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BACKGROUND: The short physical performance battery (SPPB) is an easy-to-use tool for fall risk prediction, but its predictive value for falls and fall-induced injuries among community dwellers has not been examined through a large-sample longitudinal study. METHODS: We analyzed five-round follow-up data (2, 3, 4, 5, 7 years) of the China Health and Retirement Longitudinal Study (CHARLS) (2011-2018). Data concerning falls and fall-induced injuries during multi-round follow-ups were collected through participant self-report. The Cochran-Armitage trend test examined trends in fall incidence rate across SPPB performance levels. Multivariable logistic regression and negative binomial regression models examined associations between SPPB performance and subsequent fall and fall-induced injury. The goodness-of-fit and area under the receiver operating curve (AUC) were used together to quantify the value of the SPPB in predicting fall and fall-induced injury among community-dwelling older adults. RESULTS: The CHARLS study included 9279, 6153, 4142, 4148, and 3583 eligible adults aged 60 years and older in the five included follow-up time periods. SPPB performance was associated with fall and fall-induced injury in two and three of the five follow-up time periods, respectively (P < 0.05). The goodness-of-fit for all predictive models was poor, with both Cox-Snell R2 and Nagelkerke R2 under 0.10 and AUCs of 0.53-0.57 when using only SPPB as a predictor and with both Cox-Snell R2 and Nagelkerke R2 lower than 0.12 and AUCs of 0.61-0.67 when using SPPB, demographic variables, and self-reported health conditions as predictors together. Sex and age-specific analyses displayed highly similar results. CONCLUSIONS: Neither use of SPPB alone nor SPPB together with demographic variables and self-reported health conditions appears to offer good predictive performance for falls or fall-induced injuries among community-dwelling older Chinese adults.
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Accidentes por Caídas , Pueblo Asiatico , Pueblos del Este de Asia , Rendimiento Físico Funcional , Anciano , Humanos , Persona de Mediana Edad , China/epidemiología , Estudios Longitudinales , Medición de Riesgo , Heridas y Lesiones/etiología , Vida Independiente , Valor Predictivo de las PruebasRESUMEN
INTRODUCTION: Toxicity risk evaluation based on frailty assessment is recommended for treatment individualization in old adults with diffuse large B-cell lymphoma (DLBCL). However, no specific assessment method to guide decision-making has been established yet. Here, we implement a therapeutic algorithm based on the information obtained in an updated comprehensive geriatric assessment (CGA) to assess the value that other prognostic factors add to frailty. MATERIAL AND METHODS: We prospectively recruited 31 patients aged 70 or older recently diagnosed with DLBCL. Standard dose regimen R-CHOP and dose-attenuated R-miniCHOP were the therapeutic options. A CGA-based algorithm was used for the initial treatment recommendation. The sample was compared according to frailty and treatment allocation to describe baseline differential characteristics and treatment tolerance. RESULTS: Mean age was 79 (SD: 5.5) and 45.1% were above 80. Half of the patients (51.6%) were frail; their survival was inferior to that observed in fit adults (p: .034). The mean Short Physical Performance Battery (SPPB) score of patients responding to therapy was higher than non-responders´ media (8.6 vs. 5.9; p: .022). However, when RCHOP was allocated to high functional patients within fit and frail groups, no differences in survival were found compared to R-miniCHOP. The prevalence of toxic events was higher with the standard regimen in fit (p: .054) and frail patients (p: 0.016). CONCLUSIONS: The combination of frailty and physical performance assessment in an algorithm is a promising method to guide the decision-making process in old adults with DLBCL. SPPB might complete frailty predictive information on toxicity risk.
