Subjective psychological impacts during COVID-19 lockdown on older people, risk profiles and coping strategies: Results of an online survey in Spain.

This study explores the psychological impacts of lockdown among older people during the coronavirus disease 2019 pandemic in Spain, and identifies risk profiles and adaptative behaviors. A cross-sectional online survey was disseminated by social networks through snowball sampling (April-June 2020). The survey included ad-hoc questions about psychological impacts on subjective cognitive functioning, emotional distress, and loneliness. Open end-questions were coded according to Lazarus and Folkman's coping strategies framework. Of the 2010 respondents, 76% experienced impact in at least one cognitive function (11% reporting severe effects), 78% frequent sadness and 13% frequent loneliness. Age 80+, women and low education increased the risk of loneliness and severe impact in memory and processing speed. Living alone was an additional risk factor for loneliness and sadness. Lockdown is associated with cognitive impacts, emotional distress, and loneliness being risk profiles related to inequality axes. Coping strategies should inform aging policies to prevent psychological impacts during the lockdown.

Accelerometer-Measured Sedentary and Physical Activity Time and Their Correlates in European Older Adults: The SITLESS Study.

BACKGROUND: Sedentary behavior (SB) and physical activity (PA) are important determinants of health in older adults. This study aimed to describe the composition of accelerometer-measured SB and PA in older adults, to explore self-reported context-specific SB, and to assess sociodemographic and functional correlates of engaging in higher levels of SB in participants of a multicenter study including four European countries. METHOD: One thousand three hundred and sixty community-dwelling older adults from the SITLESS study (61.8% women; 75.3 ±â€…6.3 years) completed a self-reported SB questionnaire and wore an ActiGraph accelerometer for 7 days. Accelerometer-determined compositional descriptive statistics were calculated. A fixed-effects regression analysis was conducted to assess the sociodemographic (country, age, sex, civil status, education, and medications) and functional (body mass index and gait speed) correlates. RESULTS: Older adults spent 78.8% of waking time in SB, 18.6% in light-intensity PA, and 2.6% in moderate-to-vigorous PA. Accelerometry showed that women engaged in more light-intensity PA and walking and men engaged in higher amounts of moderate-to-vigorous PA. Watching television and reading accounted for 47.2% of waking time. Older age, being a man, single, taking more medications, being obese and overweight, and having a slower gait speed were statistically significant correlates of more sedentary time. CONCLUSIONS: The high amount of SB of our participants justifies the need to develop and evaluate interventions to reduce sitting time. A clinically relevant change in gait speed can decrease almost 0.45 percentage points of sedentary time. The distribution of context-specific sedentary activities by country and sex showed minor differences, albeit worth noting.

Comparison of quality of life among community-dwelling older adults with the frailty phenotype.

PURPOSE: To compare the perception of the quality of life (QOL) of community-dwelling older adults with the phenotype of frailty. METHODS: Cross-sectional analysis of baseline data of the "Cohort of Obesity, Sarcopenia and Frailty of Mexican Older Adults" (COSFOMA). Operationalization of frailty was carried out using the phenotype as follows: weight loss, self-report of exhaustion, low physical activity, slow gait, and weakness. QOL was measured using two scales: World Health Organization Quality of Life of Older Adults (WHOQOL-OLD), which is a specific instrument for the elderly population, and Short Form-36 Health Survey (SF-36), a generic instrument to evaluate the QOL related to health. One-way analyses of variance were conducted to assess the differences among the three phenotypes of frailty and QOL perception. RESULTS: There were 1252 older adult participants who were analyzed; 11.2% (n = 140) had frailty, 50.3% (n = 630) pre-frailty and 38.5% (n = 482) were not frail. The mean (±SD) total score of the WHOQOL-OLD according to the phenotype of frailty was 60.3 (13.9) for those with frailty, 67.4 (12.7) pre-frailty and 72.4 (11.2) not frail (ANOVA, p < 0.001). The mean (±SD) of the SF-36 of the physical and mental component measures the sum, 38.9 (9.9) and 41.9 (11.3) with frailty, 45.7 (9.1) and 46.6 (9.8) pre-frailty, and 49.6 (7.3) and 49.4 (7.9) not frail, respectively (ANOVA, p < 0.001). CONCLUSIONS: Frailty is observed in 1/10 community-dwelling older adults. Those with frailty and pre-frailty had a lower perception of QOL compared with those who were not frail.

