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BACKGROUND: People living in care homes often have problems with pain, anxiety and depression. Whether being on analgesia, anxiolytics or antidepressants has any bearing on pain severity and quality of life (QoL) in this population, requires further investigation. OBJECTIVES: (i) to examine the relationship between pain, anxiety and depression and medication use in care home residents and (ii) to compare those on medications to treat pain, anxiety and depression, and those who were not, and associations with pain severity and overall QoL. METHODS: This was a secondary analysis of a randomised controlled trial testing a falls prevention intervention in care homes. We recorded pain, anxiety and depression, QoL measurements and prescribed medication use. RESULTS: In 1589 participants, the mean age was 84.7 years (±9.3 SD), 32.2% were male and 67.3% had a diagnosis of dementia. 54.3% and 53.2% of participants had some level of pain and anxiety or depression respectively, regardless of prescribed medication use. There was a direct association between pain severity and being on any analgesia, opioid analgesia, and antidepressants, but no associations between pain severity and use of paracetamol and anxiolytics. QoL was best for residents with no pain and not on any analgesia, anxiolytics or antidepressants and worst for those with moderate-extreme pain and taking at least two of these classes of medications. CONCLUSION: Many care home residents live with pain, anxiety and depression. Addressing residents' pain may also increase their quality of life, but using medication alone to reach this goal may be inadequate.
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Analgésicos , Ansiolíticos , Antidepresivos , Ansiedad , Depresión , Hogares para Ancianos , Casas de Salud , Dimensión del Dolor , Dolor , Calidad de Vida , Humanos , Masculino , Femenino , Ansiolíticos/uso terapéutico , Anciano , Anciano de 80 o más Años , Antidepresivos/uso terapéutico , Dolor/tratamiento farmacológico , Dolor/psicología , Dolor/diagnóstico , Depresión/tratamiento farmacológico , Depresión/psicología , Depresión/diagnóstico , Ansiedad/psicología , Ansiedad/tratamiento farmacológico , Ansiedad/diagnóstico , Analgésicos/uso terapéutico , Accidentes por Caídas/prevención & control , Accidentes por Caídas/estadística & datos numéricos , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
BACKGROUND: With population aging and advances in surgical and anesthetic procedures, the incidence of surgery in patients over the age of 65 years is increasing. One post-operative complication often encountered by older surgical patients is post-operative cognitive dysfunction (POCD). Preoperative exercise training can improve the overall physiological resilience of older surgical patients, yet its impact on post-operative cognition is less well-established. METHODS: Six databases (Medline (OVID); EMBASE (OVID); EMCARE (OVID); CINAHL (EBSCOHost), the Cochrane Library, and PubMed) were searched for studies reporting the effect of pre-operative physical training on post-operative cognition. The quality of evidence was assessed using the Mixed Methods Assessment Tool. RESULTS: A total of 3983 studies were initially identified, three of which met the inclusion criteria for this review. Two studies were pilot randomized trials, and one was a prospective randomized trial. Two of the studies were high-quality. Each study used a different type of physical exercise and cognition assessment tool. Across the studies, post-operative cognition (p = 0.005) and attention (p = 0.04) were found to be better in the intervention groups compared to control, with one study reporting no difference between the groups. CONCLUSION: Preoperative physical training may improve post-operative cognitive function, although more research with a consistent endpoint is required. Future studies should focus on patients at high risk of POCD, such as older adults, and explore the impact of different exercise regimes, including frequency, intensity, time, and type.
