Entwicklung und Evaluation des Fragebogens PRISCUS-PAQ zur Erfassung der körperlichen Aktivität von Personen im Alter von 70 Jahren und älter

Über das Aktivitätsverhalten der älteren Bevölkerung in Deutschland ist wenig bekannt. Um die Aktivität von älteren Erwachsener zu erfassen, fehlte bislang ein geeignetes Messinstrument. Das Ziel dieser Arbeit war, den Fragebogen PRISCUS-PAQ zur Erfassung der körperlichen Aktivität älterer Erwachsener zu entwickeln und zu evaluieren. PRISCUS-PAQ erfasst die körperliche Aktivität der vergangenen sieben Tage. Insgesamt zehn Fragen ermöglichen die Berechnung des PRISCUS-PAQ-Gesamtscores, der dem wöchentlichen Energieverbrauch entspricht. Die Gütekriterien des PRISCUS-PAQ wurden an 114 Teilnehmenden im mittleren Alter von 76 $\pm$ 5 Jahren ermittelt. Die Retest-Reliabilität lag bei Intraklassenkorrelation=0,59 (95% KI: 0,43-0,71); die Übereinstimmung des PRISCUS-PAQ-Gesamtscores mit den durch Akzelerometrie ermittelten Beschleunigungswerten betrug r$_{s}$=0,28 (95% KI: 0,10-0,44). PRISCUS-PAQ kann nun zur Erfassung der körperlichen Aktivität von Personen im höheren Lebensalter eingesetzt werden

Reliability of accelerometric measurement of physical activity in older adults - the benefit of using the trimmed sum

There is general consensus that physical activity is important for preserving functional capacities of older adults and positively influencing quality of life. While accelerometry is widely accepted and applied to assess physical activity in studies, several problems with this method remain (e.g., low retest reliability, measurement errors). The aim of this study was to test the intra-instrumental retest reliability of a wrist-worn accelerometer in a 3-day measurement of physical activity in older adults and to compare different estimators. A sample of 123 older adults (76.5 ± 5.1 years, 59 % female) wore a uniaxial accelerometer continuously for 1 week. The data were split into two repeated measurement values (week set) of 3 days each. The sum, the 80-99th quantiles and the 80-99th trimmed sums were built for each week set. Retest reliability was assessed for each estimator and graphically demonstrated by Bland-Altman plots. The intraclass correlation of the retest reliability ranged from 0.22 to 0.91. Retest reliability increases when a more robust estimator than the overall sum is used. Therefore, the trimmed sum can be recommended as a conservative estimate of the physical activity level of older adults

Die Eignung von Fragebögen zur Erfassung der körperlichen Aktivität älterer Erwachsener für den Einsatz in einer epidemiologischen Studie

Zur Erfassung der körperlichen Aktivität älterer Personen in einer epidemiologischen Beobachtungsstudie wurde ein altersspezifischer Fragebogen gesucht. Ziele dieser Arbeit waren die Darstellung und Beurteilung bestehender Fragebögen hinsichtlich ihrer Eignung für den Einsatz in dieser Studie. In der Datenbank PubMed wurde eine systematische Literaturrecherche durchgeführt. Dargestellt werden Modified Baecke Questionnaire for Older Adults, Zutphen Physical Activity Questionnaire, Physical Activity Scale for the Elderly, Yale Physical Activity Survey und CHAMPS Physical Activity Questionnaire for Older Adults. Diese Fragebögen unterscheiden sich u.a. in: Art der Befragung (z.B. persönliches oder telefonisches Interview), abgefragtes Zeitfenster (eine Woche bis ein Jahr), Berücksichtigung von Alltagsaktivitäten, Form der Fragen (offen bzw. geschlossen), Ermittlung eines Gesamtscores, Dauer der Erfassung (fünf bis 30 Minuten), Anzahl der Befragten (21 bis 254 Personen), Anteil der männlichen Teilnehmer (41 bis 100%), Abstand zur Messwiederholung (zwei Wochen bis sechs Monate), eingesetztes Außenkriterium (z.B. Tagebuchaufzeichnung, Körperfettanteil) und Ergebnisse der Gütekriterien (Reliabilität: r =0,57 bis 0,93 und Intra-Klassen-Korrelation=0,62 bis 0,67; Validität: r =-0,13 bis 0,79). Im Hinblick auf die dargestellten Bewertungskriterien für den Einsatz in einer epidemiologischen Beobachtungsstudie erschien keiner der beschriebenen Fragebögen hinreichend geeignet, um die körperliche Aktivität älterer Erwachsener zu erfassen. Folglich sollte ein neuer Fragebogen entwickelt bzw. anhand der bestehenden Fragebögen adaptiert werden, der die körperliche Aktivität der vergangenen Woche in den Bereichen Sport, Freizeit, Haushalt und Garten mit kurzer Befragungsdauer in geschlossenen Fragen erfasst und Rückschlüsse auf den Energieverbrauch zulässt