Frailty in community-dwelling older adults: association with adverse outcomes.

BACKGROUND: The study of frailty is important to identify the additional needs of medical long-term care and prevent adverse outcomes in community dwelling older adults. This study aimed to determine the prevalence of frailty and its association with adverse outcomes in community dwelling older adults. METHODS: A cross-sectional study was carried out from April to September 2014. The population sample was 1,252 older adults (≥60 years) who were beneficiaries of the Mexican Institute of Social Security (IMSS) in Mexico City. Data were derived from the database of the "Cohort of Obesity, Sarcopenia and Frailty of Older Mexican Adults" (COSFOMA). Operationalization of the phenotype of frailty was performed using the criteria of Fried et al (weight loss, self-report of exhaustion, low physical activity, slow gait, and weakness). Adverse outcomes studied were limitation in basic activities of daily living (ADLs), falls and admission to emergency services in the previous year, and low quality of life (WHOQOL-OLD). RESULTS: Frailty was identified in 20.6% (n=258), pre-frailty in 57.6% (n=721), and not frail in 21.8% (n=273). The association between frailty and limitations in ADL was odds ratio (OR) =2.3 (95% confidence interval [CI] 1.7-3.2) and adjusted OR =1.7 (95% CI 1.2-2.4); falls OR =1.6 (95% CI 1.2-2.1) and adjusted OR =1.4 (95% CI 1.0-1.9); admission to emergency services OR =1.9 (95% CI 1.1-3.1) and adjusted OR =1.9 (95% CI 1.1-3.4); low quality of life OR =3.4 (95% CI 2.6-4.6) and adjusted OR =2.1 (95% CI 1.5-2.9). CONCLUSION: Approximately 2 out of 10 older adults demonstrate frailty. This is associated with limitations in ADL, falls, and admission to emergency rooms during the previous year as well as low quality of life.

The SITLESS project: exercise referral schemes enhanced by self-management strategies to battle sedentary behaviour in older adults: study protocol for a randomised controlled trial.

BACKGROUND: Older adults are the fastest growing segment of the world's population. Recent evidence indicates that excessive sitting time is harmful to health, independent of meeting the recommended moderate to vigorous physical activity (PA) guidelines. The SITLESS project aims to determine whether exercise referral schemes (ERS) can be enhanced by self-management strategies (SMSs) to reduce sedentary behaviour (SB), increase PA and improve health, quality of life and function in the long term, as well as psychosocial outcomes in community-dwelling older European citizens from four countries, within a three-armed pragmatic randomised controlled trial, compared with ERS alone and also with general recommendations about PA. METHODS: A total of 1338 older adults will be included in this study, recruited from four European countries through different existing primary prevention pathways. Participants will be randomly allocated into an ERS of 16 weeks (32 sessions, 45-60 min per session), ERS enhanced by seven sessions of SMSs and four telephone prompts, or a control group. Outcomes will be assessed at baseline, month 4 (end of ERS intervention), month 16 (12 months post intervention) and month 22 (18 months post intervention). Primary outcomes will include measures of SB (time spent sedentary) and PA (counts per minute). Secondary outcomes will include muscle and physical function, health economics' related outcomes, anthropometry, quality of life, social networks, anxiety and depressive symptoms, disability, fear of falling, executive function and fatigue. A process evaluation will be conducted throughout the trial. The full analysis set will follow an intention-to-treat principle and will include all randomised participants for whom a baseline assessment is conducted. The study hypothesis will be tested with mixed linear models with repeated measures, to assess changes in the main outcomes (SB and PA) over time (baseline to month 22) and between study arms. DISCUSSION: The findings of this study may help inform the design and implementation of more effective interventions to reduce SB and increase PA levels, and hence improve long-term health outcomes in the older adult population. SITLESS aims to support policy-makers in deciding how or whether ERS should be further implemented or restructured in order to increase its adherence, impact and cost-effectiveness. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02629666 . Registered 19 November 2015.

