An Assessment of the Toulouse Saint Louis University Mini Falls Assessment Tool to Predict Incident Falls among Older Adults Residing in Nursing Homes: A 6-Month Prospective Study.

OBJECTIVES: Toulouse Saint Louis University Mini Falls Assessment (TSLUMFA) tool has been designed to predict falls. It was initially validated in a geriatric clinic in 2018. The primary objective was to evaluate the predictive capacity of the TSLUMFA for incident falls in older adults residing in nursing homes. The secondary objective was to determine the TSLUMFA optimal cut-off value identifying those older adults with a high-risk of falling. SETTINGS: A longitudinal study was carried out over a period of six months. PARTICIPANTS: 93 older adults residing in nursing homes were evaluated for the present study. MEASUREMENTS: The TSLUMFA (made up of 7 criteria) was administered at baseline, and incident falls were recorded based on a registry of falls. Comparisons of TSLUMFA scores between fallers and non-fallers were performed using the U Mann-Whitney test or Chi². Correlation between the total TSLUMFA score (/30 points) and incident fall(s) was explored using the Cox proportional hazard model. ROC analysis enabled an optimal cut-off value to be established to identify those adults at the highest-risk of falling. RESULTS: In the study, 93 older adults (61.3% women) with a median age of 80 (69-87) years were included. The median total TSLUMFA score was 21 (19-24.5) points. During the 6-month study period, 38 subjects (40.9%) experienced at least one fall. The total TSLUMFA score in older adults with incident fall(s) was significantly lower than in those who did not fall (20 (15.75-22.25) points versus 23 (20-25) points and a p-value of <0.001). For each 1-point higher score at the total TSLUMFA a 9% less chance of falling was observed during the study period (p-value = 0.006). The AUC was 0.736 (95%CI: 0.617-0.822) and p-value <0.001, clearly demonstrating its interesting performance as a screening tool. A score of ≤ 21 points was identified as the optimal cut-off to identify those older adults at a higher-risk of falling. CONCLUSION: The TSLUMFA performed well and successfully identified older adults with a high risk of falling in a nursing home setting. Further comparisons with existing tools are warranted.

Implementation of the Integrated Care of Older People (ICOPE) App and ICOPE Monitor in Primary Care: A study protocol.

INTRODUCTION: The World Health Organization (WHO) has recently launched the term "intrinsic capacity", defined as "the composite of all the physical and mental capacities of an individual". Intrinsic capacity has a positive value towards healthy aging, and is constructed by five domains: cognition, vitality/nutrition, sensory, psychology, and mobility. ICOPE App and ICOPE Monitor are applications for the assessment (screening) of intrinsic capacity. HYPOTHESIS: Intrinsic capacity assessed by the ICOPE Apps at baseline could be associated with the incidence of frailty, functional decline, and health outcomes during 1-year follow-up. OBJECTIVES: To assess the association between intrinsic capacity measured by the ICOPE Apps at baseline and the incidence of frailty in community-dwelling older adults during 1-year follow-up. Secondarily, to assess the association of intrinsic capacity and functional decline, mortality, pre-frailty, falls, institutionalization, and quality of life. METHODS: Protocol for a cohort study of community-dwelling adults ≥65-year-old, with no other exclusion criteria than the inability to use the Apps or communicate by telephone/video-call for any reason (cognitive or limited access to telephone/video-call) OR being considered frail at baseline (defined as having a Rockwood's clinical frailty scale, CFS score ≥4). Intrinsic capacity measured by the ICOPE Apps and CFS will be assessed at baseline, 4-, 8- and 12-month follow-up by telephone/video-call. Assuming a prevalence of frailty of 10.7%, and incidence of 13% (alpha-risk=0.05), 400 participants at 12-month end-point (relative precision=0.10) and 600 participants at baseline will be required. RESULTS: Associations among the decrease in intrinsic capacity and higher risk of frailty, functional decline, and health adverse outcomes during 1-year follow-up are expected. CONCLUSIONS: ICOPE Apps might identify individuals at higher risk of frailty, functional decline, and health adverse outcomes. The implementation of the ICOPE Apps into clinical practice might help to deliver efficient person-centered care-plans, and benefit the healthcare systems.

Profile and needs of primary informal caregivers of older patients in Belgian geriatric day hospitals: a multicentric cross-sectional study.