Optimal Jamar dynamometer handle position to assess maximal isometric hand grip strength in epidemiological studies

Hand grip strength is an indicator of general muscle strength that is measured using a hand dynamometer. In some studies, a subject's grip strength is taken to be the maximal grip strength achieved from measurements taken at several different dynamometer handle positions. However, little is known about the influence of these different positions on the measured grip strength. The aim of the study was to identify one standard handle position that could be used to assess the grip strength of all subjects.; Grip strength was assessed with a hand dynamometer (Jamar Plus+; Sammons Preston, Rolyon, Bolingbrook, IL). Each participant's grip strength was measured 3 times in each of 5 different handle positions with each hand. The best position for each participant was defined as the position at which they achieved maximal grip strength.; The mean (± standard deviation) age of the 50 participants was 41 (± 13) years. Maximal grip strength was 43.7 (± 12.4) kg for all participants; 55.0 (± 10.2) kg for men and 35.4 (± 5.2) kg for women. Handle position 2 was the best position for 70% of participants. The mean difference between the grip strength achieved by each participant at handle position 2 and that achieved at each participant's best position was 0.8 (± 1.78) kg.; Our results show that measurements taken at a single standard handle position are sufficiently accurate to assess grip strengths for all subjects. We therefore recommend handle position 2 as the standard position for measuring grip strength with the Jamar Plus+ hand dynamometer.; The assessment of grip strength with the Jamar Plus+ dynamometer is easier and faster if a single, standard handle position is used rather than multiple different positions. As well as providing accurate results, a single, standard handle position also reduces fatigue and increases the comparability of results between subjects

Sarcopenic Dysphagia Revisited: A Cross-Sectional Study in Hospitalized Geriatric Patients

Oropharyngeal dysphagia (OD) is a frequent finding in older patients with potentially lethal complications such as aspiration pneumonia, malnutrition, and dehydration. Recent studies describe sarcopenia as a causative factor for OD, which is occasionally referred to as “sarcopenic dysphagia” in the absence of a neurogenic etiology. In most of the previous studies on sarcopenic dysphagia, the diagnosis was based only on clinical assessment. In this study, flexible endoscopic evaluation of swallowing (FEES) was used as an objective method to evaluate the presence of OD, its association with sarcopenia, and the presence of pure sarcopenic dysphagia. In this retrospective cross-sectional study, 109 acute care geriatric hospital patients with suspected OD received FEES examination and bioimpedance analysis (BIA) in clinical routine. 95% of patients had at least one neurological disease, 70% fulfilled the criteria for sarcopenia, and 45% displayed moderate or severe OD. Although the prevalence of sarcopenia and OD was high, there was no significant association between OD and sarcopenia. Considering these results, both the association between sarcopenia and OD and pure sarcopenic dysphagia appear questionable. Further prospective studies are needed to elucidate if sarcopenia is merely an epiphenomenon of severe disease or whether it plays a causative role in the development of OD

Experiences of participants of a volunteer-supported walking intervention to improve physical function of nursing home residents – a mixed methods sub-study of the POWER-project