Biomarkers associated with sedentary behaviour in older adults: A systematic review.

OBJECTIVE: Pathomechanisms of sedentary behaviour (SB) are unclear. We conducted a systematic review to investigate the associations between SB and various biomarkers in older adults. METHODS: Electronic databases were searched (MEDLINE, EMBASE, CINAHL, AMED) up to July 2015 to identify studies with objective or subjective measures of SB, sample size ≥50, mean age ≥60years and accelerometer wear time ≥3days. Methodological quality was appraised with the CASP tool. The protocol was pre-specified (PROSPERO CRD42015023731). RESULTS: 12701 abstracts were retrieved, 275 full text articles further explored, from which 249 were excluded. In the final sample (26 articles) a total of 63 biomarkers were detected. Most investigated markers were: body mass index (BMI, n=15), waist circumference (WC, n=15), blood pressure (n=11), triglycerides (n=12) and high density lipoprotein (HDL, n=15). Some inflammation markers were identified such as interleukin-6, C-reactive protein or tumor necrosis factor alpha. There was a lack of renal, muscle or bone biomarkers. Randomized controlled trials found a positive correlation for SB with BMI, neck circumference, fat mass, HbA1C, cholesterol and insulin levels, cohort studies additionally for WC, leptin, C-peptide, ApoA1 and Low density lipoprotein and a negative correlation for HDL. CONCLUSION: Most studied biomarkers associated with SB were of cardiovascular or metabolic origin. There is a suggestion of a negative impact of SB on biomarkers but still a paucity of high quality investigations exist. Longitudinal studies with objectively measured SB are needed to further elucidate the pathophysiological pathways and possible associations of unexplored biomarkers.

La prevalencia de sarcopenia en residencias de España: comparación de los resultados del estudio multicéntrico ELLI con otras poblaciones / Prevalence of sarcopenia in Spanish nursing homes: Comparison of the results of the ELLI study with other populations

Introducción. El objetivo principal del estudio es conocer la prevalencia de sarcopenia, según criterios del European Working Group on Sarcopenia in Older People, en ancianos que viven en residencia. Métodos. Estudio multicéntrico en personas mayores de 70 capaces de caminar que viven en residencias. La composición corporal se evaluó mediante bioimpedanciometría, la fuerza de prensión con un dinamómetro Jamar y la velocidad de la marcha sobre un recorrido de 4m. La sarcopenia se evaluó utilizando los criterios del European Working Group on Sarcopenia in Older People (velocidad<0,8m/s; fuerza de prensión<30kg en hombres o<20kg en mujeres, e índice de masa muscular <8,31kg/m2 en hombres o<6,68kg/m2 en mujeres). Resultados. Se incluyeron 276 personas (mediana de edad 87,2 años; 69% mujeres), un 37% tenía sarcopenia (15% hombres, 46% mujeres), un 37% baja masa muscular, un 86% lentitud al caminar y un 95% debilidad muscular. La prevalencia de sarcopenia se incrementó con la edad. El 90% de las personas con sarcopenia presentaban conjuntamente una disminución de fuerza y velocidad. El 39% de personas con lentitud y el 38% de personas con debilidad muscular tenían sarcopenia. Conclusiones. La presencia de sarcopenia es un problema frecuente en personas mayores que viven en residencias, especialmente en mujeres. La mayor parte de los casos son graves, con una disminución concurrente de la fuerza muscular y de rendimiento físico. Aunque la funcionalidad muscular está alterada en 9 de cada 10 participantes, la mayoría de ellos tiene preservada la masa muscular (AU)

