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SARCOPENIA - An educational film on Sarcopenia realized by ICON. Sarcopenia is the progressive loss of muscle driven by the aging process. The film adresses the latest strategies and approaches to prevent Sarcopenia and maintain muscle as one grows older. Please feel free to distribute it around you.

 

SARCOPENIA - AIM makes an announcement regarding Sarcopenia and ICD-10 The Aging in Motion Coalition (AIM) made a major announcement regarding Sarcopenia and the 10th revision of the International Classification of Disease, or ICD-10, on April 28, 2016 at the International Conference on Frailty & Sarcopenia Research (ICFSR) 2016 held in Philadelphia, PA, USA. At the previous ICFSR 2015 conference, AIM had organized a symposium on the coalition’s September 2014 proposal to have the Centers for Disease Control and Prevention establish an ICD-10 code for Sarcopenia. This proposal was backed by internationally recognized experts in the field of Sarcopenia and frailty research. For more information, please contact Cynthia Bens (cbens@agingresearch.org) or Noel Lloyd (nlloyd@agingresearch.org) at the Aging In Motion Coalition.

 

 

OTHER ARTICLES OF INTEREST

 

ALZHEIMER PREVENTION - Defeating Alzheimer's disease and other dementias: a priority for European science and society The journal Lancet Neurology devotes its entire April issue to a detailed overview and recommendations about how patient care, as well as basic and clinical research on Alzheimer's disease and other dementias should be organised in the future. The report will be presented at a workshop hosted by the European Parliament in Brussels on March 15, during the Brain Awareness Week 2016 (March 14-20, 2016). The comprehensive report is the work of the Lancet Neurology Commission led by Professor Bengt Winblad, Centre for Alzheimer Research at Karolinska Institutet in Sweden. This commission was initiated by Lancet editors and formed with the aim to provide expert recommendations and information to politicians and policy makers about Alzheimer's disease and related dementias. More than 30 internationally leading researchers collaborated on the 78 pages long report, which identified a range of challenges that need to be addressed to reduce the burden of dementia. Authors: Bengt Winblad, Philippe Amouyel, Sandrine Andrieu, Clive Ballard, Carol Brayne, Henry Brodaty, Angel Cedazo-Minguez, Bruno Dubois, David Edvardsson, Howard Feldman, Laura Fratiglioni, Giovanni B Frisoni, Serge Gauthier, Jean Georges, Caroline Graff, Khalid Iqbal, Frank Jessen, Gunilla Johansson, Linus Jönsson, Miia Kivipelto, Martin Knapp, Francesca Mangialasche, René Melis, Agneta Nordberg, Marcel Olde Rikkert, Chengxuan Qiu, Thomas P Sakmar, Philip Scheltens, Lon S Schneider, Reisa Sperling, Lars O Tjernberg, Gunhild Waldemar, Anders Wimo, Henrik Zetterberg. Defeating Alzheimer's disease and other dementias: a priority for European science and society. The Lancet Neurology, 2016; 15 (5): 455 DOI: 10.1016/S1474-4422(16)00062-4

Full text at http://www.thelancet.com/journals/laneur/article/PIIS1474-4422(16)00062-4/abstract

 

NURSING HOMES - Patterns of Emergency Department use among long-stay nursing home residents with differing levels of dementia severity A new study from the Indiana University Center for Aging Research and the Regenstrief Institute has found that almost half of all long-stay nursing home residents experience at least one transfer to an Emergency Department (ED) over the course of a year regardless of their cognitive status. While a high percentage of long-stay nursing home residents were sent to the ED, only about a third of these individuals were subsequently admitted to the hospital. This study confirms high rates of transfer of long-stay nursing home residents. Although dementia severity is not a predictor of time to ED use, other factors that influence ED use are readily identifiable. Nursing home providers should be aware of these factors when developing strategies that meet patient care goals and avoid transfer from the nursing home to the ED. Authors: Michael A. LaMantia, Kathleen A. Lane, Wanzhu Tu, Jennifer L. Carnahan, Frank Messina, Kathleen T. Unroe. Patterns of Emergency Department use among long-stay nursing home residents with differing levels of dementia severity. JAMDA 2016 . Published online: March 24, 2016. Full text at http://www.jamda.com/article/S1525-8610(16)00111-0/pdf