BACKGROUND: With the improvement of life expectancy, the world faces increasing demands for care of older persons. In this manuscript, we define the characteristics of primary informal caregivers (PIC) of patients aged 75 years and older admitted to geriatric day hospitals (GDH) in Belgium. A PIC is defined as the person who most often provides care and assistance to persons who need to be cared for. We describe PIC socio-demographic characteristics, satisfaction, burden and wishes about caring; the type of assistance provided and received, their self-rated health, socio-demographic and medical characteristics of proxies, in particular the presence of behavioural disorders. METHODS: We conducted a cross-sectional study in 25 GDH. PARTICIPANTS: Four hundred seventy-five PIC of patients ≥75 years and their proxies. PIC completed a questionnaire at the GDH assessing burden by Zarit Burden Index-12 (ZBI-12), self-rated health, social restriction due to caregiving and financial participation. We compared the characteristics of PIC with high and low burden, and the characteristics of spouses and adult children PIC. We also analyzed factors associated with a high burden in a multivariable logistic regression model. RESULTS: PIC were mainly women (72%), adult children (53.8%) and spouses (30.6%). The mean age was 64 ± 14 years for PIC and 84 ± 5 years for care recipients. PIC helped for most of Activities in Daily Living (ADL) and Instrumental ADL (iADL). The median ZBI-12 score was 10 [IQR 5-18]. In multivariable regression analysis, a high burden was positively associated in the total group with living with the relative (p = 0.045), the difficulty to take leisure time or vacation (p < 0.001), behavioral and mood disorders (p < 0.001;p = 0.005), and was negatively associated with bathing the relative (p = 0.017) and a better subjective health status estimation (p < 0.001). CONCLUSION: Primary informal caregivers, who were predominantly women, were involved in care for ADL and iADL. A high burden was associated with living with the relative, the difficulty to take leisure time or vacation and the relative's behavioral and mood disorders. Bathing the relative and a subjective health status estimated as good as or better than people the same age, were protective factors against a high burden.

[Benefits and limitations of geriatric dysphagia screening tools]. / Intérêt et limites des outils de dépistage de la dysphagie en gériatrie.

This prospective study aims to evaluate both benefits and limitations of dysphagia screening tools (DePippo, EAT10, V-VST, the IOPI tongue-strength assessment) used in a geriatric unit. Among the 102 patients under study, 47 showed a dysphagia diagnosed by full logopedic examination. The sensitivity and the specificity of the screening tools were, respectively, 31,9 % and 83,6 % for EAT10, 86,9 % and 52,7 % for the V-VST and 76,6 % and 65,0 % for the DePippo test. Regarding the posterior tongue strength assessment, the threshold value of 31kPA showed an 77,3 % sensitivity and a 52,7 % specificity. Given the results obtained from the above-mentioned screening tools and their practical application limitations, the DePippo test appears to be the most convenient for a day-to-day geriatric utilization. Finally, this study outlines the necessity of confirming, in a larger sample, the reproducibility of the DePippo test as well as the interest of measuring the tongue strength among frail older people.

L'objectif de cette étude prospective était d'évaluer l'intérêt et les limites d'outils de dépistage de la dysphagie (DePippo, EAT10, V-VST, mesure de la force de langue par IOPI) lors de leur utilisation au sein d'un service de gériatrie. Parmi les 102 patients inclus, 47 présentaient une dysphagie relevée par une évaluation logopédique complète. La sensibilité et la spécificité des tests de dépistage ont été respectivement de 31,9 % et 83,6 % pour l'EAT10, de 86,9 % et 52,7 % pour le V-VST, et de 76,6 % et 65,0 % pour le test de DePippo. Concernant la force postérieure de la langue, la valeur seuil minimale de 31 kPa présentait une sensibilité de 77,3 % et une spécificité de 52,7 %. Bien que moins sensible que le V-VST, le test de DePippo (test à l'eau) est plus largement applicable aux patients fragiles hospitalisés en gériatrie. De plus, cette étude met en lumière la nécessité de préciser, au sein d'un échantillon plus large, la reproductibilité du test de DePippo et l'intérêt de la mesure de la force de langue. En conclusion, et sous réserve de son taux de reproductibilité à préciser, le test de DePippo apparaît, actuellement, être l'outil de dépistage le plus adapté à une utilisation en gériatrie.

Development and validation of a short version of the Sarcopenia Quality of Life questionnaire: the SF-SarQoL.

