatric patients. Further study is needed to define the most valid frailty measure. Keywords: Frailty syndrome; aged; discharge planning; geriatrics; inpatients; predictive value of test

Effects of Health Risk Assessment and Counselling on Fruit and Vegetable Intake in Older People: A Pragmatic Randomised Controlled Trial.

OBJECTIVES Interventions to increase fruit and vegetable intake among community-dwelling older people have shown mixed effects. We investigated whether an intervention based on an initial multidimensional health risk assessment and subsequent physician-lead nutrition counselling has favourable effects on dietary intake among community-dwelling older people. DESIGN Randomised controlled trial comparing the intervention versus usual care. SETTING AND PARTICIPANTS Non-disabled persons aged 65 years or older at an ambulatory geriatric clinic in Bucharest, Romania, allocated to intervention (n=100) and control (n=100) groups. INTERVENTION Participants received a computer-generated health profile report based on answers to a health risk assessment questionnaire, followed by monthly individual counselling sessions with a geriatrician on topics related to health promotion and disease prevention, with a special focus on adequate fruit and vegetable consumption. MEASUREMENTS Fruit and vegetable intake at baseline and at 6-month follow-up. RESULTS At baseline, fruit and vegetable intake was below the recommended five portions per day in most study participants (85% in the intervention group, and 86% among controls, respectively). At six months, intake increased in the intervention group from a median of 3.8 to 4.6 portions per day, and decreased in the control group due to a seasonal effect from a median of 3.8 to 3.1 portions per day. At six months, fruit and vegetable consumption was significantly higher among persons in the intervention group as compared to controls (median difference 1.4 portions per day, 95% confidence interval 1.1-1.7, p<0.001). CONCLUSION Personalised food-based dietary guidance, delivered as part of multidimensional preventive health counselling during geriatric clinic visits, results in relevant improvement of fruit and vegetable intake in community-dwelling older adults

Ability of 3 Frailty Measures to Predict Short-Term Outcomes in Older Patients Admitted for Post-Acute Inpatient Rehabilitation.

OBJECTIVES To evaluate the ability of 3 commonly used frailty measures to predict short-term clinical outcomes in older patients admitted for post-acute inpatient rehabilitation. DESIGN Observational cohort study. SETTING AND PARTICIPANTS Consecutive patients (n = 207) admitted to a geriatric inpatient rehabilitation facility. METHODS Frailty on admission was assessed using a frailty index, the physical frailty phenotype, and the Clinical Frailty Scale (CFS). Predictive capacity of the frailty instruments was analyzed for (1) nonhome discharge, (2) readmission to acute care, (3) functional decline, and (4) prolonged length of stay, using multivariate logistic regression models and receiver operating characteristic (ROC) curves. RESULTS The number of patients classified as frail was 91 (44.0%) with the frailty index, 134 (64.7%) using the frailty phenotype, and 151 (73.0%) with the CFS. The 3 frailty measures revealed acceptable discriminatory accuracy for nonhome discharge (area under the curve ≥ 0.7) but differed in their predictive ability: the adjusted odds ratio (OR) for nonhome discharge was highest for the CFS [6.2, 95% confidence interval (CI) 1.8-21.1], compared to the frailty index (4.1, 95% CI 2.0-8.4) and the frailty phenotype (OR 2.9, 95% CI 1.2-6.6). For the other outcomes, discriminatory accuracy based on ROC tended to be lower and predictive ability varied according to frailty measure. Readmission to acute care from inpatient rehabilitation was predicted by all instruments, most pronounced by the frailty phenotype (OR 5.4, 95% CI 1.6-18.8) and the frailty index (OR 2.5, 95% CI 1.1-5.6), and less so by the CFS (OR 1.4, 95% CI 0.5-3.8). CONCLUSIONS AND IMPLICATIONS Frailty measures may contribute to improved prediction of outcomes in geriatric inpatient rehabilitation. The choice of the instrument may depend on the individual outcome of interest and the corresponding discriminatory ability of the frailty measure

Promoting independence, health and well-being for older people: : a feasibility study of computer-aided health and social risk appraisal system in primary care

© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Walters et al, BMC Family Practice (2017), 18:47, DOI: 10.1186/s12875-017-0620-6Abstract Background: With population ageing, research is needed into new low-cost, scalable methods of effective promotion of health and wellbeing for older people. We aimed to assess feasibility, reach and costs of implementing a new tailored computer-aided health and social risk appraisal system in primary care. Methods: Design: Feasibility study. Setting: Five General Practices in London (Ealing) and Hertfordshire, United Kingdom (UK) Participants: Random sample of patients aged 65+years. Intervention: The Multi-dimensional Risk Appraisal for Older people (MRA-O) system includes: 1) Postal questionnaire including health, lifestyle, social and environmental domains; 2) Software system generating a personalised feedback report with advice on health and wellbeing; 3) Follow-up of people with new concerning or complex needs by GPs or practice nurses. Evaluation: Feasibility of implementation; participant wellbeing, functional ability and quality of life; social needs, health risks, potential lifestyle changes; and costs of implementation. Results: Response rates to initial postal invitations were low (526/1550, 34%). Of these, 454/526 (86%) completed MRA-O assessments. Compared to local UK Census data on older people, participants were younger, more were owner-occupiers and fewer were from ethnic minority groups than expected. A range of problems was identified by participants, including pain in last week (269/438, 61.4%), low physical activity (173/453, 38.2%), sedentary lifestyle (174/447, 38.3%), falls (117/439, 26.7%), incontinence (111/441 25.2%), impaired vision 116/451 (25.7%), impaired hearing (145/431, 33.6%), depressed mood (71/451, 15.7%), impaired memory (44/444 9.9%), social isolation (46/449, 10.2%) and loneliness (31/442, 7.0%). Self-rated health was good/excellent in 312/437 (71.4%), and quality of life and well-being were slightly above age-specific population norms. Implementation costs were low. Practices reviewed medical records of 143/454 (31.5%) of participants as a consequence of their responses, and actively followed up 110/454 (24.2%) of their patients. Conclusions: A computer-aided risk appraisal system was feasible for General Practices to implement, yields useful information about health and social problems, and identifies individual needs. Participation rates were however low, particularly for the oldest old, the poorest, and ethnic minority groups, and this type of intervention may increase inequalities in access. Widespread implementation of this approach would require work to address potential inequalities.Peer reviewedFinal Published versio