 

FRAILTY - The role of intervening hospital admissions on trajectories of disability in the last year of life: prospective cohort study of older people. Earlier study of Gill TM et al indicated that hospital admission resulted in worsening functional ability. In order to clarify whether hospital admissions have a comparable effect on trajectories of disability at the end of life, prospective longitudinal data was available that included monthly assessments of hospital admissions and disability in essential activities of daily living in a large cohort of community dwelling older people in US. 522 decedents were kept in the analytic sample. Trajectory modeling was used to identify the trajectories of disability. In the last year of life, six distinct trajectories of disability were identified, from least disabled to most disabled: 95 subjects (17.2%) had no disability, 61 (11.1%) had catastrophic disability, 53 (9.6%) had accelerated disability, 61 (11.1%) had progressively mild disability, 127 (23.0%) had progressively severe disability, and 155 (28.1%) had persistently severe disability. 392 (71.0%) participants had at least one hospital admission and 248 (44.9%) had multiple hospital admissions. For each trajectory the course of disability closely tracked the monthly prevalence of hospital admission. Multivariable model analysis found that hospital admission in a given month had a strong independent effect on the severity of disability, in both relative and absolute terms. The largest absolute effect was observed for catastrophic disability, with a mean increase in disability score of 1.9 (95% confidence interval 1.5 to 2.4) in the setting of a hospital admission, corresponding to a rate ratio (or relative effect) of 2.0 (95% confidence interval 1.5 to 2.7). Although the reported associations cannot be construed as causal relations, the results may help to inform aggressive effort should be taken to minimize the adverse functional consequences of acute hospital admissions and enhance differentiated interventions of disability. Authors: Thomas M Gill, Evelyne A Gahbauer, Ling Han, Heather G Allore. The role of intervening hospital admissions on trajectories of disability in the last year of life: prospective cohort study of older people. BMJ 2015;350:h2361. Full text at http://www.bmj.com/content/350/bmj.h2361. Summary written by Jun LI, MD, Center of Gerontology and Geriatrics, West China Medical School / West China Hospital, Sichuan University, Chengdu, Sichuan, China.

 

WHO - The World report on ageing and health: a policy framework for healthy ageing. WHO has released the first World report on ageing and health, reviewing current knowledge and gaps and providing a public health framework for action. The report is built around a redefinition of healthy ageing that centres on the notion of functional ability: the combination of the intrinsic capacity of the individual, relevant environmental characteristics, and the interactions between the individual and these characteristics. This Health Policy highlights key findings and recommendations from the report. Authors: Beard JR, Officer A, de Carvalho IA, et al. The World report on ageing and health: a policy framework for healthy ageing. Lancet 2015; published online Oct 29. http://dx.doi.org/10.1016/S0140-6736(15)00516-4.

Full text at http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)00516-4/abstract

 

NUTRITION - Cost-effectiveness of nutrition intervention in long-term care To determine the cost-effectiveness of two nutrition interventions on food, beverage, and supplement intake and body weight. DESIGN: Randomized, controlled trial. SETTING: Five skilled nursing home facilities. PARTICIPANTS: Long-stay residents with orders for nutrition supplementation (N = 154). INTERVENTION: Participants were randomized into a usual care control group, an oral liquid nutrition supplement (ONS) intervention group, or a snack intervention group. Research staff provided ONS, according to orders or a variety of snack foods and beverages twice per day between meals, 5 days per week for 24 weeks and assistance to promote consumption. MEASUREMENTS: Research staff independently weighed residents at baseline and monthly during the 24-week intervention. Resident food, beverage and supplement intake and the amount of staff time spent providing assistance were assessed for 2 days at baseline and 2 days per month during the intervention using standardized observation and weighed intake procedures. RESULTS: The ONS intervention group took in an average of 265 calories more per day and the snack intervention group an average of 303 calories more per day than the control group. Staff time required to provide each intervention averaged 11 and 14 minutes per person per offer for ONS and snacks, respectively, and 3 minutes for usual care. Both interventions were cost-effective in increasing caloric intake, but neither intervention had a significant effect on body weight, despite positive trends. CONCLUSION: Oral liquid nutrition supplements and snack offers were efficacious in promoting caloric intake when coupled with assistance to promote consumption and a variety of options, but neither intervention resulted in significant weight gain. Authors: Sandra F. Simmons, Emmett Keeler, Ruopeng An, Xulei Liu, Matthew S. Shotwell, Brittany Kuertz, Heidi J. Silver, and John F. Schnelle. J Am Geriatr Soc. 2015 Nov;63(11):2308-16. doi: 10.1111/jgs.13709.