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Fragilidad , Linfoma de Células B Grandes Difuso , Anciano , Humanos , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Anciano Frágil , Fragilidad/epidemiología , Evaluación Geriátrica/métodos , Linfoma de Células B Grandes Difuso/patología , Anciano de 80 o más AñosRESUMEN
Altered mitochondrial quality and function in muscle may be involved in age-related physical function decline. The role played by the autophagy-lysosome system, a major component of mitochondrial quality control (MQC), is incompletely understood. This study was undertaken to obtain initial indications on the relationship between autophagy, mitophagy, and lysosomal markers in muscle and measures of physical performance and lower extremity tissue composition in young and older adults. Twenty-three participants were enrolled, nine young (mean age: 24.3 ± 4.3 years) and 14 older adults (mean age: 77.9 ± 6.3 years). Lower extremity tissue composition was quantified volumetrically by magnetic resonance imaging and a tissue composition index was calculated as the ratio between muscle and intermuscular adipose tissue volume. Physical performance in older participants was assessed via the Short Physical Performance Battery (SPPB). Protein levels of the autophagy marker p62, the mitophagy mediator BCL2/adenovirus E1B 19 kDa protein-interacting protein 3 (BNIP3), the lysosomal markers transcription factor EB, vacuolar-type ATPase, and lysosomal-associated membrane protein 1 were measured by Western immunoblotting in vastus lateralis muscle biopsies. Older adults had smaller muscle volume and lower tissue composition index than young participants. The protein content of p62 and BNIP3 was higher in older adults. A negative correlation was detected between p62 and BNIP3 and the tissue composition index. p62 and BNIP3 were also related to the performance on the 5-time sit-to-stand test of the SPPB. Our results suggest that an altered expression of markers of the autophagy/mitophagy-lysosomal system is related to deterioration of lower extremity tissue composition and muscle dysfunction. Additional studies are needed to clarify the role of defective MQC in human muscle aging and identify novel biological targets for drug development.
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Mitocondrias , Músculo Esquelético , Humanos , Anciano , Adulto Joven , Adulto , Anciano de 80 o más Años , Músculo Esquelético/metabolismo , Mitocondrias/metabolismo , Envejecimiento/fisiología , Extremidad Inferior , Rendimiento Físico FuncionalRESUMEN
Background: The population of adults aged 80 years and older is heterogenous with some being robust and others having a higher risk for adverse events. This study compares the predictive value of two tools used to identify older adults who are at higher risk for adverse outcomes: frailty phenotype according to Fried and a standardized physical performance test. Methods: The BELFRAIL population-based cohort of 567 community-dwelling adults aged 80 years and older living in Belgium. Fried frailty phenotype and physical performance test (gait, chair stand, standing balance tests and putting on and off a cardigan). The predictive value of the two tools in predicting mortality (up to 5.1 ± 0.25 years), hospitalization (3.0 ± 0.25 years) and decline in activities of daily living (after 1.7 ± 0.21 years) was compared using reclassification statistics and decision curve analysis. Results: Frail participants according to Fried phenotype and those in the lowest quartile of the physical performance test score had higher risk for mortality and hospitalization. Harrell C and area under operator curve were similar (< 0.70). Reclassification statistics and net benefit in decision curve analysis showed no significant difference between the two tools in identifying higher risk for mortality, hospitalization and functional decline. Conclusion: In a cohort of community-dwelling adults 80 years and older a standardized physical performance test was as good as the Fried frailty phenotype in identifying higher risk for adverse outcomes.
Contexte: La population d'octogénaires est hétérogène, avec des sujets robustes et d'autres à risque d'événements indésirables. Dans notre étude, nous comparons la valeur prédictive de deux instruments visant à identifier les sujets à haut risque : le phénotype de fragilité selon Fried et un test de performance physique standardisé. Méthodes: La base de données de l'étude BELFRAIL nous fournit un échantillon représentatif de la population belge d'octogénaires, composé de 567 sujets. Des données sur l'hospitalisation ont été recueillies jusqu'à 3,0 ± 0,25 ans et sur la mortalité jusqu'à 5,1 ± 0,25 ans. Nous avons réalisé et calculé des analyses de survie, des indices de reclassification et des courbes décisionnelles. Résultats: Les participants fragiles (phénotype de Fried) ou dans le quartile inférieur (Short Physical Performance Battery SPPB) ont un risque de mortalité et d'hospitalisation plus élevé. Le C de Harrell et l'aire sous la courbe sont semblables (< 0,70). Les courbes de décision illustrent un bénéfice net supérieur aux stratégies par défaut pour les deux outils. Les indices de reclassification et les courbes décisionnelles ne montrent aucune différence significative entre les instruments. Conclusion: Le SPPB est aussi performant que le phénotype de fragilité pour prédire les événements indésirables chez les octogénaires.