Introduction. The main aim of this study is to assess the prevalence of sarcopenia, according to the criteria of the European Working Group on Sarcopenia in Older People, in men and women living in Spanish nursing homes. Methods. Multi-centre study was conducted on ambulatory persons over 69 years old living in nursing homes. Body composition was assessed using bioimpedance analysis, grip strength with a Jamar dynamometer, and gait speed using the 4 metre walk test. Sarcopenia was assessed using the European Working Group on Sarcopenia in Older People criteria (gait speed<0.8m/s; grip strength<30kg in men or 20kg in women, and muscle mass index <8.31kg/m2 in men or<6.68kg/m2 in women). Results. The study included 276 subjects with a median age 87.2 years, and with 69% women. Sarcopenia was demonstrated in 37% (15% men, 46% women), 37% had low muscle mass, 86% low gait speed, and 95% low grip strength. Prevalence of sarcopenia increased with advancing age. Both weakness and low gait speed was observed in 90% of individuals with sarcopenia, with 39% of the total having low gait speed, and 38% with weakness. Conclusion. Sarcopenia is a frequent condition in older persons living in nursing homes, especially among women. Most of the cases are severe, with both low muscle strength and physical performance. Although muscle function is altered in 9 out 10 participants, most of them have preserved muscle mass (AU)

Complicaciones de la hospitalización en personas mayores / Hospital complications in the elderly

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[Prevalence of sarcopenia in Spanish nursing homes: Comparison of the results of the ELLI study with other populations]. / La prevalencia de sarcopenia en residencias de España: comparación de los resultados del estudio multicéntrico ELLI con otras poblaciones.

INTRODUCTION: The main aim of this study is to assess the prevalence of sarcopenia, according to the criteria of the European Working Group on Sarcopenia in Older People, in men and women living in Spanish nursing homes. METHODS: Multi-centre study was conducted on ambulatory persons over 69 years old living in nursing homes. Body composition was assessed using bioimpedance analysis, grip strength with a Jamar dynamometer, and gait speed using the 4 metre walk test. Sarcopenia was assessed using the European Working Group on Sarcopenia in Older People criteria (gait speed<0.8m/s; grip strength<30kg in men or 20kg in women, and muscle mass index <8.31kg/m(2) in men or<6.68kg/m(2) in women). RESULTS: The study included 276 subjects with a median age 87.2 years, and with 69% women. Sarcopenia was demonstrated in 37% (15% men, 46% women), 37% had low muscle mass, 86% low gait speed, and 95% low grip strength. Prevalence of sarcopenia increased with advancing age. Both weakness and low gait speed was observed in 90% of individuals with sarcopenia, with 39% of the total having low gait speed, and 38% with weakness. CONCLUSION: Sarcopenia is a frequent condition in older persons living in nursing homes, especially among women. Most of the cases are severe, with both low muscle strength and physical performance. Although muscle function is altered in 9 out 10 participants, most of them have preserved muscle mass.

Ensayo clínico aleatorizado de una estrategia de prevención de caídas en ancianos institucionalizados basada en el Mini Falls Assessment Instrument

Introducción. El Mini Falls Assessment Instrument (MFAI) identifica factores de riesgo de caídas de un individuo y los vincula a intervenciones específicas. El objetivo de este estudio fue evaluar la eficacia del MFAI como base de una estrategia de prevención de caídas en ancianos institucionalizados. Material y métodos. Ensayo aleatorizado por conglomerados (identificador NCT00888953). Se aleatorizaron 16 residencias a aplicar el MFAI (intervención) o una versión modificada no vinculada a acciones (control). La variable principal fue la ocurrencia de caídas durante el seguimiento (12 meses). Otras variables evaluadas: número total de caídas, función física, calidad de vida, estado funcional y efectos adversos. Resultados. Se analizaron datos de 330 participantes (197 intervención, 137 control). Ambos grupos presentaron un número similar de factores de riesgo: 7 en el grupo intervención (rango 1-12) y 8 en el grupo control (1-13). En el grupo intervención cayeron más personas (49% vs 38%), y el número de caídas (315 vs 109) y la tasa por 100 personas-año fueron mayores (192,5 vs 179,8) que en el grupo control. En el análisis multivariable no hay diferencias significativas en el riesgo de caída (odds ratio = 1,45; intervalo de confianza [IC] del 95%: 0,67 a 3,14; p = 0,350), aunque la tasa de incidencia es significativamente mayor en el grupo intervención (razón de tasas de incidencia = 2,23; IC 95%: 1,43 a 3,48; p < 0,001). Conclusiones. Los resultados del MFAI como estrategia para la prevención de caídas no son concluyentes. Se necesitan estudios adicionales que proporcionen evidencia de calidad (AU)