Full text at http://onlinelibrary.wiley.com/doi/10.1111/jgs.13709/pdF

 

ALHEIMER PREVENTION - A 2-year multi-domain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial. The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) study by Tiia Ngandu and colleagues showed that a 2-year multi-domain intervention (i.e., exercise, cognitive training, nutritional counselling, and vascular risk monitoring) improved cognitive functioning in older adults at-risk for cognitive decline. In the FINGER study, 1260 older adults (60-77 years-old) at-risk for cognitive decline on the basis of a dementia risk score (but without dementia) were randomized to one of 2 groups: intensive multi-domain intervention (n = 631) or regular health advice (control group; n = 629). All participants, regardless of their group allocation, received at baseline oral and written information and advice on healthy lifestyles, such as diet and activities in the physical, cognitive and social domains. The multi-domain group further received nutritional counselling (3 individual sessions and 7-9 group sessions), supervised and individually tailored exercises for muscle strength (1-3 times per week) and cardiorespiratory endurance (2-5 times per week), cognitive training (10 group sessions and individual sessions performed in 2 periods of 6 months each, with each period including 72 training sessions (3 times per week, 10-15 min per session)), and vascular risk monitoring (3 additional meetings with study nurse and other 3 meetings with study physician). The main outcome of the study was cognitive performance as measured by a Z score derived from a neuropsychological test battery (NTB) composed of 14 tests; participants completed the NTB 3 times, at baseline, and 12 and 24 months. Secondary outcomes were domain-specific cognitive performance as measured by the NTB: executive functioning, processing speed, and memory. At the 24-month evaluation, both groups had improved the cognitive performance, with higher improvements in the intervention group compared to controls (statistically significant group x time interaction). Domain-specific cognitive performance showed significant improvements in the intervention group compared to controls for executive functioning and processing speed, but not for memory. Study groups did not differ in terms of major adverse health events (eg, death), although participants in the intervention group had more musculoskeletal pain than controls. Authors: Ngandu T, Lehtisalo J, Solomon A, et al. Lancet. 2015 Jun 6;385(9984):2255-63. doi: 10.1016/S0140-6736(15)60461-5. Full text at http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2815%2960461-5/supplemental

 

FRAILTY - Screening for frailty phenotype with objectively-measured physical activity in a west Japanese suburbancommunity: evidence from the Sasaguri Genkimon Study. A cross-sectional study was conducted with 1,527 community-dwelling older men and women aged 65 and over. Data was drawn from the baseline survey of the Sasaguri Genkimon Study. A cohort study carried out in a west Japanese suburban community. Results: The estimated prevalence of frailty was 9.3% (95% confidence intervals, CI, 8.4-11.2); 43.9% were pre-frail (95% CI, 41.5-46.4). The percentage of low physical activity was 19.5%. Objectively-assessed physical activity and other components aggregated statistically into a syndrome. Overall, increased age, poorer self-perceived health, depressive and anxiety symptoms, not consuming alcohol, no engagement in social activities, and cognitive impairment were associated with increased odds of frailty status, independent of co-morbidities. Conclusions: This study confirmed the internal construct validity of the frailty phenotype that defined the low energy expenditure domain with the objective measurement of physical activity. Accelerometry may potentially standardize the measurement of low physical activity and improve the diagnostic accuracy of the frailty phenotype criteria in primary care setting. The potential role of factors associated with frailty merits further studies to explore their clinical application. Authors: Chen S, Honda T, Chen T, Narazaki K, Haeuchi Y, Supartini A, Kumagai S. BMC Geriatr. 2015 Apr 2;15:36. Full text at http://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-015-0037-9

