Association between Disability and Edema Index Values in Rural Older Adult Osteosarcopenia Patients.

PURPOSE: This study analyzed the relationship between degree of disability and edema index [extracellular water/total body water (ECW/TBW) ratio] values in a rural population of older adult patients with osteopenia, sarcopenia, or osteosarcopenia (OS). MATERIALS AND METHODS: This study used data from the Namgaram-2 cohort. The degree of disability was measured using the World Health Organization Disability Assessment Schedule (WHODAS) 12, and ECW/TBW ratio was calculated using bioelectrical impedance analysis. Based on ECW/TBW ratio, the participants were stratified into normal (<0.391) and abnormal (≥0.391) groups, and the mean WHODAS 12 scores were compared between the two groups. Multiple regression analysis corrected for demographic factors, smoking history, hypertension, diabetes, and serological test results was also conducted. RESULTS: Significant differences in mean WHODAS 12 scores were observed in the healthy group (5.8±7.4 vs. 9.2±9.7, p=0.008), the osteopenia only group (7.4±8.7 vs. 12.9±12.0, p<0.001), and the OS group (16.0±13.2 vs. 23.1±17.1, p=0.004). However, no significant difference in mean WHODAS 12 score was observed in the sarcopenia only group (14.9±13.4 vs. 20.7±14.8, p= 0.051). There were significant differences in ECW/TBW ratio values between the abnormal and normal groups in the osteopenia only group (B=4.646 and p=0.001), the sarcopenia only group (B=5.097 and p=0.016), and the OS group (B=5.653 and p=0.043). CONCLUSION: This study found that the degree of disability is related to the edema index in older patients with osteopenia, sarcopenia, or OS. Since the edema index indicates the nutritional status of an individual, proper nutrition and fluid intake are important to reduce disability.

Associations between Frailty in Older Adults and Malnutrition in Rural Areas: 2019 Updated Version of the Asian Working Group for Sarcopenia.

PURPOSE: The purpose of this study was to evaluate the prevalence of frailty among an older adult population living in rural communities and to determine if frailty is associated with nutritional status after adjusting for sarcopenia and depression. MATERIALS AND METHODS: This research used baseline data from the Namgaram-2 study. Frailty was evaluated using the Kaigo-Yobo checklist in an older Korean population. The nutritional statuses of older people were measured using the Korean version of the mini nutritional assessment (MNA). The recent criteria of the Asian Working Group for Sarcopenia were applied for diagnosis of sarcopenia, and depression was assessed using the Geriatric Depression Scale-Short Form. RESULTS: The prevalence of frailty was 18.8% (male: 9.6%; female: 23.4%) and was significantly higher in individuals in their 80s [male, 35.3% (p<0.001); female, 42.3% (p<0.001)], those of poor economic status [male, 18.2% (p=0.012); female, 34.9% (p<0.001)], those with hypertension [female, 27.7% (p=0.008)], those with sarcopenia [male, 34.1% (p<0.001); female, 37.2% (p<0.001)], those with depression [male, 46.4% (p<0.001); female, 51.7% (p<0.001)], and those at high risk of malnutrition [male, 44.4% (p<0.001); female, 51.7% (p<0.001)]. After adjusting for demographic variables, including hypertension, diabetes, sarcopenia and depression, frailty was significantly associated with nutritional status [male: odds ratio (OR)=6.73, 95% confidence interval (CI), 1.84-24.65; female: OR=4.83, 95% CI, 2.88-8.11]. CONCLUSION: For older adults, MNA is a suitable tool of use in assessing both nutritional status and frailty. Moreover, the nutritional status of older adults appears to be associated with frailty, even after corrections for physical and psychological function.

The relationship between extracellular water-to-body water ratio and sarcopenia according to the newly revised Asian Working Group for Sarcopenia: 2019 Consensus Update.