PURPOSE: To facilitate the measurement of quality of life in sarcopenia, we set out to reduce the number of items in the previously validated Sarcopenia Quality of Life (SarQoL®) questionnaire, and to evaluate the clinimetric properties of this new short form. METHODS: The item reduction process was carried out in two phases. First, information was gathered through item-impact scores from older people (n = 1950), a Delphi method with sarcopenia experts, and previously published clinimetric data. In the second phase, this information was presented to an expert panel that decided which of the items to include in the short form. The newly created SFSarQoL was then administered to older, community-dwelling participants who previously participated in the SarcoPhAge study. We examined discriminative power, internal consistency, construct validity, test-retest reliability, structural validity and examined item parameters with a graded response model (IRT). RESULTS: The questionnaire was reduced from 55 to 14 items, a 75% reduction. A total of 214 older, community-dwelling people were recruited for the validation study. The clinimetric evaluation showed that the SF-SarQoL® can discriminate on sarcopenia status [EWGSOP2 criteria; 34.52 (18.59-43.45) vs. 42.86 (26.56-63.69); p = 0.043], is internally consistent (α = 0.915, ω = 0.917) and reliable [ICC = 0.912 (0.847-0.942)]. A unidimensional model was fitted (CFI = 0.978; TLI = 0.975; RMSEA = 0.108, 90% CI 0.094-0.123; SRMR = 0.055) with no misfitting items and good response category separation. CONCLUSIONS: A new, 14-item, short form version of the Sarcopenia Quality of Life questionnaire has been developed and shows good clinimetric properties.

Clinical Impact of Nutritional Status and Energy Balance in Elderly Hospitalized Patients.

OBJECTIVES: This study aimed 1) to assess the nutritional status of patients hospitalized in a geriatric ward using the recent Global Leadership Initiative on Malnutrition (GLIM) criteria, 2) to determine the balance between the energy intake (EI) with an enriched diet and the energy requirement (ER) using indirect calorimetry, and 3) to assess whether undernutrition is associated with 1-year outcome. DESIGN: This is a prospective cross-sectional study. SETTING: This study was performed in a geriatric unit. PARTICIPANTS: Patients of this geriatric unit were eligible for the study if they agreed to participate and if they did not meet the exclusion criteria (presence of malignant tumour, uncontrolled heart or renal failure, thyroidal disease, uncontrolled sepsis, oedema of the lower limbs, wearing of a pacemaker, biological thyroid dysfunction and inability to perform walking tests). MEASUREMENTS: Rest energy expenditure (REE) was measured by indirect calorimetry within the week of hospitalization. Total energy expenditure (TEE) was obtained by multiplying REE by a physical activity level coefficient and energy expenditure that was related to thermogenesis (i.e., 10% of the total amount of energy ingested over 24 h) was added. Food intake was measured over a 3-day period. Undernutrition was defined using MNA and the criteria of the GLIM leadership. Clinical outcomes included 1-year institutionalisation and mortality. RESULTS: Seventy-nine patients (84.9 ± 5.3 years) were included. A total of 21 (26.6 %) patients were found undernourished. REE was 1088 ± 181kcal/day (17.8 ± 2.9 kcal/kg/day) and TEE was 1556 ± 258 kcal/day (25.4 ± 4.2 kcal/kg/day). Weight-adjusted REE and TEE were higher in undernourished patients compared to those well-nourished (19.8 ± 3.1 vs. 17.1 ± 2.6 kcal/day and 28.4±4.5 vs. 24.4±3.7 kcal/day) (p<0.05). The lower was the Body Mass Index (BMI), the higher was the energy needs (p<0.01). EI was significantly greater than energy requirements (difference requirements - intake with enriched diet = -354 ± 491 kcal/day; p<0.0001). This difference did not depend on BMI (p=0.82), appendicular skeletal mass index (ASMI) (p=0.63), or the presence of undernutrition (p=0.33). At 1-year follow-up, 15 (19%) patients died and 20 (25.6%) were institutionalized. On multivariable analysis, male gender (OR=5.63; p=0.015) and undernutrition (OR=7.29; p=0.0043) emerged as independently associated with death. On multivariable analysis, only ASMI (OR 0.59 (0.35-0.99), p=0.044) and activities of daily living (ADL) (OR 1.14 (1.00-1.30), p=0.043) were significantly associated with institutionalization. CONCLUSIONS: Undernutrition as assessed by the GLIM criteria remains common in elderly patients hospitalized in a geriatric unit and is associated with increased 1-year mortality but not with institutionalization. Energy requirements are higher in undernourished patients and in patients with a low BMI. Enriched energy intakes could sufficiently cover the energy needs of this population.