 

FRAILTY - Cognitive aspects of frailty: mechanisms behind the link between frailty and cognitive impairment. Whereas physical impairment is the main hallmark of frailty, evidence suggests that other dimensions, such as psychological, cognitive and social factors also contribute to this multidimensional condition. Cognition is now considered a relevant domain of frailty. Cognitive and physical frailty interact: cognitive problems and dementia are more prevalent in physically frail individuals, and those with cognitive impairment are more prone to become frail. Disentangling the relationship between cognition and frailty may lead to new intervention strategies for the prevention and treatment of both conditions. Both frailty and cognitive decline share common potential mechanisms. This review examines the relationship between frailty and cognitive decline and explores the role of vascular changes, hormones, vitamin D, inflammation, insulin resistance, and nutrition in the development of physical frailty and cognitive problems, as potential underlying mechanisms behind this link. Dual tasking studies may be a useful way to explore and understand the relation between cognitive and physical frailty. Further studies are needed to elucidate this complex relation to improve the outcomes of frailty. Authors: Halil M(1), Cemal Kizilarslanoglu M, Emin Kuyumcu M, Yesil Y, Cruz Jentoft AJ. Cognitive Aspects of Frailty: Mechanisms behind the Link between Frailty and Cognitive Impairment. J Nutr Health Aging. 2015;19(3):276-83. Full text at http://www.ncbi.nlm.nih.gov/pubmed/25732212

 

FRAILTY - Frailty screening in the community using the FRAIL Scale. The objective of this study (Woo J et al) is to explore the feasibility of using the FRAIL scale in community screening of older Chinese people aged 65 years and older, followed by clinical validation by comprehensive geriatric assessment of those classified as pre-frail or frail. A total of 816 members of elderly centers attending by themselves or accompanied by relatives. For phase 1, questionnaire (including demographic, lifestyle, chronic diseases) and screening tools were administered by trained volunteers.
These consist of the FRAIL scale, SARC-F to screen for Sarcopenia, and mild cognitive impairment using the abbreviated screening for mild cognitive impairment (Abbreviated Memory Inventory for the Chinese). Blood pressure, body mass index, and grip strength were recorded. For phase 2, comprehensive geriatric assessment include questionnaires assessing lifestyle domain (physical activity, nutritional status using the Mini-Nutritional Assessment-Short Form), the physical domain (number of diseases and number of drugs, activities of daily living and instrumental activities of daily living disabilities, geriatric syndromes, self-rated health, sleep quality), cognitive and psychological domain (Mini-Mental State Examination, Geriatric Depression Scale), and social domain (income, housing, living satisfaction, family support). The prevalence of pre-frailty and frailty were 52.4% and 12.5%, respectively. The prevalence for frailty increasing with age from 5.1% for those aged 65-69 years to 16.8% for those ≥75, being greater in women compared with men (13.9% vs 4.2%). Of those who were pre-frail or frail (n = 529), 42.5% had Sarcopenia and 60.7% had mild cognitive impairment. Among those who were frail (n = 102), Sarcopenia and mild cognitive impairment were also frequently present: 12.8% had Sarcopenia, 14.7% had mild cognitive impairment, 63.7% had both Sarcopenia and mild cognitive impairment, and only 8.8% had neither. In phase 2, participants who were classified as pre-frail or frail (n = 529) were invited for further interviews; 255 participants (48.2%) returned. Compared with the pre-frail group, those in the frail group were less physically active, had higher number of chronic diseases, were taking more medications (more were taking sleeping pills), reported more falls, rated their health as poor, had higher prevalence of depressive symptoms and mild cognitive impairment, had higher prevalence of Sarcopenia, and a high number of activities of daily living and instrumental activities of daily living disabilities. In conclusion the FRAIL scale may be used as the first step in a step care approach to detecting frailty in the community, allowing targeted intervention to potentially retard decline and future disability. Authors: Woo J J et al)(1), Yu R(2), Wong M(2), Yeung F(2), Wong M(2), Lum C(3). Frailty Screening in the Community Using the FRAIL Scale. J Am Med Dir Assoc. 2015 Feb 24. pii: S1525-8610(15)00094-8. Full text at http://www.ncbi.nlm.nih.gov/pubmed/25732832