OBJECTIVE: The purpose of this study was to evaluate the association between sarcopenia and extracellular water-to-total body water ratio (ECW/TBW), one of the results of bioimpedance that can be easily measured in communities, following the recent revision of the Asian Working Group for Sarcopenia. METHODS: This study data were extracted from the baseline data of Namgaram-2. Among the surveyed subjects, 885 persons aged 60 years or older were selected as study subjects. All surveys were conducted on a one-on-one interview basis; blood tests, physical function evaluations (hand grip strength, short physical performance battery; SPPB), and dual-energy X-ray absorptiometry (DEXA) and bioimpedance were also conducted. The Asian Working Group's revised definition of sarcopenia was applied. ECW/TBW was one of the results of bioimpedance this study. RESULTS: A high ECW/TBW was 1.63 times higher in the low grip strength group than in the robust group (P = 0.017) and was 2.13 times higher in the low SPPB group compared to the robust group (P < 0.001). ECW/TBW higher than 0.391 was 2.17 times more likely to occur in sarcopenic patients compared to the robust group (P < 0.001). In addition, ECW/TBW lower than 0.391 was 3.65 times more likely to occur in severely sarcopenic patients compared to the robust group (P = 0.002). CONCLUSION: The ECW/TBW may be one of the valid research tools to evaluate the strength and physical performance of the elderly. In addition, it is expected to be one of the effective indicators for tracking physical function under newly revised sarcopenia criteria.

Disability, Frailty and Depression in the community-dwelling older adults with Osteosarcopenia.

BACKGROUND: The purpose of this study was to investigate the prevalence of osteosarcopenia in the over 60-year-old community and to evaluate whether osteosarcopenia is associated with disability, frailty and depression. METHODS: This study was performed using the baseline data of Namgaram-2, among the 1010 surveyed subjects, 885 study subjects who were 60 years or older and had all necessary tests performed were selected. The Kaigo-Yobo checklist (frailty), World Health Organization Disability Assessment Schedule (WHODAS) and Geriatric Depression Scale-Short Form-Korean (GDSSF-K) were used. The Asian Working Group for Sarcopenia (AWGS 2019) were applied in this study. Osteopenia was measured using data from dual energy X-ray absorptiometry (DEXA) and osteopenia was diagnosed when the T-score was less than - 1.0. The study subjects were divided into four groups: the normal group, in which both sarcopenia and osteopenia were undiagnosed, osteopenia only, sarcopenia only and the osteosarcopenia group, which was diagnosed with both sarcopenia and osteopenia. RESULTS: Of the 885 subjects over 60 years old evaluated, the normal group comprised 34.0%, the only osteopenia group 33.7%, the only sarcopenia group 13.1%, and the osteosarcopenia group 19.2%. WHODAS (17.5, 95% CI: 14.8-20.1), Kaigo-Yobo (3.0, 95% CI: 2.6-3.4), and GDSSF mean score (4.6, 95% CI: 3.9-5.4) were statistically significantly higher in the osteosarcopenia group compared the other groups. Partial eta squared (ηp2) of WHODAS (0.199) and Kaigo-Yobo (0.148) values ​​according to Osteosarcopenia were large, and GDSSF (0.096) was medium CONCLUSIONS: Osteosarcopenia is a relatively common disease group in the older adults community that may cause deterioration of health outcomes. Therefore, when evaluating osteopenia or sarcopenia in the older adults, management of those in both disease groups should occur together.

Translation and validation of the Korean version of the Sarcopenia Quality of Life (SarQoL-K®) questionnaire and applicability with the SARC-F screening tool.

