Globally, the number of drug prescriptions is increasing causing more adverse drug events, which is now a significant cause of mortality, morbidity, and disability that has reached epidemic ...proportions. The risk of adverse drug events is correlated to very old age, multiple co-morbidities, dementia, frailty, and limited life expectancy, with the major contributor being polypharmacy. Each characteristic alters the risk–benefit balance of medications, typically reducing anticipated benefits and amplifying risk. Current clinical guidelines are based on evidence proven in younger/healthier adult populations using a single disease model and their application to older adults with multimorbidity, in whom testing has not been conducted, yields a different risk–benefit prospect and makes inappropriate medication use and polypharmacy inevitable. Applying inappropriate clinical practice guidelines to older adults is antithetical to good healthcare, is likely to increase health inequity, and is associated with substantial negative clinical, economic, and social implications for health systems. The casualties are on the scale of a war or epidemic, yet are usually invisible in measures of healthcare quality and formal recommendations. Radical and rapid action is required to achieve a better quality of life for older populations and to remain true to the principles of medical professionalism and evidence-based medicine that place patients’ interests and autonomy at the fore. This first International Group for Reducing Inappropriate Medication Use & Polypharmacy position statement briefly details the causes, consequences, and extent of inappropriate medication use and polypharmacy. This article outlines current strategies to reduce inappropriate medication use, provides evidence for their effect, and then proposes recommendations for moving forward with 10 recommendations for action and 12 recommendations for research. We conclude that an urgent integrated effort to reduce inappropriate medication use and polypharmacy should be a leading global target of the highest priority. The cornerstone of this position statement from the International Group for Reducing Inappropriate Medication Use & Polypharmacy is the understanding that without evidence of definite relevant benefit, when it comes to prescribing, for many older patients ‘less is more’. This approach differs from most other current recommendations and guidance in medical care, as the focus is on what, when, and how to stop, rather than on when to start medications/interventions. Disrupting the framework that indiscriminately applies standard guidelines to older adults requires a new approach that better serves patients with multimorbidity. This transition requires a shift in medical education, research, and diagnostic frameworks, and re-examination of the measures used as quality indicators. In achieving this objective, we promote a return to some of the original concepts of evidence-based medicine: which considers scientific data (where it exists), clinical judgment, patient/family preference, and context. A shift is needed: from the current model that focuses on single conditions to one that simultaneously considers multiple conditions and patient priorities. This approach reframes the clinician’s role as a professional providing care, rather than a disease technician.
Background/Objective
In 2018 EWGSOP2 has suggested low muscle strength as the primary parameter of sarcopenia. The consensus has recommended SARC-F questionnaire as a screening test to find cases ...with low muscle strength which has been designated as probable sarcopenia. We aimed to study the ability of SARC-F to find probable sarcopenia cases in older patients.
Design
Retrospective, cross-sectional.
Setting
Istanbul University Istanbul Faculty of Medicine
Participants
A total of 456 older adults (71.1% female, mean age: 74.6±6.6 years)
Measurements
We diagnosed probable sarcopenia by EWGSOP 2 criteria, i.e., presence of low handgrip strength (HGS). SARC-F questionnaire was performed by all participants. We used a receiver operating characteristics curve to obtain SARC-F cut-off values to detect probable sarcopenia and calculated the area under the curve and 95% confidence interval (CI).
Results
We included 456 participants (71.1% female; mean age: 74.6 ± 6.6 years). Probable sarcopenia was present in 58 (12.7%). SARC-F cut-off ≥ 2 presented the best balance between sensitivity and specificity (sensitivity: 64.9% vs specificity: 67.9%) to detect probable sarcopenia the area under the receiver operating characteristics curve (AUC) = 0.710; 95% Cl: 0.660–0.752, p< 0.001. SARC-F with a cutoff point ≥ 1 had sensitivity 84.2% and specificity 40.5% and SARC-F ≥ 4 had high specificity 88.2% with 40.3% sensitivity.
Conclusion
SARC-F is a good screening tool for sarcopenia in practice. Our findings suggest SARC-F ≥ 1 cut-off point to be used as the probable sarcopenia screening tool regarding its high sensitivity. Consequently, SARC-F ≥ 4 cut-off is better to be used if one prefers to exclude probable sarcopenia.
Background/Objectives
The physical phenotype of frailty, described by Fried et al., shows significant overlap with sarcopenia. EWGSOP2 recommends the SARC-F questionnaire to screen for sarcopenia. ...Considering common features between both conditions, we aimed to investigate whether the SARC-F questionnaire could also be a valid and reliable tool to screen or evaluate frailty.
Design
Retrospective, cross-sectional.
Setting
Istanbul University Istanbul Faculty of Medicine.