Assessing gait parameters with accelerometer-based methods to identify older adults at risk of falls: a systematic review.

PURPOSE: The purpose of this study was to perform a systematic review to assess the utility of accelerometric methods to identify older adults at risk of falls. METHODS: The Preferred Reporting Item for Systematic review and Meta-Analysis (PRISMA) guidelines were followed during all steps of this systematic review. Cross sectional and longitudinal studies assessing gait parameters in older adults using accelerometric devices, and comparing groups based on the risk of falls or fall history were identified from studies published in the MEDLINE, SCOPUS and Cochrane Database of Systematic Reviews databases between January 1996 and January 2017. Study selection and data extraction were performed independently by two reviewers. The quality of the methodology used in the studies included was assessed using the Newcastle-Ottawa Scale. RESULTS: In total, 354 references were identified through the database search. After selection, ten studies were included in this systematic review. According to the cross sectional studies, people who fall or are at risk of fall are slower, and walk with shorter steps, lower step frequency, worse stride and step regularity in terms of time, position and acceleration profiles. One longitudinal study suggests considering harmonic ratio of upper trunk acceleration in the vertical plane. Two other longitudinal studies highlight the importance of considering more than one gait parameter, and sophisticated statistical tools to discern older adults at risk for future fall(s). CONCLUSION: This systematic review essentially highlights the lack of available literature providing strong evidence that gait parameters obtained using acceleration-based methods could be useful to discern older people at risk of fall. Available literature is encouraging, but further high quality studies are needed to highlight the cross-sectional and longitudinal relationships between gait parameters and falls in older adults.

Prevalence of Frailty in Nursing Home Residents According to Various Diagnostic Tools.

BACKGROUND: Although the theoretical foundations of frailty are well established in the literature, it remains an evolving concept lacking any unique definition or diagnostic criteria for use in clinical practice and epidemiological research. No consensus exists about the accurate prevalence rates of frailty. The various operational definitions of frailty can at least partly explain such discrepancies. OBJECTIVE: To compare the prevalence of frailty, measured with different diagnostic tools, among elderly nursing home residents. DESIGN: This is an analysis of baseline data collected among the SENIOR (Sample of Nursing home Elderly Individuals: an Observational Research) cohort. SETTING: Nursing homes. POPULATION: A total of 662 volunteer subjects from 28 nursing homes were included in this analysis. Among them, the mean age was 83.2 ± 8.99 years and 484 (72.5%) of them were women. MEASUREMENT: The percentages of frail and non-frail subjects were calculated according to 10 different definitions. RESULTS: Prevalence of frailty varies from 1.70% (Frailty Index) to 76.3% (Groningen Frailty Indicator) depending on the tool used. CONCLUSIONS: The prevalence of frailty is highly dependent on the diagnostic tool used. It would be necessary to reach a consensus on which diagnostic tools to use if one wishes to have comparable data obtained in epidemiological studies.

Prevalence of Concomitant Bone and Muscle Wasting in Elderly Women from the SarcoPhAge Cohort: Preliminary Results.

BACKGROUND: Recent studies suggest that bone and muscle wasting are closely interconnected. OBJECTIVE: The aim was of this study is to assess the prevalence of osteoporosis in a population of women diagnosed with sarcopenia. Participants, setting and design: We analyzed cross-sectional data of women, aged 65 years and above, for whom bone mineral density was available at the time of inclusion in the SarcoPhAge (Sarcopenia and Physical impairment with advancing Age) cohort, an ongoing prospective study with the aim to assess consequences of sarcopenia. MEASUREMENTS: Muscle strength was evaluated with a hydraulic hand-dynamometer, appendicular lean mass and bone mineral density by Dual-Energy X-Ray Absorptiometry and physical performance by the Short Physical Performance Battery test (SPPB). Sarcopenia was diagnosed according to the European Working Group on Sarcopenia in Older People definition, i.e. a low muscle mass plus either low muscle strength or low physical performance. A bone mineral density T-score equal to or below -2.5SD at the lumbar spine, at the total hip or at the femoral neck was used to define osteoporosis (World Health Organization definition). RESULTS: A total of 126 women aged 74.38±6.32 years were included. Among them, 26 were assessed with sarcopenia (20.6%) and 34 (27.0%) with osteoporosis. There were more osteoporotic women among sarcopenic subjects (46.1%) than among non-sarcopenic subjects (22.0%) (p-value=0.011). A significant lower appendicular lean mass index was observed in osteoporotic women (p-value=0.025). We also observed, in osteoporotic subjects, a lower muscle strength (p-value=0.023). Numerical values of bone mineral density were lower in the sarcopenic population but the differences did not reach the level of statistical significance. CONCLUSION: Our study demonstrated that muscle mass and strength are lower in patients with osteoporosis. Prospective changes in bone and muscle mass will be investigated during the follow-up of our cohort.