PURPOSE: The purpose of this paper was to translate and validate into the Korea language and setting the Sarcopenia Quality of Life (SarQoL®) questionnaire. METHODS: The participants consisted of 450 individuals in Namgaram-2 cohort who were followed up in 2019-2020. The study participants were divided into four groups: (1) SARC-F < 4, (2) SARC-F ≥ 4 and robust grip strength, (3) SARC-F ≥ 4, low grip strength, robust muscle mass, (4) SARC-F ≥ 4, low grip strength, and low muscle mass. To assess construct validity, population with sarcopenia-associated symptoms (SARC-F ≥ 4) apart from the Korean SarQoL (SarQoL-K®) completed the Korean versions of two generic questionnaires, the Short Form-36 and the EuroQoL 5-dimension. To validate the Korean SarQoL®, we assessed its validity (discriminative power, construct validity), reliability (internal consistency, test-retest reliability), and floor/ceiling effects. RESULTS: The SarQoL-K® questionnaire was translated without major difficulties. The mean SarQoL-K scores were 72.9 (95%, CI; 71.2-74.6) in SARC-F < 4, 54.6 (95%, CI; 50.7-58.3) in SARC-F ≥ 4 and robust grip strength, 47.0 (95%, CI; 43.8-50.1) in SARC-F ≥ 4, low grip strength, robust muscle mass, 46.6 (95%, CI; 43.0-50.1) in SARC-F ≥ 4, low grip strength, and low muscle mass. The results indicated good discriminative power across each four groups (p < 0.001), high internal consistency (Cronbach's alpha of 0.866), and excellent test-retest reliability (ICC = 0.977, 95% CI 0.975-0.979). No floor- or ceiling-effects were observed. CONCLUSIONS: This is the first study to confirm the reliability and validity of the Korean version of the SarQoL®. We demonstrated that the population with sarcopenia-associated symptoms (determined using the SARC-F questionnaire) has a lower quality of life.

Association of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) with Muscle Strength in Community-Dwelling Elderly with Knee Osteoarthritis.

PURPOSE: The purpose of this study was to evaluate the correlation between muscle strength and knee symptoms (pain, stiffness, and functional limitation) regardless of the presence of radiologic knee osteoarthritis (RKOA) in community-dwelling elderly. PATIENTS AND METHODS: This cross-sectional study used data from the Namgaram-2 cohort. The Namgaram-2 cohort consisted of participants living in three rural communities. Such participants were included for studies on activity limitation due to age-related musculoskeletal disorders including knee osteoarthritis, osteoporosis, and sarcopenia. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), a health assessment tool for patients with arthritis in lower extremities, was used to assess health-related quality of life (HRQOL). Muscle strengths were measured by knee strength (by using the isokinetic dynamometer) and hand grip strength. RESULTS: The WOMAC pain of Kallgren-Lawrence (K/L) grade < 2 was correlated with age, grip strength, nutrition status, and knee extension 180 peak torque. The WOMAC pain of K/L grade ≥ 2 was correlated with age, nutrition status, and knee extension 60 peak torque. The WOMAC stiffness of K/L grade < 2 was correlated with having a spouse, nutrition status, and knee extension 60 peak torque. The WOMAC stiffness of K/L grade ≥ 2 was correlated with knee extension 60 peak torque. The WOMAC function of K/L grade < 2 was correlated with age, grip strength, osteoporosis, nutrition status, and knee extension 180 peak torque. The WOMAC function of K/L grade ≥ 2 was correlated with age, nutrition status, and knee extension 60 peak torque. CONCLUSION: Muscle strength as measured by grip strength and knee extension was statistically significantly correlated with the WOMAC scores in patients with knee symptoms regardless of whether radiologic signs of knee osteoarthritis were observed.

Validation of the Western Ontario and McMaster Universities Arthritis Index Short Form (WOMAC-SF) and Its Relevance to Disability and Frailty.

PURPOSE: This study aimed to evaluate the validity of the Western Ontario and McMaster Universities Arthritis Index Short Form (WOMAC-SF) for the assessment of musculoskeletal disorders. We evaluated whether WOMAC-SF correlated with the World Health Organization Disability Assessment Schedule 12 (WHODAS-12) and Kaigo-Yobo questionnaires for assessing health-outcomes in Korea. MATERIALS AND METHODS: This cross-sectional study used data from the Namgaram-2 cohort. WOMAC, WOMAC-SF, WHODAS-12, and Kaigo-Yobo questionnaires were administered to patients with musculoskeletal disorders, including radiology-confirmed knee osteoarthritis (RKOA), sarcopenia, and osteoporosis. The relationships among WOMAC-SF, WHODAS-12, and Kaigo-Yobo scores were analyzed by stepwise multiple regression analysis. RESULTS: WOMAC-SF was associated with the WOMAC questionnaire. The results of confirmatory factor analysis for the hypothesized model with two latent factors, pain and function, provided satisfactory fit indices. WOMAC-SF pain and function were associated with RKOA. Kaigo-Yobo was associated with WOMAC-SF pain (B=0.140, p=0.001) and WOMAC-SF function (B=0.042, p=0.004). WHODAS-12 was associated with WOMAC-SF pain (B=0.679, p=0.003) and WOMAC-SF function (B=0.804, p<0.001). CONCLUSION: WOMAC-SF was validated for the evaluation of low extremity musculoskeletal disorders and health-related quality of life in a community-based population. Furthermore, we confirmed that WOMAC-SF were reflective of disability and frailty, which affect health outcomes.