Introduction. The Mini Falls Assessment Instrument (MFAI) identifies risk factors for falls in an individual and links them to specific interventions. This study evaluates the effectiveness of MFAI as the basis for a falls prevention strategy in institutionalized elderly. Material and methods. A cluster randomized clinical trial (identifier NCT00888953) was conducted in 16 nursing homes randomized to apply MFAI (intervention) or a modified version not linked to actions (control). The primary endpoint was the occurrence of falls during follow-up (12 months). Secondary variables were total number of falls, physical function, quality of life, functional status, and adverse effects. Results. Data from 330 participants (197 intervention, 137 control) were analyzed. Both groups had a similar number of risk factors: 7 in the intervention group (range 1-12) and 8 (1-13) in the control group. In the intervention group there were more fallers (49% vs. 38%), and higher number of falls (315 vs. 109), and fall rate per 100 person-years (192.5 vs. 179.8) than the control group. In the multivariate analysis, there were no significant differences in fall risk (odds ratio = 1.45; 95% confidence interval [CI]: .67 to 3.14; P = .350), but the incidence rate is significantly higher in the intervention group (Incidence rate ratio = 2.23; 95% CI: 1.43 to 3.48; P < .001). Conclusions. The results on the efficacy of the MFAI as a fall prevention strategy are inconclusive. Additional studies are needed in order to provide good quality evidence (AU)

[Randomized clinical trial of a fall-prevention strategy for institutionalized elderly based on the Mini Falls Assessment Instrument]. / Ensayo clínico aleatorizado de una estrategia de prevención de caídas en ancianos institucionalizados basada en el Mini Falls Assessment Instrument.

INTRODUCTION: The Mini Falls Assessment Instrument (MFAI) identifies risk factors for falls in an individual and links them to specific interventions. This study evaluates the effectiveness of MFAI as the basis for a falls prevention strategy in institutionalized elderly. MATERIAL AND METHODS: A cluster randomized clinical trial (identifier NCT00888953) was conducted in 16 nursing homes randomized to apply MFAI (intervention) or a modified version not linked to actions (control). The primary endpoint was the occurrence of falls during follow-up (12 months). Secondary variables were total number of falls, physical function, quality of life, functional status, and adverse effects. RESULTS: Data from 330 participants (197 intervention, 137 control) were analyzed. Both groups had a similar number of risk factors: 7 in the intervention group (range 1-12) and 8 (1-13) in the control group. In the intervention group there were more fallers (49% vs. 38%), and higher number of falls (315 vs. 109), and fall rate per 100 person-years (192.5 vs. 179.8) than the control group. In the multivariate analysis, there were no significant differences in fall risk (odds ratio=1.45; 95% confidence interval [CI]: .67 to 3.14; P=.350), but the incidence rate is significantly higher in the intervention group (Incidence rate ratio=2.23; 95% CI: 1.43 to 3.48; P<.001). CONCLUSIONS: The results on the efficacy of the MFAI as a fall prevention strategy are inconclusive. Additional studies are needed in order to provide good quality evidence.

Prevalence of sarcopenia in patients attending outpatient geriatric clinics: the ELLI study.

