Donja M. Mijnarends

Instruments to Assess Sarcopenia and Physical Frailty in Older People Living in a Community (Care) Setting: Similarities and Discrepancies

OBJECTIVES Both sarcopenia and physical frailty are geriatric syndromes causing loss of functionality and independence. This study explored the association between sarcopenia and physical frailty and the overlap of their criteria in older people living in different community (care) settings. Moreover, it investigated the concurrent validity of the FRAIL scale to assess physical frailty, by comparison with the widely used Fried criteria. DESIGN Data were retrieved from the cross-sectional Maastricht Sarcopenia Study (MaSS). SETTING The study was undertaken in different community care settings in an urban area (Maastricht) in the south of the Netherlands. PARTICIPANTS Participants were 65 years or older, gave written informed consent, were able to understand Dutch language, and were not wheelchair bound or bedridden. INTERVENTION Not applicable. MEASUREMENTS Sarcopenia was identified using the algorithm of the European Working Group on Sarcopenia in Older People. Physical frailty was assessed by the Fried criteria and by the FRAIL scale. Logistic regression was performed to assess the association between sarcopenia and physical frailty measured by the Fried criteria. Spearman correlation was performed to assess the concurrent validity of the FRAIL scale compared with the Fried criteria. RESULTS Data from 227 participants, mean age 74.9 years, were analyzed. Sarcopenia was identified in 23.3% of the participants, when using the cutoff levels for moderate sarcopenia. Physical frailty was identified in 8.4% (≥3 Fried criteria) and 9.3% (≥3 FRAIL scale criteria) of the study population. Sarcopenia and physical frailty were significantly associated (P = .022). Frail older people were more likely to be sarcopenic than those who were not frail. In older people who were not frail, the risk of having sarcopenia increased with age. Next to poor grip strength (78.9%) and slow gait speed (89.5%), poor performance in other functional tests was common in frail older people. The 2 physical frailty scales were significantly correlated (r = 0.617, P < .001). CONCLUSION Sarcopenia and physical frailty were associated and partly overlap, especially on parameters of impaired physical function. Some evidence for concurrent validity between the FRAIL scale and Fried criteria was found. Future research should elicit the value of combining sarcopenia and frailty measures in preventing disability and other negative health outcomes.

Micronutrient intakes and potential inadequacies of community-dwelling older adults: a systematic review.

Micronutrient deficiencies and low dietary intakes among community-dwelling older adults are associated with functional decline, frailty and difficulties with independent living. As such, studies that seek to understand the types and magnitude of potential dietary inadequacies might be beneficial for guiding future interventions. We carried out a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Observational cohort and longitudinal studies presenting the habitual dietary intakes of older adults ( ≥ 65 years) were included. Sex-specific mean (and standard deviation) habitual micronutrient intakes were extracted from each article to calculate the percentage of older people who were at risk for inadequate micronutrient intakes using the estimated average requirement (EAR) cut-point method. The percentage at risk for inadequate micronutrient intakes from habitual dietary intakes was calculated for twenty micronutrients. A total of thirty-seven articles were included in the pooled systematic analysis. Of the twenty nutrients analysed, six were considered a possible public health concern: vitamin D, thiamin, riboflavin, Ca, Mg and Se. The extent to which these apparent inadequacies are relevant depends on dynamic factors, including absorption and utilisation, vitamin and mineral supplement use, dietary assessment methods and the selection of the reference value. In light of these considerations, the present review provides insight into the type and magnitude of vitamin and mineral inadequacies.

Physical activity and incidence of sarcopenia: the population-based AGES-Reykjavik Study.

BACKGROUND the prevalence of sarcopenia increases with age. Physical activity might slow the rate of muscle loss and therewith the incidence of sarcopenia. OBJECTIVE to examine the association of physical activity with incident sarcopenia over a 5-year period. DESIGN data from the population-based Age, Gene/Environment, Susceptibility-Reykjavik Study were used. SETTING people residing in the Reykjavik area at the start of the study. SUBJECTS the study included people aged 66-93 years (n = 2309). METHODS the amount of moderate-vigorous physical activity (MVPA) was assessed by a self-reported questionnaire. Sarcopenia was identified using the European Working Group on Sarcopenia in Older People algorithm, including muscle mass (computed tomography imaging), grip strength (computerised dynamometer) and gait speed (6 m). RESULTS mean age of the participants was 74.9 ± 4.7 years. The prevalence of sarcopenia was 7.3% at baseline and 16.8% at follow-up. The incidence proportion of sarcopenia over 5 years was 14.8% in the least-active individuals and 9.0% in the most-active individuals. Compared with the least-active participants, those reporting a moderate-high amount of MVPA had a significantly lower likelihood of incident sarcopenia (OR = 0.64, 95% CI 0.45-0.91). Participants with a high amount of MVPA had higher baseline levels of muscle mass, strength and walking speed, but baseline MVPA was not associated with the rate of muscle loss. CONCLUSION a higher amount of MVPA seems to contribute to counteracting the development of sarcopenia. To delay the onset of sarcopenia and its potential adverse outcomes, attention should be paid to increasing physical activity levels in older adults.

