Bert Vaes

Muscle Strength and Physical Performance as Predictors of Mortality, Hospitalization, and Disability in the Oldest Old

To evaluate the predictive value of muscle strength and physical performance in the oldest old for all‐cause mortality; hospitalization; and the onset of disability, defined as a decline in activities of daily living (ADLs), independent of muscle mass, inflammatory markers, and comorbidities.

The prevalence of sarcopenia in very old individuals according to the European consensus definition: insights from the BELFRAIL study

BACKGROUND the prevalence of sarcopenia varies widely between studies. The objective of this study was to assess the prevalence of sarcopenia in a representative sample of persons aged 80 years and older according to the European Working Group on Sarcopenia in Older People (EWGSOP) algorithm and the proposed cut-off values. A secondary aim was to investigate the relationship between different individual criteria and low physical performance capacity. METHODS baseline data of the prospective BELFRAIL study (BFC80+) were analysed. Sarcopenia status was determined according to the EWGSOP guidelines. The skeletal muscle mass index (SMI) was assessed according to bioelectrical impedance. Muscle strength and muscle performance were evaluated according to grip strength and the modified short physical performance battery (SPPBm). A logistic regression analysis was performed. RESULTS according to the EWGSOP algorithm, 12.5% of the participants were classified in the sarcopenia group. Sixty percent of the female participants had muscle strength values below the cut-off and 70% had low SPPBm values. In males, these prevalence values were 49.5% for grip strength and 39.7% for SPPB. The logistic regression analysis showed that low SPPBm was associated with grip strength (OR: 0.88, 95% CI: 0.84-0.92) independent of SMI. CONCLUSION in a population-based sample of the very old the prevalence of sarcopenia according to the EWGSOP algorithm is similar to the prevalence of sarcopenia with SMI as a single criterion. A large number of participants with a sufficient SMI value showed low muscle strength and/or a poor SPPBm score. A low SPPBm was associated with grip strength but not with SMI.

Associations Between Cytomegalovirus Infection and Functional Impairment and Frailty in the BELFRAIL Cohort

To investigate whether an observed association between cytomegalovirus (CMV) exposure and functional impairment and frailty in older adults is reproducible in a cohort of individuals aged 80 and older.

The relationship between grip strength and muscle mass (MM), inflammatory biomarkers and physical performance in community-dwelling very old persons.

The main consequence of the loss of MM and muscle strength is limitations of physical performance and disability in older people. It is unclear whether a decline in functional capacity results from the loss of MM and/or the qualitative impairment of the muscle tissue. The aim of our research was to investigate the relationship between physical performance and grip strength, inflammatory markers and MM in a population of community-dwelling very old persons. This study is a cross-sectional analysis within the BELFRAIL-study, a cohort study of subjects aged 80 years and older (n=567). MM was assessed by bioelectrical impedance. Interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) concentrations were determined on fasting blood samples. Logistic regression analysis was build using a low physical performance level evaluated according to Short Physical Performance Battery (SPPB) (dependent variable) and grip strength, pro-inflammatory status and MM (independent variables) adjusted for age and for the total number of chronic diseases. Low SPPB scores were associated with grip strength scores for women (OR 0.86 (95% CI 0.77-0.96)), and for men (OR 0.89 (95% CI 0.81-0.96)). The relationships between low SPPB and MM or inflammatory profile were not significant. Our results show that low physical performance remains associated with low grip strength even after considering other risk factors for sarcopenia in the oldest old and support the hypothesis that low muscle strength is a better indicator than low MM. The role of an inflammatory component in the age-related loss of muscle strength and function could not be confirmed.

No relation between vitamin D status and physical performance in the oldest old: results from the Belfrail study

BACKGROUND vitamin D deficiency is a well-known cause of bone loss and fractures but its association, especially among the oldest old, with muscle weakness is less obvious. OBJECTIVE to investigate the relationship between 25-hydroxyvitamin D (25-OHD) and muscle performance in persons aged 80 years and older. METHODS baseline results of the Belfrail study, a prospective, population-based cohort study were used to study balance, grip strength and gait speed in relation to 25-OHD serum levels in 367 subjects. RESULTS a sufficient 25-OHD serum level of 30 ng/ml or more was found in 12.8% of the population. The prevalence of vitamin deficiency (20-29 ng/ml), insufficiency (10-19 ng/ml) and severe insufficiency (<10 ng/ml) was 21.5, 33 and 32.7%, respectively. No significant relation between balance, gait speed and grip strength, and serum 25-OHD was detected neither in bivariate analysis nor after adjustment for age, gender, level of education, institutionalisation, smoking status, body mass index, co-morbidity, level of activity, season, CRP, renal function, serum calcium parathyroid hormone levels, vitamin D intake and use of loop or thiazide diuretics. CONCLUSION in this cohort of octogenarians vitamin D deficiency was highly prevalent. We could not confirm the findings of previous studies showing an association between serum 25-OHD and physical performance in elderly.