OBJECTIVES: the aim of this study is to know the prevalence of sarcopenia in geriatric outpatient clinics using the EGWSOP (European Working Group on Sarcopenia in Older People) diagnostic criteria that include muscle mass, muscle strength and physical performance. METHODS: subjects over 69 years old, able to walk without help and who attended five geriatric outpatient clinics were recruited. Body composition was assessed using bioimpedance analysis (BIA), grip strength using a JAMAR dynamometer and physical performance by the 4 m gait speed. Sarcopenia was diagnosed using the EGWSOP criteria (gait speed <0.8 m/s; grip strength <30 kg in men or <20 kg in women, and muscle mass index (MMI) <8.31 kg/m(2) in men or <6.68 kg/m(2) in women). RESULTS: two hundred and ninety-eight subjects were included (median age 83.2 years, 63.1% women). 19.1% had sarcopenia (12.7% men, 22.9% women); 20.1% had low muscle mass; 68.8% had low gait speed and 81.2% low grip strength. Only 21.9% of the subjects with low grip strength and 19.5% of those with low gait speed had sarcopenia. No correlations between muscle mass and either muscle strength or gait speed were detected. CONCLUSIONS: sarcopenia is present in one out of five subjects attending geriatric outpatient clinics.

Medio siglo de la Revista Española de Geriatría y Gerontología / Half a century of Spanish journal of geriatrics and gerontology

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Changes in whole-brain functional networks and memory performance in aging.

We used resting-functional magnetic resonance imaging data from 98 healthy older adults to analyze how local and global measures of functional brain connectivity are affected by age, and whether they are related to differences in memory performance. Whole-brain networks were created individually by parcellating the brain into 90 cerebral regions and obtaining pairwise connectivity. First, we studied age-associations in interregional connectivity and their relationship with the length of the connections. Aging was associated with less connectivity in the long-range connections of fronto-parietal and fronto-occipital systems and with higher connectivity of the short-range connections within frontal, parietal, and occipital lobes. We also used the graph theory to measure functional integration and segregation. The pattern of the overall age-related correlations presented positive correlations of average minimum path length (r = 0.380, p = 0.008) and of global clustering coefficients (r = 0.454, p < 0.001), leading to less integrated and more segregated global networks. Main correlations in clustering coefficients were located in the frontal and parietal lobes. Higher clustering coefficients of some areas were related to lower performance in verbal and visual memory functions. In conclusion, we found that older participants showed lower connectivity of long-range connections together with higher functional segregation of these same connections, which appeared to indicate a more local clustering of information processing. Higher local clustering in older participants was negatively related to memory performance.

Descripción del perfil de complejidad de los pacientes admitidos en unidades sociosanitarias de larga estancia entre los años 2003 y 2009 / Description of the clinical complexity of patients admitted to long term care hospitals in Catalonia during 2003-2009

Introducción: Describir la complejidad clínica de los pacientes al ingreso en unidades de larga estancia sociosanitaria en Cataluña entre los años 2003 y 2009. Material y métodos: Análisis transversal de 47.855 ingresos registrados en el sistema de información Conjunt Mínim Bàsic de Dades dels Recursos Sociosanitaris. Las variables analizadas fueron agrupaciones diagnósticas, las comorbilidades y los procedimientos médicos, estado funcional y cognitivo, categorías de uso de recursos del Resource Utilization Groups III (RUG-III), la cobertura y la intensidad de las terapias rehabilitadoras. Se realizó un análisis descriptivo de la información. Resultados: Las agrupaciones diagnósticas más frecuentes en el periodo de estudio fueron demencia y enfermedad cerebrovascular aguda, que mostraron un descenso continuado (descenso del 8,8 y el 2,3%). El mayor aumento correspondió a ingresos por descanso familiar y fractura (7,7% y 1,9%). El estado funcional y cognitivo promedio se mantuvo estable, aunque aumentó el porcentaje de individuos con dependencia en todas las actividades de la vida diaria. Las categorías RUG-III más frecuentes fueron rehabilitación, funciones físicas reducidas, complejidad clínica y cuidados especiales. Durante el periodo estudiado, la categoría «rehabilitación» se incrementó marcadamente (20,3%), mientras las otras categorías disminuyeron. Las terapias rehabilitadoras incrementaron su cobertura durante el periodo (20,8%), especialmente la fisioterapia (25,4%) y la terapia ocupacional (17,4%). Conclusiones: La complejidad clínica de la población atendida en unidades de larga estancia aumentó en el periodo 2003-2009. El uso de recursos y terapias indican un creciente esfuerzo rehabilitador, como posible respuesta a cambios en la complejidad clínica atendida, los estándares de práctica clínica o las prácticas establecidas en el registro y notificación de la información (AU)