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INTRODUCTION: Understanding genetic contributors to sarcopenia (age-related loss of muscle strength and mass) is key to finding effective therapies. Variants of the bradykinin receptor 2 (BDKRB2) have been linked to athletic and muscle performance. The rs1799722-9 and rs5810761 T alleles have been shown to be overrepresented in endurance athletes, possibly due to increased transcriptional rates of the receptor. These variants have been rarely studied in older people or people with sarcopenia. METHODS: We performed a post hoc sub-study of the Leucine and ACE (LACE) inhibitor trial, which enrolled 145 participants aged ≥70 years with low grip strength and low gait speed. Participants' blood samples were genotyped for rs179972 using TaqMan and rs5810761 by amplification through Hotstar Taq. Genotypes were compared with outcomes of physical performance and body composition measures. RESULTS: Data from 136 individuals were included in the analysis. For rs1799722 the genotype frequency (TT: 17, CC: 48, CT: 71) remained in Hardy-Weinberg Equilibrium (HWE p = 0.248). There was no difference between the genotypes for six-Minute Walk Distance (6MWD) or Short Physical Performance Battery (SPPB). Men with the TT genotype had a significantly greater 6MWD than other genotypes (TT 400m vs CT 310m vs CC 314m, p = 0.027), and greater leg muscle mass (TT 17.59kg vs CT 15.04kg vs CC 15.65kg, p = 0.007). For rs5810761, the genotype frequency (-9-9: 31, +9+9: 43, -9+9: 60) remained in HWE (p = 0.269). The +9+9 genotype was associated with a significant change in SPPB score at 12 months (-9-9 0 vs -9+9 0 vs +9+9-1, p<0.001), suggesting an improvement. In men, the -9-9 genotype was associated with lower arm fat (-9-9 2.39kg vs -9+9 2.72kg vs +9+9 2.76kg, p = 0.019). CONCLUSION: In men, the rs1799722 TT genotype was associated with longer 6MWD and greater leg muscle mass, while the rs5810761 -9-9 genotype was associated with lower arm fat mass.
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Rendimiento Físico Funcional , Receptor de Bradiquinina B2 , Sarcopenia , Humanos , Masculino , Anciano , Femenino , Receptor de Bradiquinina B2/genética , Sarcopenia/genética , Músculo Esquelético/patología , Músculo Esquelético/fisiopatología , Genotipo , Alelos , Polimorfismo de Nucleótido Simple , Composición Corporal , Leucina/genética , Anciano de 80 o más Años , Fuerza de la Mano , Fuerza Muscular/genéticaRESUMEN
PURPOSE: There is variation in organization of geriatric rehabilitation across Europe. The purpose of this study was to describe the selection criteria for referral to geriatric rehabilitation, care provided, and recovery trajectories of post-COVID-19 patients referred to geriatric rehabilitation in Europe. METHODS: This observational cohort study included 723 patients in 59 care facilities for geriatric rehabilitation across 10 countries. Patient data were collected from medical records on admission to geriatric rehabilitation (between September 2020 and October 2021), discharge, 6 weeks and 6 months follow-up. The primary and secondary outcomes were recovery in daily functioning (Barthel Index) and Quality of Life (EQ-5D-5L) from admission to discharge. These were examined using linear mixed models with two levels (measurements nested in patients) and country as an independent variable. Random intercept and random linear slope parameters were added when they improved model fit. A survey about organization of geriatric rehabilitation for post-COVID-19 patients was filled out by country coordinators and data were analyzed using descriptive statistics and inductive coding of answers to open questions. RESULTS: Patients had a mean age of 75.7 years old and 52.4% were male. Many countries used various combinations of the selection criteria, such as functional status, age, frailty, Comprehensive Geriatric Assessment, comorbidities, and cognitive impairments. Most patients received physiotherapy (88.8%) and occupational therapy (69.7%), but there was substantial variance between countries in the percentages of patients that received protein or calorie enriched diets, oxygen therapy, and other treatment components. In all countries, patients showed recovery in daily functioning and quality of life, although there was variation in between countries in rate of recovery. Daily functioning seemed to increase most rapidly in the Czech Republic, Germany, and Russia. The steepest increases in quality of life were seen in the Czech Republic, Germany, and Spain. CONCLUSION: Post-COVID-19 patients showed recovery during geriatric rehabilitation, albeit at variable rates. The observed variation may be explained by the heterogeneity in selection criteria and care provided. This study highlights the need for harmonization of measurements in geriatric rehabilitation order to perform explanatory research and optimize geriatric rehabilitation throughout Europe to ensure optimal patient recovery.