Data set of healthy old people assessed for three walking conditions using accelerometric and opto-electronic methods.

BACKGROUND: Gait patterns of healthy aging are needed to allow a comparison with pathological situations. However, little data is available. OBJECTIVE: To present gait pattern of healthy older specially selected to be "healthy walkers". METHOD: Fifty-seven older people benefited from a geriatric assessment including clinical and functional evaluations to include only those without gait disorders. Gait data were simultaneously recorded using a tri-axial accelerometer placed on the waist and four 3D position markers placed on the feet at the level of the heel and the toe. Volunteers walked at comfortable self-selected speed (CW), fast self-selected speed (FW), and finally in dual task walking condition (DTW). The extracted gait parameters were: gait speed, stride length, stride frequency, regularity and symmetry, swing, stance and double support time and ratio and minimum toe clearance. Gait speed and stride length were normalized to the right leg length. RESULTS: Fifty-seven older people with a mean age of 69.7 ± 4.2 years old (range from 65 to 82 years) were included. Data were analyzed according to the gender and according to the age (<70 or ≥70 years old). After normalization to leg length, the main significant differences were shown for stride length and minimum toe clearance in CW, FW and in DTW that were shorter in women. The regularity in FW was significantly lower among older volunteers. CONCLUSIONS: This work provides a data set considering 14 gait parameters obtained from 57 healthy old people strictly selected and assessed for three walking conditions and shows that GS, SL and MTC have to be related to the gender. The age-related impact on gait performances appears reduced in this cohort.

Gait speed or gait variability, which one to use as a marker of risk to develop Alzheimer disease? A pilot study.

BACKGROUND: Previous literature demonstrates the interest of gait analysis to predict cognitive decline in old people. AIMS: This pilot study aims to determine if gait speed or gait variability is a marker able to early identify, among mild cognitive impairment (MCI) subjects, those at risk to develop Alzheimer's disease (AD) in the future. METHODS: 13 MCI subjects were included in 2007. Their gait parameters (walking speed, stride length and gait frequency, regularity and symmetry) were measured in 2007 and 2008 in simple task (ST) and in dual task (DT) using a triaxial accelerometer (Locometrix(®)). Among the 13 MCI subjects included in 2007, 10 were assessed in 2008. So, 23 (13 in 2007 + 10 in 2008) gait tests were collected. In 2011, MCI people were considered as "MCI+" when they developed AD (between baseline and 2011) and as "MCI-" if they did not. Among the 23 gait tests, 15 were from MCI+ (9 gait tests in 2007 and 6 in 2008) and 8 from MCI- (4 gait tests in 2007 and 4 gait tests in 2008). Mann-Whitney non-parametric U test was used to compare gait parameters of MCI+ and MCI-. RESULTS: Gait speed, symmetry and regularity were lower in MCI+ than in MCI-. DISCUSSION: Despite the small sample size, the results presented in this original pilot study are in line as the infrequent previous literature related to this topic. The authors discuss lacks and strengths of this work. CONCLUSIONS: These results suggest that both gait speed and gait variability could be markers to early identify MCI at risk to develop AD.

Quality of life and physical components linked to sarcopenia: The SarcoPhAge study.