Introduction: This work describes the clinical complexity of patients admitted to long term care hospitals between 2003 and 2009. Material and methods: Cross-sectional analysis of Minimum Basic Dataset for Social and Healthcare Units information system data for 47,855 admissions. Outcomes assessed were functional and cognitive status, Resource Utilization Groups III (RUG-III), resource use categories, coverage and intensity of therapies, diagnosis, comorbidities, and medical procedures. Descriptive analyses were performed by year of admission. Results: Dementia and acute cerebrovascular disease were the most frequent primary diagnoses, and showed a steady decline over time (8.8% and 2.3% decline), while family respite admissions and fractures increased (7.7% and 1.9%, respectively). The average functional and cognitive status of the treated population was similar across all years, although individuals with dependence in each Activity of Daily Living increased. The most frequent resource use categories were rehabilitation, reduced physical function, clinically complex care, and special care. A sharp increase in rehabilitation was observed during the study period (20.3%), while the other categories decreased. Increasingly more patients received rehabilitation therapy during their hospital stay (20.8%). Coverage increased particularly for physiotherapy (25.4%) and occupational therapy (17.4%). Conclusion: The clinical complexity faced by long term care hospitals increased during 2003- 2009. The use of resources and provision of therapies show an increasing rehabilitation effort, possibly as a response to changes in the clinical complexity of the treated population, the standards of care, or the established information reporting practices (AU)

Prevalencia de sarcopenia en consultas de geriatría y residencias. Estudio ELLI / Prevalence of sarcopenia in geriatric outpatients and nursing homes. The ELLI study

Introducción: Existen hasta ahora pocos estudios sistemáticos con los nuevos criterios diagnósticos sobre la prevalencia de la sarcopenia en distintos niveles asistenciales geriátricos. Objetivo: Conocer la prevalencia de sarcopenia, aplicando los criterios y el algoritmo diagnóstico propuesto por el European Working Group on Sarcopenia in older People (EWGSOP), en personas mayores que acuden a consultas externas de geriatría y en aquellas que están ingresadas en residencias. Material y métodos: Estudio multicéntrico nacional en 2 muestras de personas mayores: una formada por aquellas que acuden a consultas externas de geriatría hospitalarias, y la otra por aquellas que están ingresadas en una residencia. Se recogen variables demográficas, antecedentes clínicos, medicamentos consumidos, presencia de síndromes geriátricos, situación funcional (valoración de las actividades básicas e instrumentales de la vida diaria), movilidad, situación cognitiva, comorbilidad, calidad de vida, valoración nutricional y parámetros analíticos. Para realizar el diagnóstico de sarcopenia se valora la velocidad de la marcha (4 m), la fuerza de prensión de la mano y la composición corporal mediante bioimpedanciometría. Resultados: Utilizando el algoritmo diagnóstico del EWGSOP se espera obtener datos sobre la prevalencia de sarcopenia en la población mayor española. Además se analizará la concordancia entre los 3 parámetros de la definición (masa muscular, fuerza muscular y rendimiento físico) y se aplicarán los diferentes puntos de corte existentes para cada uno de ellos, explorando el rendimiento diagnóstico de cada uno de ellos. Por último, se analizarán los datos demográficos, antropométricos y funcionales que definen a los pacientes con sarcopenia Conclusiones: El estudio ELLI permitirá profundizar en el conocimiento de la prevalencia de sarcopenia en los mayores de nuestro entorno (AU)