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BACKGROUND: NHS England's 'Enhanced Health in Care Homes' specification aims to make the healthcare of care home residents more proactive. Primary care networks (PCNs) are contracted to provide this, but approaches vary widely: challenges include frailty identification, multidisciplinary team (MDT) capability/capacity and how the process is structured and delivered. AIM: To determine whether a proactive healthcare model could improve healthcare outcomes for care home residents. DESIGN AND SETTING: Quality improvement project involving 429 residents in 40 care homes in a non-randomised crossover cohort design. The headline outcome was 2-year survival. METHOD: All care home residents had healthcare coordinated by the PCN's Older Peoples' Hub. A daily MDT managed the urgent healthcare needs of residents. Proactive healthcare, comprising information technology-assisted comprehensive geriatric assessment (i-CGA) and advanced care planning (ACP), were completed by residents, with prioritisation based on clinical needs.Time-dependent Cox regression analysis was used with patients divided into two groups:Control group: received routine and urgent (reactive) care only.Intervention group: additional proactive i-CGA and ACP. RESULTS: By 2 years, control group survival was 8.6% (n=108), compared with 48.1% in the intervention group (n=321), p<0.001. This represented a 39.6% absolute risk reduction in mortality, 70.2% relative risk reduction and the number needed to treat of 2.5, with little changes when adjusting for confounding variables. CONCLUSION: A PCN with an MDT-hub offering additional proactive care (with an i-CGA and ACP) in addition to routine and urgent/reactive care may improve the 2-year survival in older people compared with urgent/reactive care alone.
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Mejoramiento de la Calidad , Humanos , Femenino , Masculino , Anciano de 80 o más Años , Anciano , Evaluación Geriátrica/métodos , Evaluación Geriátrica/estadística & datos numéricos , Inglaterra , Casas de Salud/estadística & datos numéricos , Casas de Salud/normas , Casas de Salud/organización & administración , Hogares para Ancianos/estadística & datos numéricos , Hogares para Ancianos/normas , Estudios de Cohortes , Atención Primaria de Salud/estadística & datos numéricos , Atención Primaria de Salud/normasRESUMEN
Telerehabilitation (TR) shows promise as a method of remote service delivery, yet there is little guidance to inform implementation in the context of the National Health Service (NHS) in England. This paper presents the protocol for a realist synthesis study aiming to investigate how TR can be implemented to support the provision of high-quality, equitable community-based stroke rehabilitation, and under what conditions. Using a realist approach, we will synthesise information from (1) an evidence review, (2) qualitative interviews with clinicians (n ≤ 30), and patient-family carer dyads (n ≤ 60) from three purposively selected community stroke rehabilitation services in England. Working groups including rehabilitation professionals, service-users and policy-makers will co-develop actionable recommendations. Insights from the review and the interviews will be synthesised to test and refine programme theories that explain how TR works and for whom in clinical practice, and draw key messages for service implementation. This protocol highlights the need to improve our understanding of TR implementation in the context of multidisciplinary, community-based stroke service provision. We suggest the use of a realist methodology and co-production to inform evidence-based recommendations that consider the needs and priorities of clinicians and people affected by stroke.