The relationship of multimorbidity with disability and frailty in the oldest patients: A cross-sectional analysis of three measures of multimorbidity in the BELFRAIL cohort

Abstract Background: Ageing people show increasing morbidity, dependence and vulnerability. Objectives: To compare the relationships of different measures of multimorbidity with dependence (operationalized as disability) and vulnerability (operationalized as frailty). Method: A cross-sectional analysis within the BELFRAIL cohort (567 subjects aged ≥ 80). Multimorbidity was measured using a disease count (DC), the Charlson comorbidity index (CCI) and the cumulative illness rating scale (CIRS), respectively. Associations with disability (based on activities of daily living) and frailty (defined by the Fried frailty criteria) were assessed using bivariable and multivariable analyses. Net reclassification improvement (NRI) values were calculated to compare the abilities of the DC, CCI and CIRS to identify patients with disability or frailty. Results: Disability was associated with the DC (crude odds ratio, OR: 2.1; 95% confidence interval, CI: 1.4–3.4), CCI (crude OR: 1.8; 95% CI: 1.2–2.7) and CIRS (crude OR: 4.0; 95% CI: 2.5–6.5); only the association with CIRS was independent of age, sex, chronic inflammation, impaired cognition and frailty (adjusted OR: 3.2; 95% CI: 1.7–5.8). Frailty was associated with CCI (crude OR: 2.4; 95% CI: 1.2–4.6) and CIRS (crude OR: 2.6; 95% CI: 1.3–5.3); adjusted for age, sex, chronic inflammation, impaired cognition and disability. These associations were not statistically significant. The NRIs demonstrated a similar ability of the DC, CCI, and CIRS to identify patients with disability or frailty, respectively. Conclusion: The associations of different measures of multimorbidity with disability and frailty differ but their ability to identify patients with disability or frailty is similar. Generally, multimorbidity scores incompletely reflect dependence and vulnerability in this age group.

The impact of a nurse-led care programme on events and physical and psychosocial parameters in patients with heart failure with preserved ejection fraction: A randomized clinical trial in primary care in Russia

Abstract Background: Disease management programmes (DMPs) improve quality of care for patients with heart failure (HF). However, only a limited number of trials have studied the efficacy of such programmes for patients with heart failure with preserved ejection fraction (HFPEF). Objective: To estimate the impact of a structured, nurse-led patient education programme and care plan in general practice on outcome parameters and events in patients with HFPEF. Methods: Single blinded randomized clinical trial with an intervention over six months and a follow-up during 12 additional months. In the control group, the patients (n = 41) were managed according to Russian national guidelines. Patients in the intervention group (n = 44) received education on individual lifestyle changes and modifications of cardiovascular disease (CVD) risk factors, home-based exercise training and weekly nurse consultations in addition to usual care. Results: Six months after their inclusion, patients in the intervention group significantly improved body mass index, waist circumference, six-min walk test distance, total cholesterol, low-density lipoprotein, left ventricular end-diastolic volume index, quality of life and level of anxiety. After 18 months, there were 11 deaths (25%) or hospitalizations in the intervention group and 12 (29%) in the control group (P = 0.134). Cardiovascular mortality and readmission rate were not reduced significantly after six months of follow-up: the hazard ratio was 0.47 (95% CI: 0.17–1.28; P = 0.197). After 18 months, this was 0.85 (0.42–1.73; P = 0.658). Conclusion: This primary care based DMP for patients with HFPEF improved the patients’ emotional status and quality of life, positively influenced body weight, functional capacity and lipid profile, and attenuated heart remodelling.