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Fragilidad , Humanos , Anciano , Fragilidad/diagnóstico , Fragilidad/epidemiología , Anciano Frágil , Octogenarios , Actividades Cotidianas , Vida Independiente , Fenotipo , Evaluación Geriátrica , Rendimiento Físico FuncionalRESUMEN
End-stage kidney disease patients treated with conventional hemodialysis (CHD) are known to have impaired physical performance and protein-energy wasting (PEW). Nocturnal hemodialysis (NHD) was shown to improve clinical outcomes, but the evidence is limited on physical performance and PEW. We investigate whether NHD improves physical performance and PEW. This prospective, multicenter, non-randomized cohort study compared patients who changed from CHD (2−4 times/week 3−5 h) to NHD (2−3 times/week 7−8 h), with patients who continued CHD. The primary outcome was physical performance at 3, 6 and 12 months, assessed with the short physical performance battery (SPPB). Secondary outcomes were a 6-minute walk test (6MWT), physical activity monitor, handgrip muscle strength, KDQOL-SF physical component score (PCS) and LAPAQ physical activity questionnaire. PEW was assessed with a dietary record, dual-energy X-ray absorptiometry, bioelectrical impedance spectroscopy and subjective global assessment (SGA). Linear mixed models were used to analyze the differences between groups. This study included 33 patients on CHD and 32 who converted to NHD (mean age 55 ± 15.3). No significant difference was found in the SPPB after 1-year of NHD compared to CHD (+0.24, [95% confidence interval −0.51 to 0.99], p = 0.53). Scores of 6MWT, PCS and SGA improved (+54.3 [95%CI 7.78 to 100.8], p = 0.02; +5.61 [−0.51 to 10.7], p = 0.03; +0.71 [0.36 to 1.05], p < 0.001; resp.) in NHD patients, no changes were found in other parameters. We conclude that NHD patients did not experience an improved SPPB score compared to CHD patients; they did obtain an improved walking distance and self-reported PCS as well as SGA after 1-year of NHD, which might be related to the younger age of these patients.
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Fuerza de la Mano , Fallo Renal Crónico , Humanos , Adulto , Persona de Mediana Edad , Anciano , Estudios de Cohortes , Estudios Prospectivos , Diálisis Renal/efectos adversos , Diálisis Renal/métodos , Fallo Renal Crónico/terapia , Rendimiento Físico Funcional , Caquexia/etiologíaRESUMEN
BACKGROUND: Muscle pump dysfunction is an essential component of chronic venous disease (CVD) pathology. Aging reduces muscle strength which further weakens the venous return. However, the epidemiology of CVD and its relationship with the physical performance in older persons is poorly studied. We studied the prevalence of CVD in subjects aged over 70 years and its association primarily with the Short Physical Performance Battery (SPPB) and 10 m walk test. METHODS: An accurate clinical leg examination was performed and the Clinical-Etiological-Anatomical-Pathophysiological-classification (CEAP, clinical classification of chronic venous disorders, C1-C6) determined by dermatologists in 552 subjects aged between 70 and 93 years belonging to the Northern Finland Birth Cohort 1966 - Parents' Study (NFBC-PS). Linear regression analyses were used to examine the association between CVD and functional tests and anthropometric measurements. RESULTS: The prevalence of CVD (C1-C6) was 54.3%. C1 was diagnosed in 22.1% (n=84), C2 in 15.2% (n=45), C3 in 8.2% (n=45), C4 in 7.8% (43), C5 in 0.4% (n=2) and C6 in 0.5% (n=3). The prevalence and severity of CVD increased with increasing age (p<0.05). Males presented more with severe stages of CVD (C4-C6) (p<0.001). Subjects with CVD had significantly lower total SPPB scores and longer times in the 10 m walk test (p<0.001). The association between CVD severity and SPPB remained statistically significant in females after adjusting for age, body mass index (BMI) and number of children. The 10 m walk test times were associated with CVD when adjusted for sex and age but not after adjusting for BMI. CONCLUSIONS: It is recommended that detailed skin examination of legs should be performed by physicians treating older subjects in order to improve early diagnosis of CVD. We highlight the importance of physical activity in older persons - lower limb activation of older persons with CVD may improve venous return and therefore prevent progression of CVD. We found an association between CVD and gait speed, however, there may exist bidirectional relationship.