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This longitudinal study aimed to assess muscle morphological and functional changes in older patients admitted with fragility fractures managed by immobilisation of the affected limb for at least 6 weeks. Patients aged ≥ 70 hospitalised with non-weight bearing limb fractures, and functionally limited to transfers only, were recruited. Handgrip (HGS) and knee extensor strength (KES), Vastus Lateralis muscle thickness (VLMT) and cross-sectional area at ultrasound (VLCSA) were measured in the non-injured limb at hospital admission, 1, 3 and 6 weeks later. Barthel Index, mobility aid use and residential status were recorded at baseline and 16 weeks. Longitudinal changes in muscle measurements were analysed using one-way repeated measures ANOVA. In a sub-study, female patients' baseline measurements were compared to 11 healthy, female, non-frail, non-hospitalised control volunteers (HC) with comparable BMI, aged ≥ 70, using independent t tests. Fifty patients (44 female) participated. Neither muscle strength nor muscle size changed over a 6-week immobilisation. Dependency increased significantly from pre-fracture to 16 weeks. At baseline, the patient subgroup was weaker (HGS 9.2 ± 4.7 kg vs. 19.9 ± 5.8 kg, p < 0.001; KES 4.5 ± 1.5 kg vs. 7.8 ± 1.3 kg, p < 0.001) and had lower muscle size (VLMT 1.38 ± 0.47 cm vs. 1.75 ± 0.30 cm, p = 0.02; VLCSA 8.92 ± 4.37 cm2 vs. 13.35 ± 3.97 cm2, p = 0.005) than HC. The associations with lower muscle strength measures but not muscle size remained statistically significant after adjustment for age. Patients with non-weight bearing fractures were weaker than HC even after accounting for age differences. Although functional dependency increased after fracture, this was not related to muscle mass or strength loss, which remained unchanged.
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BACKGROUND: After an acute infection, older persons may benefit from geriatric rehabilitation (GR). OBJECTIVES: This study describes the recovery trajectories of post-COVID-19 patients undergoing GR and explores whether frailty is associated with recovery. DESIGN: Multicentre prospective cohort study. SETTING: 59 GR facilities in 10 European countries. PARTICIPANTS: Post-COVID-19 patients admitted to GR between October 2020 and October 2021. METHODS: Patients' characteristics, daily functioning (Barthel index; BI), quality of life (QoL; EQ-5D-5L) and frailty (Clinical Frailty Scale; CFS) were collected at admission, discharge, 6 weeks and 6 months after discharge. We used linear mixed models to examine the trajectories of daily functioning and QoL. RESULTS: 723 participants were included with a mean age of 75 (SD: 9.91) years. Most participants were pre-frail to frail (median [interquartile range] CFS 6.0 [5.0-7.0]) at admission. After admission, the BI first steeply increased from 11.31 with 2.51 (SE 0.15, P < 0.001) points per month and stabilised around 17.0 (quadratic slope: -0.26, SE 0.02, P < 0.001). Similarly, EQ-5D-5L first steeply increased from 0.569 with 0.126 points per month (SE 0.008, P < 0.001) and stabilised around 0.8 (quadratic slope: -0.014, SE 0.001, P < 0.001). Functional recovery rates were independent of frailty level at admission. QoL was lower at admission for frailer participants, but increased faster, stabilising at almost equal QoL values for frail, pre-frail and fit patients. CONCLUSIONS: Post-COVID-19 patients admitted to GR showed substantial recovery in daily functioning and QoL. Frailty at GR admission was not associated with recovery and should not be a reason to exclude patients from GR.
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Actividades Cotidianas , COVID-19 , Anciano Frágil , Fragilidad , Evaluación Geriátrica , Calidad de Vida , Recuperación de la Función , Humanos , COVID-19/rehabilitación , COVID-19/epidemiología , COVID-19/psicología , Anciano , Femenino , Masculino , Estudios Prospectivos , Anciano de 80 o más Años , Evaluación Geriátrica/métodos , Fragilidad/diagnóstico , Fragilidad/rehabilitación , Fragilidad/psicología , SARS-CoV-2 , Europa (Continente)RESUMEN
BACKGROUND: Frailty correlates with poor clinical outcomes and is not routinely assessed in neurorehabilitation inpatient settings. METHODS: We recruited adults from two neurorehabilitation units. We administered six validated tools for assessing frailty and collected data around length of stay, discharge, readmission and change in rehabilitation outcome measures. RESULTS: Seventy-eight participants aged between 31 and 84 years were recruited with a range of neurological diagnoses. Frailty prevalence ranged between 23% and 46%, depending on the scale used, with little agreement between tools. Frailty status did not correlate with age, gender, length of stay, discharge destination and rehabilitation outcome measures. One-year readmission was higher in participants rated as frail by the Frail-Non-Disabled Questionnaire, the FRESH-screening questionnaire and the Clinical Frailty Scale. CONCLUSION: Frailty ascertainment was variable depending on the tool used. Three frailty indices predicted readmission rate at 1 year but no other outcome measures. Therefore, frailty tools may have limited utility in this clinical population.