Abstract Background Regular physical activity improves physical health and mental well-being and reduces the risk of falling in older adults. The randomized controlled “Prevention by lay-assisted Outdoor-Walking in the Elderly at Risk” POWER-study investigates whether volunteer-supported outdoor-walking improves physical function and quality of life in older people living independently or in nursing homes. This sub-study explores the experiences of older participants and volunteers in relation to their physical and psychosocial well-being as well as the challenges faced by both groups. A further aim was to explore volunteers’ experience with people living in nursing homes during the first pandemic lockdown (spring 2020). Methods The sub-study was designed as mixed-methods approach consisting of 11 individual semi-structured guide-based interviews (nursing home residents), two focus group interviews (volunteers), and a cross-sectional questionnaire survey (volunteers). The interviews were audiotaped, transcribed verbatim, and analyzed by content analysis as described by Kuckartz. Topics addressed in the interviews were triangulated by means of a questionnaire. The quantitative data were analyzed using descriptive statistics. Results Participants’ evaluation of the intervention was generally positive. Nursing home residents appreciated the social interaction associated with the assisted walking, which motivated them to take part regularly, provided a sense of safety, and caused pleasure on both sides. The impact on physical health status of the nursing home residents of this sub-study varied to a large degree as reported in interviews: in some cases, an improvement in physical performance, a decrease in physical complaints, and an improvement in gait or independence was reported. If not, reference was made to previous or sudden illnesses and the advanced age of the participants. Despite the COVID-19-lockdown and the associated restrictions, about 60% of contacts were still possible and participants planned to continue the assisted walks after the lockdown. Conclusion Volunteers have a positive effect on the quality of life, mobility, and general health of nursing home residents. Even more than the improvement of physical performance, social interaction was seen as helpful. Despite their advanced age, the nursing home residents were curious and open to new contacts. When removing the identified barriers, it might be possible to integrate this program into the long-term everyday life of nursing homes. Trial registration DRKS-ID: DRKS00015188, date of registration: 31.08.2018

Sarcopenic dysphagia revisited

Oropharyngeal dysphagia (OD) is a frequent finding in older patients with potentially lethal complications such as aspiration pneumonia, malnutrition, and dehydration. Recent studies describe sarcopenia as a causative factor for OD, which is occasionally referred to as "sarcopenic dysphagia" in the absence of a neurogenic etiology. In most of the previous studies on sarcopenic dysphagia, the diagnosis was based only on clinical assessment. In this study, flexible endoscopic evaluation of swallowing (FEES) was used as an objective method to evaluate the presence of OD, its association with sarcopenia, and the presence of pure sarcopenic dysphagia. In this retrospective cross-sectional study, 109 acute care geriatric hospital patients with suspected OD received FEES examination and bioimpedance analysis (BIA) in clinical routine. 95% of patients had at least one neurological disease, 70% fulfilled the criteria for sarcopenia, and 45% displayed moderate or severe OD. Although the prevalence of sarcopenia and OD was high, there was no significant association between OD and sarcopenia. Considering these results, both the association between sarcopenia and OD and pure sarcopenic dysphagia appear questionable. Further prospective studies are needed to elucidate if sarcopenia is merely an epiphenomenon of severe disease or whether it plays a causative role in the development of OD

Osteosarcopenia, an asymmetrical overlap of two connected syndromes

Osteoporosis and sarcopenia are two chronic conditions, which widely affect older people and share common risk factors. We investigated the prevalence of low bone mineral density (BMD) and sarcopenia, including the overlap of both conditions (osteosarcopenia) in 572 older hospitalized patients (mean age 75.1 $\pm$ 10.8 years, 78% women) with known or suspected osteoporosis in this prospective observational multicenter study. Sarcopenia was assessed according to the revised definition of the European Working Group on Sarcopenia in Older People (EWGSOP2). Low BMD was defined according to the World Health Organization (WHO) recommendations as a T-score < −1.0. Osteosarcopenia was diagnosed when both low BMD and sarcopenia were present. Low BMD was prevalent in 76% and the prevalence of sarcopenia was 9%, with 90% of the sarcopenic patients showing the overlap of osteosarcopenia (8% of the entire population). Conversely, only few patients with low BMD demonstrated sarcopenia (11%). Osteosarcopenic patients were older and frailer and had lower BMI, fat, and muscle mass, handgrip strength, and T-score compared to nonosteosarcopenic patients. We conclude that osteosarcopenia is extremely common in sarcopenic subjects. Considering the increased risk of falls in patients with sarcopenia, they should always be evaluated for osteoporosis