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Enfermedades Vasculares , Anciano , Anciano de 80 o más Años , Envejecimiento , Enfermedad Crónica , Femenino , Humanos , Extremidad Inferior , Masculino , Rendimiento Físico Funcional , Enfermedades Vasculares/diagnóstico , Enfermedades Vasculares/epidemiologíaRESUMEN
PURPOSE OF REVIEW: The treatment of debilitating pain and loss of function secondary to lumbar stenosis is in high demand with the aging patient population. Options, including epidural steroid injections (ESIs) and medication therapy, are limited and it is unclear if they provide any functional improvements. In this prospective study, we evaluate functional outcomes in older adults with symptomatic lumbar stenosis treated with ESIs compared to those managed with medications by introducing the Short Physical Performance Battery (SPPB). Our study was IRB-approved and included 16 patients, 68 to 83 years old, with symptomatic back and radicular leg pain secondary to lumbar stenosis. Patients could elect to undergo a lumbar ESI (n = 11) or be treated via medication management (n = 5). Numeric pain score, SPPB score, and adverse events were measured and compared at baseline and a 1-month follow-up visit. RECENT FINDINGS: Statistically significant improvements were observed from baseline compared to the 1-month follow-up for total SPPB score in the injection group. Similar improvements in the injection group were observed for pain scores and the SPPB subcomponents such as the 4-m walk test, chair stand time, and balance score. Comparatively, no statistically significant improvements were observed in the medication group. Lumbar ESIs improved objective physical capacity parameters and pain scores in elderly patients with symptomatic lumbar stenosis compared to medication management. In addition, the SPPB is an easy-to-use tool to measure changes in physical function in older adults and could easily be integrated into an outpatient pain clinic.
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Dolor/tratamiento farmacológico , Rendimiento Físico Funcional , Esteroides/administración & dosificación , Esteroides/uso terapéutico , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Inyecciones Epidurales , Masculino , Dolor/etiología , Manejo del Dolor , Dimensión del Dolor , Estudios Prospectivos , Estenosis Espinal/tratamiento farmacológico , Estenosis Espinal/etiología , Resultado del TratamientoRESUMEN
OBJECTIVE: To determine the relationship between serum levels of 25(OH)D and 1, 25(OH)2 D and the hand-grip strength and balance ability of women in Sichuan, China. METHODS: A cross-sectional study on a representative sample of 1 095 women aged 29-95 yr. in Sichuan Province was undertaken. Their hand-grip strength and balance ability were assessed using a hand-held dynamometer and the short physical performance battery (SPPB), respectively. The participants were divided into four groups according to the level of serum 25(OH)D: sufficient (>75 nmol/L), insufficient (51-75 nmol/L), deficiency (25-50 nmol/L), and serious deficiency (<25 nmol/L). General liner models were established to compare the differences of the four groups in balance ability. Logistic regression models were established to examine the associations of serum 25(OH)D and 1, 25(OH)2 D withhand-grip strength and physical performance. RESULTS: About 70.9% of the participants had vitamin D deficiency. Those with vitamin D insufficiency or deficiency were more likely to reside in a higher latitudinal area (P<0.001), spend less time in outdoor activities (P=0.013), and take less vitamin D supplements (P<0.001). Older women (≥65 years) had lower serum 25(OH)D (P=0.001) and were more likely to have ≤50 nmol/L 25(OH)D than their younger counterparts (74.6% vs. 68.9%, P=0.046). However, no significant age differences were found in serum 1, 25(OH)2 D. Serum levels of 25(OH)D and 1, 25(OH)2 D were not found to be associated with hand-grip strength and balance ability after adjusting for confounding factors. Hand-grip strength and balance ability decreased with age (OR=1.066, P<0.001; OR=1.111, P<0.001). Higher body mas was associated with higher hand-grip strength (OR=0.958, P<0.001). Higher serum albumin (OR=0.896, P=0.001) and longer walking time (OR=0.799, P=0.001) were associated with higher balance ability. CONCLUSION: Serum levels of 25(OH)D and 1, 25(OH)2D are not associated with hand-grip strength and balance ability.