 

NURSING HOMES - Treatment With multiple blood pressure medications, achieved blood pressure, and mortality in older nursing home residents: the PARTAGE Study. In the PARTAGE study 1127 individuals over 80 years of age, living in nursing homes in France and in Italy were recruited, examined and then followed for a 2-year period. The aim of this study was to assess the relationships between blood pressure and arterial stiffness with several outcomes: all cause mortality, cardiovascular morbidity and mortality, and cognitive decline. In the present analysis published last month in the JAMA IM, it is reported that the subgroup (20% of the total studied population) with systolic blood pressure less than 130 mmHg, under combination antihypertensive therapy, had a greater than 2-fold risk of mortality as compared to all other subjects. These findings raise a cautionary note regarding the safety of maintaining old frail patients with low SBP under a combination antihypertensive therapy regimen. Controlled interventional studies are warranted to assess the corresponding benefits/risks ratio in the growing population of elderly frail patients. Authors: Benetos A, Labat C, Rossignol P, Fay R, Rolland Y, Valbusa F, Salvi P, Zamboni M, Manckoundia P, Hanon O, Gautier S. Treatment With Multiple Blood Pressure Medications, Achieved Blood Pressure, and Mortality in Older Nursing Home Residents: The PARTAGE Study. JAMA Intern Med.2015 Feb 16 Full text at http://www.ncbi.nlm.nih.gov/pubmed/25685919

 

FRAILTY - Implementing frailty screening, assessment, and sustained intervention: the experience of the Gérontopôle. Despite its interest, frailty is not yet adequately implemented in the everyday clinical practice. Frailty is characterized by an initial functional loss which 1) still allows the individual to be independent in the daily life (although with some difficulties), and 2) may be reversed by targeted interventions. In the present article, we discuss: Why frailty is clinically relevant? Why frailty has not yet been implemented in daily clinical practice? How to implement frailty into clinical practice following the Gérontopôle experience? Intervention to be effective must be targeted, strong, and maintained. Authors: Vellas B. JNHA 2015 Feb;19(6):673-680. Full text at http://www.ncbi.nlm.nih.gov/pubmed/26054504 See also the chinese version of the paper.

 

FRAILTY - Prevalence of reduced muscle strength in older U.S. adults: United States, 2011-2012. Recently, the American NCHS published national estimates of muscle strength in older adults in the United States in 2011-2012, based on maximum hand grip strength. Weak muscle strength is clinically relevant, because of its associations with mobility impairment. The report shows that 5% of adults aged 60 and over had weak muscle strength, 13% had intermediate muscle strength, while 82% had normal muscle strength. The prevalence of reduced (weak and intermediate) muscle strength increased with age, while the prevalence of normal strength decreased with age. Muscle strength status did not differ by sex, except among persons aged 80 and over, where women had a higher prevalence of weak muscle strength than men. Non-Hispanic Asian and Hispanic persons had a higher prevalence of reduced muscle strength than non-Hispanic white persons. Authors: Looker, AC, Wang, C-Y. NCHS Data Brief, No. 179, January 2015. Full text at http://www.cdc.gov/nchs/data/databriefs/db179.pdf

 