The Association of Perceived Neighborhood Walkability and Environmental Pollution With Frailty Among Community-dwelling Older Adults in Korean Rural Areas: A Cross-sectional Study.

OBJECTIVES: The aim of this study was to evaluate the associations of frailty with perceived neighborhood walkability and environmental pollution among community-dwelling older adults in rural areas. METHODS: The participants were 808 community-dwelling men and women aged 65 years and older in 2 rural towns. Comprehensive information, including demographics, socioeconomic status, grip strength, polypharmacy, perceived neighborhood environment (specifically, walkability and environmental pollution), and frailty, was collected from participants using face-to-face interviews conducted between June and August 2018. Perceived neighborhood walkability was measured using 20 items that were selected and revised from the Neighborhood Environment Walkability Scale, the Neighborhood Walkability Checklist from the National Heart Foundation of Australia, and the Physical Activity Neighborhood Environment Survey. The Kaigo-Yobo Checklist was used to assess participants' frailty. RESULTS: The overall prevalence of frailty in this community-dwelling population was 35.5%. Sex, age, cohabitation status, educational attainment, employment status, grip strength, and polypharmacy were significantly associated with frailty. In the logistic regression analysis, frailty was associated with low perceived neighborhood walkability (adjusted odds ratio [aOR], 0.881; 95% confidence interval [CI], 0.833 to 0.932; p<0.001) and severe perceived neighborhood environmental pollution (aOR, 1.052; 95% CI, 1.017 to 1.087; p=0.003) after adjusting for sex, age, cohabitation status, educational attainment, employment status, monthly income, grip strength, and polypharmacy. CONCLUSIONS: More studies are warranted to establish causal relationships between walkability and environmental pollution and frailty.

The Association between Frailty and Disability among the Elderly in Rural Areas of Korea.

BACKGROUND: The rapid increase in the elderly population in Korea is associated with an expanded burden of health problems. The purpose of this study was to investigate the association between frailty and physical disability among Koreans using the frailty index, which was developed to assess health conditions in elderly people. METHODS: We included 503 elderly people from the Namgaram-II cohort. We used the Korean version of the Kaigo-Yobo checklist as our frailty assessment tool. For the disability assessment tool, we used the Korean version of the 12-item World Health Organization Disability Assessment Schedule (WHODAS-12). We fit multiple linear regression models for men and women for each section. Our models also included variables for musculoskeletal diseases that are known to be associated with frailty, such as sarcopenia, osteoporosis, and radiologic knee osteoarthritis. RESULTS: After correcting for social demographic characteristics, blood profiles, high blood pressure, and diabetes, the Kaigo-Yobo results showed a significant difference in frailty between men (1.53 ± 0.74) and women (2.60 ± 0.77), and WHODAS-12 also showed a significant difference between men (6.59 ± 5.08) and women (15.99 ± 5.70). After correcting for social demographic characteristics, blood profiles, high blood pressure, and diabetes, Kaigo-Yobo and WHODAS-12 were significantly associated with each other among both men (ß = 2.667) and women (ß = 3.200) (p < 0.001). CONCLUSIONS: The study results show an association between frailty and disability among elderly people in rural areas. Therefore, prevention should occur at the pre-frailty stage of a person's life to prevent further disability. Also, disability welfare programs should be provided to elderly people who present with frailty.