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Fuerza de la Mano , Equilibrio Postural , Deficiencia de Vitamina D/diagnóstico , Vitamina D/sangre , Adulto , Anciano , Anciano de 80 o más Años , China , Estudios Transversales , Femenino , Humanos , Persona de Mediana Edad , Deficiencia de Vitamina D/fisiopatologíaRESUMEN
BACKGROUND: In older patients with aortic stenosis (AS) undergoing TAVI, the potential role of prior CGA is not well established. To explore the value of comprehensive geriatric assessment (CGA) for predicting mortality and/or hospitalisation within the first 3 months after transcatheter aortic valve implantation (TAVI). METHODS: An international, multi-centre, prospective registry (CGA-TAVI) was established to gather data on CGA results and medium-term outcomes in geriatric patients undergoing TAVI. Logistic regression was used to evaluate the predictive value of a multidimensional prognostic index (MPI); a short physical performance battery (SPPB); and the Silver Code, which was based on administrative data, for predicting death and/or hospitalisation in the first 3 months after TAVI (primary endpoint). RESULTS: A total of 71 TAVI patients (mean age 85.4 years; mean log EuroSCORE I 22.5%) were enrolled. Device success according to VARC criteria was 100%. After adjustment for selected baseline characteristics, a higher (poorer) MPI score (OR: 3.34; 95% CI: 1.39-8.02; p = 0.0068) and a lower (poorer) SPPB score (OR: 1.15; 95% CI: 1.01-1.54; p = 0.0380) were found to be associated with an increased likelihood of the primary endpoint. The Silver Code did not show any predictive ability in this population. CONCLUSIONS: Several aspects of the CGA have shown promise for being of use to physicians when predicting TAVI outcomes. While the MPI may be useful in clinical practice, the SPPB may be of particular value, being simple and quick to perform. Validation of these findings in a larger sample is warranted. TRIAL REGISTRATION: The trial was registered in ClinicalTrials.gov on November 7, 2013 ( NCT01991444 ).
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Estenosis de la Válvula Aórtica/diagnóstico , Estenosis de la Válvula Aórtica/cirugía , Válvula Aórtica/cirugía , Técnicas de Apoyo para la Decisión , Evaluación Geriátrica , Reemplazo de la Válvula Aórtica Transcatéter , Factores de Edad , Anciano de 80 o más Años , Válvula Aórtica/fisiopatología , Estenosis de la Válvula Aórtica/mortalidad , Estenosis de la Válvula Aórtica/fisiopatología , Femenino , Humanos , Italia , Modelos Logísticos , Masculino , Países Bajos , Oportunidad Relativa , Readmisión del Paciente , Valor Predictivo de las Pruebas , Estudios Prospectivos , Quebec , Sistema de Registros , Factores de Riesgo , Factores de Tiempo , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Reemplazo de la Válvula Aórtica Transcatéter/mortalidad , Resultado del TratamientoRESUMEN
BACKGROUND: Chronic inflammation, changes in body composition, and declining physical function are hallmarks of the ageing process. The aim of the present study was to provide a preliminary characterisation of the relationship among these age-related phenomena via multivariate modelling. METHODS: Thirty-five old adults (OAs) and 17 young adults (YAs) were enrolled. The volume of skeletal muscle, subcutaneous adipose tissue (SAT), and intermuscular adipose tissue (IMAT) of the thigh was quantified by three-dimensional magnetic resonance imaging. Muscle strength was measured by knee extension strength testing. In OAs, physical performance was further assessed via the Short Physical Performance Battery (SPPB). Multi-block partial least squares-discriminant analysis (PLS-DA) was employed to explore the relationship among inflammatory profiles and functional and imaging parameters. Double cross-validation procedures were used to validate the predictive ability of the PLS-DA model. RESULTS: The optimal complexity of the PLS-DA model was found to be two latent variables. The