INTRODUCTION: The SarcoPhAge project is an ongoing longitudinal study following community-dwelling elderly subjects with the objective to assess some health and functional consequences of sarcopenia. The sarcopenia diagnosis algorithm developed by the European Working Group on Sarcopenia in Older People (EWGSOP) and used in the present study needs further validation through cross-sectional and longitudinal studies. The aim of the present study is to assess, using this algorithm, the prevalence of sarcopenia and the clinical components linked to this geriatric syndrome. METHODS: Participants were community dwelling subjects aged 65years or older. To diagnose sarcopenia, we applied the definition of the EWGSOP. Muscle mass was measured by dual-energy X-ray absorptiometry, muscle strength by a hydraulic dynamometer and physical performance by the SPPB test. Large amounts of socio-demographic, anamnestic and clinical data were collected in all subjects. RESULTS OVER ONE YEAR: 534 subjects were recruited for this study (60.5% of women, mean age of 73.5±6.16years), among whom 73 subjects were diagnosed sarcopenic, which represents a global prevalence of 13.7%. Prevalence was 11.8% in men and 14.9% in women. Sarcopenic subjects were older; had a lower Body Mass Index, lower calf, waist, wrist and arm circumferences; presented more cognitive impairments (Mini-Mental State Examination), more comorbidities; were more often malnourished; and consumed more drugs. After adjustment for age, BMI, cognitive status, nutritional status, number of comorbidities and number of drugs, sarcopenic subjects had a worse physical health-related quality of life (SF-36) for the domain of physical functioning, were at higher risk of falls (Timed Up and Go test), were more frail (Fried), presented more often tiredness for the achievement of activities of daily living (Mobility-test), presented less fat mass and obviously less lean mass. Sarcopenic women were also more dependent for housekeeping and handling finances (Lawton scale) than non-sarcopenic ones. CONCLUSION: Sarcopenia seems to be associated with many harmful clinical components making this geriatric syndrome a real public health burden. Follow-up data of the SarcoPhAge study will be helpful to assess the outcomes of sarcopenia based on the EWGSOP diagnosis algorithm and its different proposed cut-offs.

Added value of a triaxial accelerometer assessing gait parameters to predict falls and mortality among nursing home residents: A two-year prospective study.

BACKGROUND: Gait impairment seems to be a risk factor for falls and mortality. Because gait change cannot be determined easily with classical clinical tests, some authors have suggested that it might be useful to use a gait-analysis system among elderly community-dwelling people. OBJECTIVE: The main objective of the present study was to determine the predictive value of a quantitative evaluation of the gait characteristics in nursing home residents for the occurrence of falls and death performed using a tri-axial accelerometer (Locométrix®). MATERIAL AND METHODS: One hundred elderly nursing home residents (80 women and 20 men, mean age 86.4 ± 6.04 years) were included in this study with the aim to follow them for 2 years. Deaths and falls were systematically recorded. A quantitative evaluation of a 10-second walk was performed with a tri-axial accelerometer (Locometrix®). Demographic data (i.e age, sex, body mass index) and clinical data (i.e. fall risk evaluated by the Tinetti test) were also recorded. RESULTS: During the two years of follow-up, 27 patients died. After adjustment on all potential confounding variables, only body mass index was significantly associated with the risk of mortality with an odds ratio of 0.86 (95% CI: 0.77-0.96, p=0.04). At the end of the study period, 440 falls had occurred (mean: 4.44 ± 6.79 falls per patient) but no single factors were independently associated with fall incidence. CONCLUSION: Our results show that a quantitative gait analysis performed using a tri-axial accelerometer is not predictive of long-term falls and mortality among nursing home residents.

Estimation of sarcopenia prevalence using various assessment tools.

BACKGROUND: Sarcopenia is defined as a progressive and generalized loss of muscle mass with either a loss of muscle strength or a loss of physical performance but there is no recommendation regarding the diagnostic tools that have to be used. In this study, we compared the prevalence of sarcopenia assessed using different diagnostic tools. METHODS: To measure muscle mass, muscle strength and physical performance, we used for each outcome two different diagnostic tools. For muscle mass, we used Dual Energy X-Ray Absorptiometry (DXA) and bio-electrical impedance analysis (BIA); for muscle strength, we used a hydraulic dynamometer and a pneumatic dynamometer; for physical performance we used the Short Physical Performance Battery test (SPPB test) and the walk speed. Eight diagnostic groups were hereby established. RESULTS: A total of 250 consecutive subjects were recruited in an outpatient clinic in Liège, Belgium. Estimated prevalence of sarcopenia varied from 8.4% to 27.6% depending on the method of diagnosis used. Regarding muscle mass, BIA systematically overestimated muscle mass compared to DXA (mean estimated prevalence with BIA=12.8%; mean prevalence with DXA=21%). For muscle strength, the pneumatic dynamometer diagnosed twice more sarcopenic subjects than the hydraulic dynamometer (mean estimated prevalence with PD=22.4%; mean estimated prevalence with HD=11.4%). Finally, no difference in prevalence was observed when the walking speed or the SPPB test was used. A weak overall kappa coefficient was observed (0.53), suggesting that the 8 methods of diagnosis are moderately concordant. CONCLUSION: Within the same definition of sarcopenia, prevalence of sarcopenia is highly dependent on the diagnostic tools used.