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Fragilidad , Tiempo de Internación , Rehabilitación Neurológica , Alta del Paciente , Readmisión del Paciente , Humanos , Anciano , Masculino , Femenino , Fragilidad/diagnóstico , Fragilidad/rehabilitación , Fragilidad/epidemiología , Persona de Mediana Edad , Encuestas y Cuestionarios , Anciano de 80 o más Años , Estudios Transversales , Alta del Paciente/estadística & datos numéricos , Adulto , Rehabilitación Neurológica/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Pacientes Internos/estadística & datos numéricos , Estudios de Seguimiento , Anciano Frágil/estadística & datos numéricos , Estudios de Cohortes , Evaluación de Resultado en la Atención de SaludRESUMEN
BACKGROUND: Older people with frailty are at risk of harm from immobility or isolation, yet data about how COVID-19 lockdowns affected them are limited. Falls and fractures are easily measurable adverse outcomes correlated with frailty. We investigated whether English hospital admission rates for falls and fractures varied from the expected trajectory during the COVID-19 pandemic, and how these varied by frailty status. METHODS: NHS England Hospital Episode Statistics Admitted Patient Care data were analysed for observed versus predicted outcome rates for 24 January 2020 to 31 December 2021. An auto-regressive integrated moving average time-series model was trained using falls and fracture incidence data from 2013 to 2018 and validated using data from 2019. Models included national and age-, sex- and region-stratified forecasts. Outcome measures were hospital admissions for falls, fractures, and falls and fractures combined. Frailty was defined using the Hospital Frailty Risk Score. RESULTS: 144,148,915 pre-pandemic hospital admissions were compared with 42,267,318 admissions after pandemic onset. For the whole population, falls and fracture rates were below predicted for the first period of national lockdown, followed by a rapid return to rates close to predicted. Thereafter, rates followed expected trends. For people living with frailty, however, falls and fractures increased above expected rates during periods of national lockdown and remained elevated throughout the study period. Effects of frailty were independent of age. CONCLUSIONS: People living with frailty experienced increased fall and fracture rates above expected during and following periods of national lockdown. These remained persistently elevated throughout the study period.
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COVID-19 , Fracturas Óseas , Fragilidad , Humanos , Anciano , Fragilidad/diagnóstico , Fragilidad/epidemiología , Estudios de Cohortes , Pandemias , COVID-19/epidemiología , Anciano Frágil , Control de Enfermedades Transmisibles , Fracturas Óseas/diagnóstico , Fracturas Óseas/epidemiología , HospitalesRESUMEN
Pain and frailty are closely linked. Chronic pain is a risk factor for frailty, and frailty is a risk factor for pain. People living with frailty also commonly have cognitive impairment, which can make assessment of pain and monitoring of pain management even more difficult. Pain may be sub-optimally treated in people living with frailty, people living with cognitive impairment and those with both these factors. Reasons for sub-optimal treatment in these groups are pharmacological (increased drug side effects, drug-drug interactions, polypharmacy), non-pharmacological (erroneous beliefs about pain, ageism, bidirectional communication challenges), logistical (difficulty in accessing primary care practitioners and unaffordable cost of drugs), and, particularly in cognitive impairment, related to communication difficulties. Thorough assessment and characterisation of pain, related sensations, and their functional, emotional, and behavioural consequences ("phenotyping") may help to enhance the assessment of pain, particularly in people with frailty and cognitive impairment, as this may help to identify who is most likely to respond to certain types of treatment. This paper discusses the potential role of "digital phenotyping" in the assessment and management of pain in people with frailty. Digital phenotyping is concerned with observable characteristics in digital form, such as those obtained from sensing-capable devices, and may provide novel and more informative data than existing clinical approaches regarding how pain manifests and how treatment strategies affect it. The processing of extensive digital and usual data may require powerful algorithms, but processing these data could lead to a better understanding of who is most likely to benefit from specific and targeted treatments.