Background: There are few systematic studies on the prevalence of sarcopenia using the new diagnostic criteria in different geriatric care settings. Objective: To estimate the prevalence of sarcopenia, using the European Working Group on Sarcopenia in Older People (EWGSOP) criteria in older subjects living in nursing homes and in those who attend geriatric outpatient clinics. Material and methods: A single country multicentre study in two samples of older subjects: patients cared for in outpatient geriatric clinics, and individuals living in nursing homes. Data collected will include demographic variables, medical history, medication, geriatric syndromes, functional status (assessment of basic and instrumental activities of daily living), mobility, cognitive status, comorbidity, quality of life, nutritional status, and laboratory parameters. For the diagnosis of sarcopenia, 4 m walking speed, handgrip strength, and body composition measured by bioelectrical impedance analysis will be assessed. Results: Using the EWGSOP algorithm, the prevalence of sarcopenia in an elderly Spanish population will be estimated. In addition, concordance and correlation between the three parameters included in the definition (muscle mass, muscle strength, and physical performance) will be analysed, using the different existing cut-off points, and examining the diagnostic accuracy of each. Finally, demographic, anthropometric and functional data that define subjects with sarcopenia will be investigated. Conclusions: The ELLI study should improve knowledge on the prevalence and characteristics of sarcopenia in older people in our population (AU)

Physical exercise interventions for improving performance-based measures of physical function in community-dwelling, frail older adults: a systematic review and meta-analysis.

OBJECTIVE: To conduct a systematic review to determine the efficacy of exercise-based interventions on improving performance-based measures of physical function and markers of physical frailty in community-dwelling, frail older people. DATA SOURCES: Comprehensive bibliographic searches in MEDLINE, the Cochrane Library, PEDro, and CINAHL databases were conducted (April 2013). STUDY SELECTION: Randomized controlled trials of community-dwelling older adults, defined as frail according to physical function and physical difficulties in activities of daily living (ADL). Included trials had to compare an exercise intervention with a control or another exercise intervention, and assess performance-based measures of physical function such as mobility and gait, or disability in ADL. DATA EXTRACTION: Two review authors independently screened the search results and performed data extraction and risk of bias assessment. Nineteen trials were included, 12 of them comparing exercise with an inactive control. Most exercise programs were multicomponent. DATA SYNTHESIS: Meta-analysis was performed for the comparison of exercise versus control with the inverse variance method under the random-effects models. When compared with control interventions, exercise was shown to improve normal gait speed (mean difference [MD]=.07m/s; 95% confidence interval [CI], .04-.09), fast gait speed (MD=.08m/s; 95% CI, .02-.14), and the Short Physical Performance Battery (MD=2.18; 95% CI, 1.56-2.80). Results are inconclusive for endurance outcomes, and no consistent effect was observed on balance and the ADL functional mobility. The evidence comparing different modalities of exercise is scarce and heterogeneous. CONCLUSIONS: Exercise has some benefits in frail older people, although uncertainty still exists with regard to which exercise characteristics (type, frequency, duration) are most effective.

[Prevalence of sarcopenia in geriatric outpatients and nursing homes. The ELLI study]. / Prevalencia de sarcopenia en consultas de geriatría y residencias. Estudio ELLI.

BACKGROUND: There are few systematic studies on the prevalence of sarcopenia using the new diagnostic criteria in different geriatric care settings. OBJECTIVE: To estimate the prevalence of sarcopenia, using the European Working Group on Sarcopenia in Older People (EWGSOP) criteria in older subjects living in nursing homes and in those who attend geriatric outpatient clinics. MATERIAL AND METHODS: A single country multicentre study in two samples of older subjects: patients cared for in outpatient geriatric clinics, and individuals living in nursing homes. Data collected will include demographic variables, medical history, medication, geriatric syndromes, functional status (assessment of basic and instrumental activities of daily living), mobility, cognitive status, comorbidity, quality of life, nutritional status, and laboratory parameters. For the diagnosis of sarcopenia, 4m walking speed, handgrip strength, and body composition measured by bioelectrical impedance analysis will be assessed. RESULTS: Using the EWGSOP algorithm, the prevalence of sarcopenia in an elderly Spanish population will be estimated. In addition, concordance and correlation between the three parameters included in the definition (muscle mass, muscle strength, and physical performance) will be analysed, using the different existing cut-off points, and examining the diagnostic accuracy of each. Finally, demographic, anthropometric and functional data that define subjects with sarcopenia will be investigated. CONCLUSIONS: The ELLI study should improve knowledge on the prevalence and characteristics of sarcopenia in older people in our population.