Participants
A total of 447 older adults (70.7% female, mean age: 74.5±6.6 years).
Measurements
Frailty was assessed by the modified Fried scale. SARC-F questionnaire was performed by all participants. We used a receiver operating characteristics curve to obtain SARC-F cut-off values to detect frailty, and calculated the area under the curve and 95% confidence interval.
Results
There were 93 (20.8%) older adults with frailty according to the modified Fried scale. SARC-F cut-off ≥1 had 91.4% sensitivity and 44.9% specificity. SARC-F cut-off ≥2 presented the best balance between sensitivity and specificity (sensitivity: 74.1% vs. specificity: 73.7%) to identify frailty (area under curve: 0.807; 95% confidence interval: 0.76–0.84, p<0.001). SARC-F ≥4 had high specificity of 92.6% with a sensitivity of 46.2%.
Conclusion
We suggest that SARC-F ≥1 point can be used to screen for frailty with high sensitivity, and SARC-F ≥4 can be used to diagnose frailty with high specificity. SARC-F may be used to evaluate frailty in usual geriatric practice.
Computerized tomography (CT) is considered the gold standard for the evaluation of total skeletal muscle quantity. Skeletal muscle assessments at the L3 vertebra level revealed significantly ...correlated with total body muscle measurements. Clinicians need cut-offs to evaluate low muscle mass in various patients who already had CT imaging without any additional cost. This assessment is important to help the physicians to stratify the patients for mortality and other complications. It may also enable the diagnosis of malnutrition by the GLIM criteria. Few studies reported cut-offs in different populations. We aimed to provide cut-off values for total skeletal muscle index (SMI) and psoas muscle mass index (PMI) at the L3 vertebra level in the Turkish population.
We assessed the preoperative plain CT images of living adult liver donors who were admitted to a single transplantation center between June 2010 and April 2018. We derived cut-off values with two alternative methods, the 5th percentile value or mean minus two standard deviations and from two groups of study participants, i.e. the total study population and the younger subgroup aged between 18 and 40.
The study population involved 601 subjects with a mean age of 32.5 ± 9 (range: 18–59 years) and 326 (54.2%) was male. The younger subgroup was composed of 482 individuals with a mean age of 28.8 ± 5.9 and 55.6% male. In patients aged between 18 and 40, PMI and SMI cut-offs by using the 5th percentile were 5.40 cm2/m2, 41.42 cm2/m2 for males; and 3.56 cm2/m2, 30.70 cm2/m2 for females; respectively. The cut-offs of PMI and SMI by using mean minus two standard deviations were 4.62 cm2/m2, 38.67 cm2/m2 for males; and 2.66 cm2/m2, 27.8 cm2/m2 for females; respectively. These cut-offs were comparable to the other populations.
Our study provided cut-offs to be used in CT images for PMI and SMI. There is a need for further longitudinal studies to verify whether these cut-offs are successful in predicting mortality or other adverse outcomes associated with low muscle mass.
Summary Background The reported prevalence of sarcopenia ranges widely depending on its definition criterion. European Working Group on Sarcopenia in Older People (EWGSOP) developed a practical ...clinical definition and consensus diagnostic criteria. This definition recommends using normative data of the study population rather than other reference populations. Objective We aimed to define the reference cut-off values for muscle mass, muscle strength and calf circumference in Turkey in order to improve general applicability of EWGSOP criteria. Material and methods Healthy young adults between 18 and 39 years of age with no known chronic disease or chronic drug usage were included in our study to serve as reference population for assessing muscle mass. Community-dwelling older outpatients were prospectively recruited from the geriatrics outpatient clinics of a university hospital for assessing hand grip strength and calf circumference. Body composition was assessed by bioimpedance analysis. Muscle strength was assessed measuring hand grip strength with a Jamar hand dynamometer. The cut-off thresholds for muscle mass were defined as the mean-2SD of the values of the young reference study population; for grip strength were calculated from ROC analyses using cut-off values that predicted gait speed < 0.8 m/s; and for calf circumference were calculated from ROC analyses using cut-off values that predicted low muscle mass. Results The young reference group included a total of 301 participants (187 male, 114 female; mean age: 26.5 ± 4.6 years). The cut-off thresholds for skeletal muscle mass indexes were 9.2 kg/m2 and 7.4 kg/m2 in males and females, respectively. The older community dwelling group included 406 subjects (123 male, 283 female, mean age: 76.6 ± 6.7 years). The cut-off thresholds for hand grip strength were 32 kg and 22 kg for males and females. The cut-off threshold for calf circumference was 33 cm for both males and females. Conclusions The cut-off thresholds for muscle mass, grip strength and calf circumference were somewhat higher but comparable with other reference populations. Further worldwide studies from different nations and countries are needed to obtain better reference values.
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