[Sarcopenia: what's new in 2014]. / Sarcopénie. Quoi de neuf en 2014?

The term "sarcopenia" was first introduced in 1989 by Irwin Rosenberg to define a progressive and generalized loss of muscle mass and muscle strength with advancing age. Above certain thresholds, that loss of muscle mass and muscle strength is considered abnormal. Despite the progress of scientific knowledge, a universally accepted definition of sarcopenia is still lacking to date. Therefore, it is a real challenge to establish the prevalence of sarcopenia because the results highly depend on the definition used for its diagnosis. This geriatric syndrome represents a public health issue with multiple clinical consequences. Loss of autonomy and quality of life, altered functional status, increase of fatigue, falls and a higher mortality rate are well-known consequences of sarcopenia. Although many pharmacological and non-pharmacological therapeutical strategies seem to have a positive impact on muscle strength and muscle mass, very few studies have yet assessed the effects of those treatments on sarcopenia itself. Therefore, developing high-quality interventional studies, in this field, seem necessary.

[Falls in the elderly]. / Les chutes de la personne agée.

Falls are frequent in the elderly; they can have severe consequences, and sometimes reveal some underlying pathology. They represent a real public health problem which prompts numerous teams to search for adequate preventative measures, adapted therapeutic options, and means to reduce the various resulting costs. This paper describes the multidisciplinary hospital day service organized, by the CHU of Liege, for older patients who fall, or are at risk of falling.

Contribution of new techniques to study the gait in old populations.

OBJECTIVES: For several years, the concept of "physiological senile gait" has been strongly contested and seems to be associated with abnormal gait. Indeed, some changes characteristic of senile gait appear early on in subjects with neurodegenerative pathologies. The aim of this article was to determine how recent contributions can improve the study of gait in old populations. This paper is a thematic review of recent contributions from medical imaging techniques as well as instrumental gait analysis techniques in older adults. This article did not focus on Parkinson's disease or other specific diseases bearing certain gait disturbances, since they belong to literature focusing on these particular disorders. MATERIAL AND METHODS: This work was not intended as a systematic review but only as a thematic one conducted by geriatricians in order review the recent literature in order to better apprehend how new technics could be implemented within their clinical practice. Articles were selected in online Medline and Cochrane Library databases, and some were previously identified by the authors. RESULTS: This paper highlights the most recent contributions in magnetic resonance imaging, functional magnetic resonance imagery, positron emission tomography and instrumental gait analyzing devices better understanding the underlying gait mechanisms in elderly populations. CONCLUSIONS: This thematic review suggests that gait could be considered as a marker of "successful aging". Its evaluation associated to longitudinal follow-up could be useful to predict cognitive and functional changes in frail older adults.

[Psychomotor disadaptation syndrome: a poorly known clinical entity]. / Le syndrome de désadaptation psychomotrice (SDPM): une entité clinique encore méconnue.

Psychomotor disadaptation syndrome is a typical geriatric clinical syndrome. It includes postural disorders such as body retropulsion, specific gait disorders, with axial akinesia and hypertonia, and psychobehavioral disorders akin to those found in depression. The diagnosis is essentially based on clinical observation rather than on iconographic data. This syndrome causes falls which induce a fear of falling. The old patient has a tendency to put himself down, to withdraw from society and to lose autonomy. This article briefly describes the physiopathology of the syndrome, recalls the diagnostic tools, and makes some suggestions regarding the care of patients suffering from this clinical entity.

[Sarcopenia: a physical marker of frailty]. / La sarcopénie: un marqueur de fragilité physique.

Sarcopenia is defined by loss of muscular mass, strength and quality that occur in elderly. Multiple factors underlie this process: low physical activity, low steroids hormones, increase of cytokines, loss of motoneurons, decrease of protein synthesis...However, the role of these factors is not yet well understood and consensual clinical definition and assessment are still needed. It has become an important area of research because of its frequency and the influence in the disability of old people. It is a major component of frailty. So far, no pharmacological treatment has proven definitive evidence to treat or prevent sarcopenia. Nevertheless, it needs a multidimensional approach based on physical activity and prevention of malnutrition.