proportion of correct classification was 92.3% in calibration (94.1% in YAs and 91.4% in OAs), 84.6% in internal validation (95.3% in YAs and 78.5% in OAs), and 82.6% in external validation (94% in YAs and 76.9% in OAs). Relative to YAs, OAs were characterised by smaller muscle volume, greater IMAT volume, lower muscle strength, and higher levels of myeloperoxidase, P-selectin, soluble intercellular adhesion molecule 1, and vascular cell adhesion molecule 1. Compared with OAs with SPPB >8, those scoring ≤8 were characterised by smaller muscle volume, greater SAT volume, lower muscle strength, and higher levels of interleukin 1 beta, 6, 10, 12, 13, tumour necrosis factor alpha, and granulocyte-macrophage colony-stimulating factor. CONCLUSIONS: Multi-block PLS-DA identified distinct patterns of relationships among circulating cytokines and functional and imaging parameters in persons of different ages and varying levels of physical performance. The longitudinal implementation of such an innovative strategy could allow for the tracking of health status over time, the early detection of deviations in health trajectories, and the monitoring of response to treatments.
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Envejecimiento/fisiología , Composición Corporal , Citocinas/sangre , Vida Independiente , Fuerza Muscular , Tejido Adiposo/diagnóstico por imagen , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Envejecimiento/sangre , Femenino , Humanos , Inflamación/sangre , Inflamación/diagnóstico por imagen , Inflamación/fisiopatología , Análisis de los Mínimos Cuadrados , Imagen por Resonancia Magnética , Masculino , Músculo Esquelético/diagnóstico por imagen , Músculo Esquelético/fisiología , Muslo/diagnóstico por imagen , Adulto JovenRESUMEN
OBJECTIVES: Declining muscle mass and function are hallmarks of the aging process. The preservation of muscle trophism may protect against various negative health outcomes. Age- and sex-specific curves of muscle mass, strength, and function, using data from a large sample of community-dwelling people, are necessary. MATERIAL AND METHODS: Two surveys (Longevity Check-up and Very Important Protein [VIP]), conducted during EXPO 2015 in Milan, consisted of a population assessment aimed at evaluating the prevalence of specific health metrics in subjects outside of a research setting (n = 3206), with a special focus on muscle mass, strength, and function. Muscle mass was estimated by using mid-arm muscle circumference (MAMC) and calf circumference of the dominant side. Muscle strength and function were assessed through handgrip strength testing and repeated chair stand test, respectively. RESULTS: The mean age of 3206 participants in the Longevity Check-up and VIP surveys was 51.9 years (SD 15.6, range 18-98 years), and 1694 (52.8%) were women. Cross-sectional inspection suggests that both calf circumference and MAMC decline nonlinearly with age and the rate of decline varies by gender. These measures are stable until 50 years and then begin to decrease slightly with age, with the effect being more evident in men than in women. The main effect of the age category was observed in muscle strength and physical performance parameters. Muscle strength declined significantly after 45 years of age, both in men and women (P < .001). The muscle quality of the upper extremities, defined as handgrip strength divided by MAMC, declined significantly with aging, as well (P < .001). The time to complete the chair stand test was similar from 18 years to 40 to 44 years, and then a linear decline in performing the test across age groups was observed, with an increased time of more than 3 seconds, both in men and women (P < .001). CONCLUSIONS: Muscle mass and strength curves may be used to extract reference values for subsequent use in research as well as in the clinical setting. In particular, the analyses of trajectories of muscle parameters may help identify cutoffs for the estimation of risk of adverse events.