Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People

The European Working Group on Sarcopenia in Older People (EWGSOP) developed a practical clinical definition and consensus diagnostic criteria for age-related sarcopenia. EWGSOP included representatives from four participant organisations, i.e. the European Geriatric Medicine Society, the European Society for Clinical Nutrition and Metabolism, the International Association of Gerontology and Geriatrics—European Region and the International Association of Nutrition and Aging. These organisations endorsed the findings in the final document. The group met and addressed the following questions, using the medical literature to build evidence-based answers: (i) What is sarcopenia? (ii) What parameters define sarcopenia? (iii) What variables reflect these parameters, and what measurement tools and cut-off points can be used? (iv) How does sarcopenia relate to cachexia, frailty and sarcopenic obesity? For the diagnosis of sarcopenia, EWGSOP recommends using the presence of both low muscle mass + low muscle function (strength or performance). EWGSOP variously applies these characteristics to further define conceptual stages as ‘presarcopenia', ‘sarcopenia' and ‘severe sarcopenia'. EWGSOP reviewed a wide range of tools that can be used to measure the specific variables of muscle mass, muscle strength and physical performance. Our paper summarises currently available data defining sarcopenia cut-off points by age and gender; suggests an algorithm for sarcopenia case finding in older individuals based on measurements of gait speed, grip strength and muscle mass; and presents a list of suggested primary and secondary outcome domains for research. Once an operational definition of sarcopenia is adopted and included in the mainstream of comprehensive geriatric assessment, the next steps are to define the natural course of sarcopenia and to develop and define effective treatmen

Nutritional status, literacy, and risk factors of malnutrition in the population over 50 years of age - findings from the SHARE project

Summary: Background &amp; Aims: The transition from middle age to old age (from adults aged 50–55 years to older seniors aged 75–80 years) represents a critical period in terms of changes in body composition, i.e., increase in body fat percentage and decrease in fat-free body mass, which occur even at long-term stable weight. These changes are caused, among other things, by a gradual reduction in physical activity and deterioration in dietary habits. For many health conditions, like weight status, nutritional assessment and nutritional literacy can provide valuable information that can guide treatment efforts and maintenance of healthy eating habits. We therefore attempted to map this issue using data from the Survey of Health, Ageing and Retirement in Europe (SHARE) project. Methods: The basis for this study was data from the 8th wave of the SHARE project. The analysis included the results of the primary questionnaires CAPI (Computer Assisted Personal Interviewing) and the National Dropoff Questionnaire developed exclusively for the Czech Republic with a special module D “Nutrition” summarizing questions on eating habits, nutrition care and nutritional literacy. Results: A total of 2316 respondents were included in the study, 37.9% of whom were female and 62.1% male, with a mean age of 71.7±7.6 years. The prevalence of undernutrition, overweight and obesity in the study population was 9.2%, 42.8% and 32.2%, respectively. The presence of depression, anxiety, polypharmacy, multimorbidity and pain were associated with poor nutritional status (Pearson correlation coefficient, P < 0.001 for all five factors). The lifestyle factors of dietary habits and regular physical activity of the subjects did not meet current recommendations. Awareness of the existence and availability of dietitians and the possibilities of nutritional therapy and its reimbursement from public health insurance proved to be low. Conclusion: The results show a high prevalence of overweight, obesity and malnutrition in the Czech population over 50 years of age, low nutritional literacy, and inadequate coverage of nutritional care

Indwelling catheter use in home care - elderly, aged 65+ in 11 different countries in Europe

Objective: to describe possible differences/patterns in the use of indwelling urinary catheters (IUC) in Europe. Methods: the clients were assessed by using the Resident Assessment Instrument MDS-HC; epidemiological and medical characteristics of clients and service utilisation were recorded. Results: the sample consisted of 4,010 informants: 74% female, with mean age 82.3 ± 7.3 years; men 80.9 ± 7.5 years and female 82.8 ± 7.3 years. A total of 216 (5.4%) clients were using IUC. In Italy 23% were using a catheter compared with 0% in The Netherlands. Catheter use was more common in men than in women (11.5% versus 3.3%). Use of IUC was significantly correlated to certain diseases and symptoms and increase in care burden and formal services. Twenty-six per cent of the informants with indwelling catheters scored three or more on a hierarchical ADL scale (0–6). The clients using IUC in the Nordic countries were less dependent on care than in the other European countries. Models built on multivariate analysis explained 37% of the use of IUC. Tradition and attitudes may explain the differences between the sites. Conclusions: catheter use is associated with formal or family care burden. The need for nursing home placement ought to be considered in some cases. A stricter criterion for using IUC may be considered in the southern European countries

Effects of Nutrition and Exercise Interventions on Persons with Sarcopenic Obesity: An Umbrella Review of Meta-Analyses of Randomised Controlled Trials

Background: Sarcopenic obesity (SO) is an increasing phenomenon and has been linked to several negative health consequences. The aim of this umbrella review is the assessment of effectiveness and certainty of evidence of nutrition and exercise interventions in persons with SO. Method: We searched for meta-analyses of RCTs in PubMed, EMBASE and CENTRAL that had been conducted in the last five years, focusing on studies on the treatment and prevention of SO. The primary endpoints were parameters for SO, such as body fat in %, skeletal muscle mass index (SMMI), gait speed, leg strength and grip strength. The methodological quality was evaluated using AMSTAR and the certainty of evidence was assessed using GRADE. Results: Four systematic reviews with between 30 to 225 participants were included in the umbrella review. These examined four exercise interventions, two nutrition interventions and four interventions that combined nutrition and exercise. Resistance training was the most frequently studied intervention and was found to improve gait speed by 0.14 m/s to 0.17 m/s and lower leg strength by 9.97 kg. Resistance, aerobic, mixed exercise and hypocaloric diet combined with protein supplementation is not significantly effective on selected outcomes for persons with SO compared to no intervention. The low number of primary studies included in the reviews resulted in moderate to very low certainty of evidence. Conclusion: Despite the lack in certainty of evidence, resistance training may be a suitable intervention for persons with SO, in particular for improving muscle function. Nevertheless, further research is necessary to strengthen the evidence