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Dolor Crónico , Disfunción Cognitiva , Fragilidad , Humanos , Manejo del Dolor , Fragilidad/complicaciones , Factores de RiesgoRESUMEN
High-quality care for older people is best delivered by multidisciplinary teams involving a range of professions. Similarly, if research evidence is to effectively inform practice, it needs to be designed and executed by teams that are both multidisciplinary and multiprofessional. Here, we summarise the discussions from a 1-day workshop convened by the National Institute for Health and Care Research (NIHR) Newcastle Biomedical Research Centre in Spring 2021, which focussed on multidisciplinary academic teams. Barriers to success include small numbers of clinical academic researchers across all professions focussing on older people, and lack of career pathways, role models and support for non-medical clinical researchers. The workshop identified strengths in the tradition of multidisciplinary working in the care of older people, research questions that lend themselves naturally to multidisciplinary working, increasing interest from funders in multidisciplinary research, and untapped opportunities for greater commercial engagement. Initiatives to improve engagement of students and trainees, mentorship, career pathways, networking across research centres and possibly developing a national School of Older People's Care Research are all ways that we can ensure the growth of multidisciplinary research to best serve older people's health and social care in the future.
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Investigación Biomédica , Geriatría , Humanos , Anciano , Calidad de la Atención de Salud , Grupo de Atención al PacienteRESUMEN
BACKGROUND: Care home residents live with frailty and multiple long-term conditions. Their medical management is complex and specialised. We set out to develop a list of core competencies for doctors providing medical care in long-term care homes. METHODS: A scoping review searched MEDLINE, EMBASE and CAB Abstracts, supplemented by grey literature from the Portal of Online Geriatrics Education and the International Association of Geriatrics and Gerontology, looking for core competencies for doctors working in care homes. These were mapped to the UK nationally mandated Generic Professional Competencies Framework. A Delphi exercise was conducted over three rounds using a panel of experts in care homes and medicine of older people. Competencies achieving 80% agreement for inclusion/exclusion were rejected/accepted, respectively. RESULTS: The scoping review identified 22 articles for inclusion, yielding 124 competencies over 21 domains. The Delphi panel comprised 23 experts, including 6 geriatricians, 4 nurses, 3 general practitioners, 2 advanced clinical practitioners, 2 care home managers, and one each of a patient and public representative, palliative care specialist, psychiatrist, academic, physiotherapist and care home audit lead. At the end of three rounds, 109 competencies over 19 domains were agreed. Agreement was strongest for generic competencies around frailty and weaker for sub-specialist knowledge about specific conditions and competencies related to care home medical leadership and management. CONCLUSION: The resulting competencies provide the basis of a curriculum for doctors working in long-term care homes for older people. They are specialty agnostic and could be used to train general practitioners or medical specialty doctors.