FRAILTY - Cognitive frailty, a novel target for the prevention of elderly dependency. In a recent review published in Ageing Research Reviews, Ruan Qingwei and colleagues discuss their view on cognitive frailty. They propose that cognitive impairment related to cognitive frailty results from physical or pre-physical frailty and can be classified into two sub-types: 1) the “reversible” cognitive impairment, which the authors claim is associated with the presence of subjective cognitive decline and/or biomarkers of amyloid-β and neurodegeneration and 2) the “potentially reversible” one, which they associate with mild cognitive impairment (defined as CDR=0.5).
The term cognitive frailty was introduced into the literature relatively recently, in an attempt to encapsulate the cognitive decline that is often observed in non-demented elderly individuals who are physically frail. Ever since, there has been much debate about what cognitive frailty actually is. The prevailing hypothesis is that the pathophysiology underlying cognitive decline in the frailty syndrome is different from that driving the cognitive trajectory in neurodegenerative disorders. Insofar as frailty is a predictor of major health-related events (including dementia), one possibility is that frail subjects are more vulnerable to the onset and development of age-related neuropathologies, including Alzheimer’s disease. From this perspective, individuals identified as cognitively frail potentially represent a novel target for primary and secondary prevention strategies for dementia. However, to date the exact neurobiological substrates of the so-called cognitive frailty, and to what extent these are reversible, remain unknown. More research is needed to help define what cognitive frailty is, so the field can advance. Authors: Ruan Q, Yu Z, Chen M, Bao Z, Li J, He W, Ageing Res Rev. 2014 Dec 30;20C:1-10.

Full text at http://www.ncbi.nlm.nih.gov/pubmed/?term=Qingwei+Ruan+2014+a+novel+target

 

ALZHEIMER PREVENTION - Dementia prevention: optimizing the use of observational data for personal, clinical, and public health decision-making. Alzheimer’s disease and other age-related dementias afflict over 35 million people world-wide. The societal cost of care in 2010 was estimated at over $600 billion, 1% of the world’s aggregated gross domestic product, with 89% of those costs incurred by high-income countries. Mounting evidence suggests that modifiable factors in mid-life will alter an individual’s risk of dementia in later decades. For example, one analysis concluded that almost half the statistical probability of getting Alzheimer’s disease may be accounted for by seven modifiable risk factors – diabetes, midlife hypertension, midlife obesity, smoking, depression, cognitive inactivity or low educational attainment, and physical inactivity – and reducing the prevalence of these risk factors by 10% could prevent up to 1.1 million cases of the disease worldwide. How can we optimize the existing data particularly for low-risk long-term interventions on modifiable risk factors? Meta-analyses of randomized controlled trials currently are viewed to provide the highest level of evidence for causal inference and intervention efficacy. However, sole dependence on randomized controlled trials is not a feasible solution. While observational studies have inherent limitations, they can provide evidence complementary to RCTs. The goal of this paper published in the JPAD (following the Alzheimer’s Drug Discovery Foundation Task Force in New York, with the participation of an IAGG expert) is to recommend strategies to maximize the utility of observational data for low-risk health choices that may protect against dementia. Dementia Prevention: optimizing the use of observational data for personal, clinical, and public health decision-making. Authors: Penny A. Dacks et al, J Prev Alz Dis 2014;1(2):117-123. Full text at http://www.jpreventionalzheimer.com

 

ALZHEIMER PREVENTION - The BrainHealthRegistry.org: Using the internet for identification, assessment, screening, recruitment, and longitudinal monitoring of subjects for neuroscience and Alzheimer’s disease studies. The major obstacle preventing development of effective treatments for Alzheimer’s disease (AD) is the high cost of conducting clinical trials. The use of the Internet for the identification, assessment, screening, recruitment, and longitudinal monitoring of subjects for neuroscience and AD studies is one promising approach towards lowering this cost and thereby accelerating successful trials. The BrainHealthRegistry.org: Using the Internet for identification, assessment, screening, recruitment, and longitudinal monitoring of subjects for neuroscience and Alzheimer’s disease studies. Author: M.W. Weiner. J Prev Alz Dis 2014;1(2):59-61. Full text at http://www.jpreventionalzheimer.com

 

 

 

 

Page updated January 9, 2017