The prevalence of cardiac dysfunction and the correlation with poor functioning among the very elderly

BACKGROUND Little is known about the relationship between cardiac dysfunction and poor functioning in the elderly. This study sought to describe the prevalence of cardiac dysfunction in the very elderly and to investigate the correlation between echocardiographic abnormalities and indicators of poor functioning. METHODS A cross-sectional analysis within the BELFRAIL (BF(C80+)) study of 567 subjects aged 80 years and older. The clinical research assistant performed an examination including performance testing, questionnaires and technical examinations. Echocardiography was performed at the subjects home by a cardiologist using a portable system. RESULTS The mean age of the participants was 84.7 years and 62.9% were women. Severe cardiac dysfunction was found in 19.3% and was defined as systolic dysfunction (5.8%), valvular heart disease (10.4%) or isolated severe diastolic dysfunction (3.1%). Severe cardiac dysfunction showed to be an independent identifier of poor performance (OR 1.8 (95% CI 1.1-3.2)), a low LAPAQ (LASA Physical Activity Questionnaire) score (OR 1.9 (95% CI 1.2-3.3)) and a high GDS-15 (Geriatric Depression Scale) score (OR 1.7 (95% CI 1.0-2.9)). This relationship was mainly explained by the independent correlation between aortic stenosis and poor functioning. Classic indicators of systolic and diastolic dysfunction were not able to identify participants with poor functioning. CONCLUSION This study shows the very elderly represent a heterogeneous group of subjects with a high prevalence of comorbidities, among whom poor functioning might be triggered by multiple causes. Severe cardiac dysfunction, and more specifically aortic stenosis, showed an independent relationship with poor functioning.

The diagnostic accuracy of the MyDiagnostick to detect atrial fibrillation in primary care

BackgroundAtrial fibrillation is very common in people aged 65 or older. This condition increases the risk of death, congestive heart failure and thromboembolic conditions. Many patients with atrial fibrillation are asymptomatic and a cerebrovascular accident (CVA) is often the first clinical presentation. Guidelines concerning the prevention of CVA recommend monitoring the heart rate in patients aged 65 or older. Recently, the MyDiagnostick (Applied Biomedical Systems BV, Maastricht, The Netherlands) was introduced as a new screening tool which might serve as an alternative for the less accurate pulse palpation. This study was designed to explore the diagnostic accuracy of the MyDiagnostick for the detection of atrial fibrillation.MethodsA phase II diagnostic accuracy study in a convenience sample of 191 subjects recruited in primary care. The majority of participants were patients with a known history of atrial fibrillation (n = 161). Readings of the MyDiagnostick were compared with electrocardiographic recordings. Sensitivity and specificity and their 95% confidence interval were calculated using 2x2 tables.ResultsA prevalence of 54% for an atrial fibrillation rhythm was found in the study population at the moment of the study. A combination of three measurements with the MyDiagnostick for each patient showed a sensitivity of 94% (95% CI 87 – 98) and a specificity of 93% (95% CI 85 – 97).ConclusionThe MyDiagnostick is an easy-to-use device that showed a good diagnostic accuracy with a high sensitivity and specificity for atrial fibrillation in a convenience sample in primary care. Future research is needed to determine the place of the MyDiagnostick in possible screening or case-finding strategies for atrial fibrillation.

CD4:8 Ratio >5 Is Associated With a Dominant Naive T-Cell Phenotype and Impaired Physical Functioning in CMV-Seropositive Very Elderly People: Results From the BELFRAIL Study

A subset of older people is at increased risk of hospitalization and dependency. Emerging evidence suggests that immunosenescence reflected by an inverted CD4:8 ratio and cytomegalovirus (CMV) seropositivity plays an important role in the pathophysiology of functional decline. Nevertheless, the relation between CD4:8 ratio and functional outcome has rarely been investigated. Here, CD4:8 ratio and T-cell phenotypes of 235 community-dwelling persons aged ≥81.5 years in the BELFRAIL study and 25 younger persons (mean age 28.5 years) were analyzed using polychromatic flow cytometry. In the elderly persons, 7.2% had an inverted CD4:8 ratio, which was associated with CMV seropositivity, less naive, and more late-differentiated CD4+ and CD8+ T cells. However, 32.8% had a CD4:8 ratio >5, a phenotype associated with a higher proportion of naive T cells and absent in young donors. In CMV seropositives, this subgroup had lower proportions of late-differentiated CD4+ and CD8+ T cells and weaker anti-CMV immunoglobulin G reactivity. This novel naive T-cell-dominated phenotype was counterintuitively associated with a higher proportion of those with impaired physical functioning in the very elderly people infected with CMV. This underscores the notion that in very elderly people, not merely CMV infection but also the state of its accompanying immune dysregulation is of crucial importance with regard to physical impairment.