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Fragilidad , Geriatría , Humanos , Anciano , Competencia Clínica , Curriculum , Rol de la Enfermera , Técnica DelphiRESUMEN
INTRODUCTION: Neuromuscular electrical stimulation (NMES) is a treatment to prevent or reverse acquired disability in hospitalised adults. We conducted a systematic review and meta-analysis of its effectiveness. METHOD: We searched MEDLINE, EMBASE, Cumulative Index to Nursing & Allied Health (CINAHL) and the Cochrane library. Inclusion criteria: randomised controlled trials of hospitalised adult patients comparing NMES to control or usual care. The primary outcome was muscle strength. Secondary outcomes were muscle size, function, hospital length of stay, molecular and cellular biomarkers, and adverse effects. We assessed risk of bias using the Cochrane risk-of-bias tool. We used Review Manager (RevMan) software for data extraction, critical appraisal and synthesis. We assessed certainty using the Grading of Recommendations Assessment, Development and Evaluation tool. RESULTS: A total of 42 papers were included involving 1,452 participants. Most studies had unclear or high risk of bias. NMES had a small effect on muscle strength (moderate certainty) (standardised mean difference (SMD) = 0.33; P < 0.00001), a moderate effect on muscle size (moderate certainty) (SMD = 0.66; P < 0.005), a small effect on walking performance (moderate certainty) (SMD = 0.48; P < 0.0001) and a small effect on functional mobility (low certainty) (SMD = 0.31; P < 0.05). There was a small and non-significant effect on health-related quality of life (very low certainty) (SMD = 0.35; P > 0.05). In total, 9% of participants reported undesirable experiences. The effects of NMES on length of hospital stay, and molecular and cellular biomarkers were unclear. CONCLUSIONS: NMES is a promising intervention component that might help to reduce or prevent hospital-acquired disability.
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Terapia por Estimulación Eléctrica , Calidad de Vida , Humanos , Biomarcadores , Estimulación Eléctrica , Terapia por Estimulación Eléctrica/efectos adversos , Fuerza Muscular , Ensayos Clínicos Controlados Aleatorios como Asunto , HospitalizaciónRESUMEN
BACKGROUND: Ageing is associated with changes in body composition including an overall reduction in muscle mass and a proportionate increase in fat mass. Sarcopenia is characterised by losses in both muscle mass and strength. Body composition and muscle strength are at least in part genetically determined, consequently polymorphisms in pathways important in muscle biology (e.g., the activin/myostatin signalling pathway) are hypothesised to contribute to the development of sarcopenia. METHODS: We compared regional body composition measured by DXA with genotypes for two polymorphisms (rs10783486, minor allele frequency (MAF) = 0.26 and rs2854464, MAF = 0.26) in the activin 1B receptor (ACVR1B) determined by PCR in a cross-sectional analysis of DNA from 110 older individuals with sarcopenia from the LACE trial. RESULTS: Neither muscle mass nor strength showed any significant associations with either genotype in this cohort. Initial analysis of rs10783486 showed that males with the AA/AG genotype were taller than GG males (174±7cm vs 170±5cm, p = 0.023) and had higher arm fat mass, (median higher by 15%, p = 0.008), and leg fat mass (median higher by 14%, p = 0.042). After correcting for height, arm fat mass remained significantly higher (median higher by 4% padj = 0.024). No associations (adjusted or unadjusted) were seen in females. Similar analysis of the rs2854464 allele showed a similar pattern with the presence of the minor allele (GG/AG) being associated with greater height (GG/AG = 174±7 cm vs AA = 170 ±5cm, p = 0.017) and greater arm fat mass (median higher by 16%, p = 0.023). Again, the difference in arm fat remained after correction for height. No similar associations were seen in females analysed alone. CONCLUSION: These data suggest that polymorphic variation in the ACVR1B locus could be associated with body composition in older males. The activin/myostatin pathway might offer a novel potential target to prevent fat accumulation in older individuals.
