Sarcopenia in older adults Walston, Jeremy D
Current opinion in rheumatology
24, Številka:
6
Journal Article
Odprti dostop
Sarcopenia, or the decline of skeletal muscle tissue with age, is one of the most important causes of functional decline and loss of independence in older adults. The purpose of this article is to ...review the current definitions of sarcopenia, its potential causes and clinical consequences, and the potential for intervention.
Although no consensus diagnosis has been reached, sarcopenia is increasingly defined by both loss of muscle mass and loss of muscle function or strength. Its cause is widely regarded as multifactorial, with neurological decline, hormonal changes, inflammatory pathway activation, declines in activity, chronic illness, fatty infiltration, and poor nutrition, all shown to be contributing factors. Recent molecular findings related to apoptosis, mitochondrial decline, and the angiotensin system in skeletal muscle have highlighted biological mechanisms that may be contributory. Interventions in general continue to target nutrition and exercise.
Efforts to develop a consensus definition are ongoing and will greatly facilitate the development and testing of novel interventions for sarcopenia. Although pharmaceutical agents targeting multiple biological pathways are being developed, adequate nutrition and targeted exercise remain the gold standard for therapy.
Frailty is a complex age-related clinical condition characterised by a decline in physiological capacity across several organ systems, with a resultant increased susceptibility to stressors. Because ...of the heterogeneity of frailty in clinical presentation, it is important to have effective strategies for the delivery of care that range across the continuum of frailty severity. In clinical practice, we should do what works, starting with frailty screening, case identification, and management of frailty. This process is unarguably difficult given the absence of an adequate evidence base for individual and health-system interventions to manage frailty. We advocate change towards individually tailored interventions that preserve an individual's independence, physical function, and cognition. This change can be addressed by promoting the recognition of frailty, furthering advancements in evidence-based treatment options, and identifying cost-effective care delivery strategies.
Fried and colleagues described a frailty phenotype measured in the Cardiovascular Health Study (CHS). This phenotype is manifest when ≥3 of the following are present: low grip strength, low energy, ...slowed waking speed, low physical activity, or unintentional weight loss. We sought to approximate frailty phenotype using only administrative claims data to enable frailty to be assessed without physical performance measures.
We used the CHS cohort data linked to participants Medicare claims. The reference standard was the frailty phenotype measured at visits 5 and 9. With penalized logistic regression, we developed a parsimonious index for predicting the frailty phenotype using a linear combination of diagnoses, operationalized with claims data. We assessed the predictive validity of frailty index by examining how well it predicted common aging-related outcomes including hospitalization, disability, and death.
There were 4454 CHS participants from 4 clinical sites. In total, 84% were white, 58% were women and their mean age was 72 years at enrollment. Approximately 11% of the cohort was frail. The model had an area under the receiver operating curve of 0.75 to concurrently predict a frailty phenotype. This Claims-based Frailty Indicator significantly predicted death (odds ratio, 1.84), time to death (hazards ratio, 1.71), number of hospital admissions (incidence rate ratio, 1.74), and nursing home admission (odds ratio, 1.47) in models adjusted for age and sex.
Claims data alone can be used to classify individuals as frail and nonfrail. The Claims-based Frailty Indicator might be used in research with large datasets for confounding adjustment or risk prediction. The indicator might also be used for emergency preparedness for identification of regions enriched with frail individuals.
Abstract
Older adults are far more vulnerable to adverse health outcomes and mortality after contracting COVID-19. There are likely multiple age-related biological, clinical, and environmental ...reasons for this increased risk, all of which are exacerbated by underlying age-associated changes to the immune system as well as increased prevalence of chronic disease states in older adults. Innate immune system overactivity, termed the cytokine storm, appears to be critical in the development of the worst consequences of COVID-19 infection. Pathophysiology suggests that viral stimulation of the innate immune system, augmented by inflammatory signals sent from dying cells, ramps up into a poorly controlled outpouring of inflammatory mediators. Other aging-related changes in cells such as senescence as well as higher prevalence of chronic disease states also likely ramp up inflammatory signaling. This in turn drives downstream pathophysiological changes to pulmonary, cardiovascular, skeletal muscle, and brain tissues that drive many of the adverse health outcomes observed in older adults. This article provides an overview of the underlying etiologies of innate immune system activation and adaptive immune system dysregulation in older adults and how they potentiate the consequences of the COVID-19-related cytokine storm, and possible uses of this knowledge to develop better risk assessment and treatment monitoring strategies.
Frailty assessment provides a means of identifying older adults most vulnerable to adverse outcomes. Attention to frailty in clinical practice is more likely with better understanding of its ...prevalence and associations with patient characteristics. We sought to provide national estimates of frailty in older people.
A popular, validated frailty phenotype proposed by Fried and colleagues was applied to 7,439 participants in the 2011 baseline of the National Health and Aging Trends Study, a national longitudinal study of persons aged 65 and older. All measures drew on a 2-hour in-person interview. Weighted estimates of frailty prevalence were obtained.
Fifteen percent (95% CI: 14%, 16%) of the older non-nursing home population is frail, and 45% is prefrail (95% CI: 44%, 47%). Frailty is more prevalent at older ages, among women, racial and ethnic minorities, those in supportive residential settings, and persons of lower income. Independently of these characteristics, frailty prevalence varies substantially across geographic regions. Chronic disease and disability prevalence increase steeply with frailty. Among the frail, 42% were hospitalized in the previous year, compared to 22% of the prefrail and 11% of persons considered robust. Hip, back, and heart surgery in the last year were associated with frailty. Over half of frail persons had a fall in the previous year.