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Sarcopenia , Masculino , Femenino , Humanos , Anciano , Sarcopenia/genética , Miostatina , Receptores de Activinas , Estudios Transversales , Composición Corporal/genética , Activinas/genética , Músculo EsqueléticoRESUMEN
BACKGROUND: Angiotensin II (AII), has been suggested to promote muscle loss. Reducing AII synthesis, by inhibiting angiotensin converting enzyme (ACE) activity has been proposed as a method to inhibit muscle loss. The LACE clinical trial was designed to determine whether ACE inhibition would reduce further muscle loss in individuals with sarcopenia but suffered from low recruitment and returned a negative result. Polymorphic variation in the ACE promoter (I/D alleles) has been associated with differences in ACE activity and muscle physiology in a range of clinical conditions. This aim of this analysis was to determine whether I/D polymorphic variation is associated with muscle mass, strength, in sarcopenia or contributed to the lack of response to treatment in the LACE study. METHODS: Sarcopenic individuals were recruited into a 2x2 factorial multicentre double-blind study of the effects of perindopril and/or leucine versus placebo on physical performance and muscle mass. DNA extracted from blood samples (n = 130 72 women and 58 men) was genotyped by PCR for the ACE I/D polymorphism. Genotypes were then compared with body composition measured by DXA, hand grip and quadriceps strength before and after 12 months' treatment with leucine and/or perindopril in a cross-sectional analysis of the influence of genotype on these variables. RESULTS: Allele frequencies for the normal UK population were extracted from 13 previous studies (I = 0.473, D = 0.527). In the LACE cohort the D allele was over-represented (I = 0.412, D = 0.588, p = 0.046). This over-representation was present in men (I = 0.353, D = 0.647, p = 0.010) but not women (I = 0.458, D = 0.532, p = 0.708). In men but not women, individuals with the I allele had greater leg strength (II/ID = 18.00 kg (14.50, 21.60) vs DD = 13.20 kg (10.50, 15.90), p = 0.028). Over the 12 months individuals with the DD genotype increased in quadriceps strength but those with the II or ID genotype did not. Perindopril did not increase muscle strength or mass in any polymorphism group relative to placebo. CONCLUSION: Our results suggest that although ACE genotype was not associated with response to ACE inhibitor therapy in the LACE trial population, sarcopenic men with the ACE DD genotype may be weaker than those with the ACE I/D or II genotype.
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Sarcopenia , Masculino , Humanos , Femenino , Anciano , Sarcopenia/tratamiento farmacológico , Sarcopenia/genética , Perindopril/uso terapéutico , Peptidil-Dipeptidasa A/genética , Estudios Transversales , Leucina , Fuerza de la Mano , Genotipo , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéuticoRESUMEN
BACKGROUND: Sarcopenia is the progressive loss of muscle mass and function with age. A number of different sarcopenia definitions have been proposed and utilised in research. This study aimed to investigate how the prevalence of sarcopenia in a research cohort of older adults is influenced by the use of independent aspects of these different definitions. METHODS: Data from 255 research participants were compiled. Defining criteria by the European Working Group on Sarcopenia in Older People, the International Working Group on Sarcopenia (IWGS), and the Foundation for the National Institutes of Health were applied. RESULTS: Prevalence of sarcopenia using muscle mass ranged from 4 to 22%. Gait speed and handgrip strength criteria identified 4-34% and 4-16% of participants as sarcopenic, respectively. CONCLUSION: Prevalence of sarcopenia differs substantially depending on the criteria used. Work is required to address the impact of this for sarcopenia research to be usefully translated to inform on clinical practice.
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Sarcopenia , Humanos , Anciano , Sarcopenia/diagnóstico , Sarcopenia/epidemiología , Fuerza de la Mano/fisiología , Prevalencia , Velocidad al CaminarRESUMEN
While eHealth can help improve outcomes for older patients receiving geriatric rehabilitation, the implementation and integration of eHealth is often complex and time-consuming. To use eHealth effectively in geriatric rehabilitation, it is essential to understand the experiences and needs of healthcare professionals. In this international multicentre cross-sectional study, we used a web-based survey to explore the use, benefits, feasibility and usability of eHealth in geriatric rehabilitation settings, together with the needs of working healthcare professionals. Descriptive statistics were used to summarize quantitative findings. The survey was completed by 513 healthcare professionals from 16 countries. Over half had experience with eHealth, although very few (52 of 263 = 20%) integrated eHealth into daily practice. Important barriers to the use or implementation of eHealth included insufficient resources, lack of an organization-wide implementation strategy and lack of knowledge. Professionals felt that eHealth is more complex for patients than for themselves, and also expressed a need for reliable information concerning available eHealth interventions and their applications. While eHealth has clear benefits, important barriers hinder successful implementation and integration into healthcare. Tailored implementation strategies and reliable information on effective eHealth applications are needed to overcome these barriers.