Our findings support the importance of frailty in late-life health etiology and potential value of frailty as a marker of risk for adverse health outcomes and as a means of identifying opportunities for intervention in clinical practice and public health policy.
Frailty: a tale of two concepts Walston, Jeremy D; Bandeen-Roche, Karen
BMC medicine,
08/2015, Letnik:
13, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Frailty is increasingly relevant for clinicians to improve care for vulnerable older adults. Prominent frailty measures include the frailty phenotype and the frailty index. The frailty phenotype is ...grounded in a theoretical construct hypothesized to have an underlying biological basis. The frailty index describes frailty as a nonspecific age-associated vulnerability, reflected in an accumulation of medical, social, and functional deficits. Building on this model, Minitski et al. describe the development of a biological index that proves to be a reasonable method to predict mortality when compared to other frailty measurements. Strengths include its ability to import clinical measures, interchangeable components, and its potential ability to identify latent risk factors. Obstacles include the lack of a unifying biological theory related to aging, inclusion of costly research measures, and its inability to provide specific clues to the etiology of frailty according to the frailty index definition. Refinement in measures focused on aging-related biological changes rather than using measures that result from chronic disease states could help provide important biological insights and aid in the development of future treatment and preventive modalities.Please see related article: http://www.biomedcentral.com/1741-7015/13/161 .
Highlights • Frailty tool proliferation is a challenge for selecting an assessment instrument. • We categorized how the nine most-cited frailty instruments have been utilized. • Instruments most used ...were frailty phenotype, deficit accumulation index, and VES-13. • Risk assessment, etiology, and methodology were the common types of uses. • In selecting an instrument, consider intended purpose, domains captured, and past use, as well as validity and feasibility.
Abstract
Aims
Physical frailty is a commonly encountered geriatric syndrome among older adults without coronary heart disease (CHD). The impact of frailty on the incidence of long-term cardiovascular ...outcomes is not known.We aimed to evaluate the long-term association of frailty, measured by the Fried frailty phenotype, with all-cause-mortality and MACE among older adults without a history of CHD at baseline in the National Health and Aging Trends Study.
Methods and Results
We used the National Health and Aging Trends Study, a prospective cohort study linked to a Medicare sample. Participants with a prior history of CHD were excluded. Frailty was measured during the baseline visit using the Fried physical frailty phenotype. Cardiovascular outcomes were assessed during a 6-year follow-up.
Of the 4656 study participants, 3259 (70%) had no history of CHD 1 year prior to their baseline visit. Compared to those without frailty, subjects with frailty were older (mean age 82.1 vs. 75.1 years, P < 0.001), more likely to be female (68.3% vs. 54.9%, P < 0.001), and belong to an ethnic minority. The prevalence of hypertension, falls, disability, anxiety/depression, and multimorbidity was much higher in the frail and pre-frail than the non-frail participants. In a Cox time-to-event multivariable model and during 6-year follow-up, the incidences of death and of each individual cardiovascular outcomes were all significantly higher in the frail than in the non-frail patients including major adverse cardiovascular event (MACE) hazard ratio (HR) 1.77, 95% confidence interval (CI) 1.53, 2.06, death (HR 2.70, 95% CI 2.16, 3.38), acute myocardial infarction (HR 1.95, 95% CI 1.31, 2.90), stroke (HR 1.71, 95% CI 1.34, 2.17), peripheral vascular disease (HR 1.80, 95% CI 1.44, 2.27), and coronary artery disease (HR 1.35, 95% CI 1.11, 1.65).
Conclusion
In patients without CHD, frailty is a risk factor for the development of MACEs. Efforts to identify frailty in patients without CHD and interventions to limit or reverse frailty status are needed and, if successful, may limit subsequent adverse cardiovascular events.
Graphical abstract
The ageing of the US population and the influence of frailty on the incidence of cardiovascular outcomes in over 6 years of follow-up. (A) Estimates on the projected number (%) of all older adults in 2040 were obtained from www.census.gov. (B) The cumulative incidence of each cardiovascular outcome during 6 years of follow-up was derived from the National Health and Aging and Trends Study.
Growth differentiation factor 15 (GDF-15) is associated with disease progression, mitochondrial dysfunction, and mortality. Elevated GDF-15 level was recently reported to be associated with poorer ...physical performance in healthy adults. However, the association between serum GDF-15 level and sarcopenia in community-dwelling older adults has not been well characterized.
We conducted cross-sectional (n = 929) and 2-year prospective analyses (n = 788) among participants aged 70-84 years enrolled in the Korean Frailty and Aging Cohort Study. Participants with an estimated glomerular filtration rate of <60 mL/min/1.73 m2 were excluded. Appendicular lean mass was measured using dual-energy x-ray absorptiometry. Sarcopenia status was determined according to the Asian Working Group for Sarcopenia-2019 algorithm.
At baseline, 16.6% of the participants had sarcopenia. Median GDF-15 concentration was higher in the sarcopenic group than in the non-sarcopenic group (1221 pg/mL vs 1019 pg/mL, p < .001). In the multivariate analysis adjusted for cardiometabolic risk and biological factors, the highest GDF-15 tertile (≥1245 pg/mL) had an increased likelihood of sarcopenia (odds ratio, 1.96; 95% confidence interval, 1.16-3.33) than the lowest tertile (<885 pg/mL). During the 2-year follow-up period, 67 (10.1%) individuals without sarcopenia at baseline developed sarcopenia. There were no significant associations between baseline serum GDF-15 levels and incident sarcopenia or its components (all p > .05).
Elevated GDF-15 was associated with prevalent sarcopenia but not able to predict incident sarcopenia in the 2-year follow-up. Further studies are needed to explore the pathophysiological roles of GDF-15 in the development of sarcopenia.
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