Macronutrient Intake and Inadequacies of Community-Dwelling Older Adults, a Systematic Review

Background: Anorexia of ageing may predispose older adults to under-nutrition and protein energy malnutrition. Studies, however, report a large variation in nutrient inadequacies among community-dwelling older adults. Summary: This systematic review provides a comprehensive overview of the energy and macronutrient intakes and possible inadequacies in community-dwelling older adults. PubMed and EMBASE were screened up to December 2013; data from national nutrition surveys were added. Forty-six studies were included, following the PRISMA guideline. Key Messages: Mean daily energy intake was 8.9 MJ in men and 7.3 MJ in women. Mean daily carbohydrate and protein intakes were 46 and 15 En% in men and 47 and 16 En% in women, respectively. Mean daily total fat, saturated fatty acid (SFA), mono-unsaturated fatty acid (MUFA) and poly-unsaturated fatty acid intakes were respectively 34, 13, 13 and 5-6 En%. The carbohydrates and MUFA intakes are below the acceptable macronutrient distribution ranges (AMDR). Fat intake is relatively high, and SFA intake exceeds the upper-AMDR. Based on the estimated average requirement (EAR) cut-point method, 10-12% of older adults do not meet the EAR for protein. To interpret a possible energy imbalance additional information is needed on physical activity, energy expenditure and body weight changes. This systematic review indicates a suboptimal dietary macronutrient distribution and a large variation in nutrient intakes among community-dwelling older adults.

Quality of Austrian and Dutch falls-prevention information: a comparative descriptive study

Objectives: The aim of this study was to evaluate and compare the quality of written patient information material available in Austrian and Dutch hospitals and nursing homes pertaining to falls prevention. Design: Comparative descriptive study design Setting: Hospitals and nursing homes in Austria and the Netherlands. Method: Written patient information material (n = 77) was independently evaluated by two assessors using the 36-item Ensuring Quality Information for Patients (EQIP) scale with regard to content, structure and identification data. EQIP global scores were calculated and country- and institution-specific (hospitals and nursing homes) differences were analysed. Results: The written patient information material available in Dutch hospitals had a significantly higher EQIP mean score than that in Austrian hospitals (p < .0001). The difference in EQIP global score between the countries was not significant for the written patient information material in nursing homes (p = .479). Sub-scale analyses indicated that Dutch institutions reached significantly higher mean values in the global scores for content and structure than Austrian ones (p < .05). Conclusion: Although Dutch written patient information material pertaining to falls prevention was of higher quality than that in Austria, both countries suffered from shortcomings, especially with regard to content and identification data. Authors of written patient information material face a great challenge in taking consumer involvement and evidence-based criteria into account.

A feedback system to improve the quality of nutritional care

OBJECTIVE The main objective of this study was to develop a feedback system that improves the translation of malnutrition performance data from the Dutch National Prevalence Measurement of Care Problems (LPZ) into relevant evidence- and practice-based interventions in care homes. METHODS The process consisted of two stages. The first was the development of a feedback system. Twenty-four interviews were held with health care professionals in care homes that participated in the LPZ to gain insight into needs regarding the translation of performance data into relevant improvement interventions. Subsequently, three multidisciplinary focus groups discussed how to develop a feedback system to deal with those needs. In the second stage, the feasibility of this system was evaluated via a questionnaire (N = 93) that was sent to care homes participating in LPZ. RESULTS It was important that performance data be more transparent regarding which information was relevant and that insight was gained into how to improve nutritional care. To address these needs, a dashboard was developed to present performance data in a transparent way. Subsequently, a decision tree was developed that links LPZ dashboard outcomes to evidence-based nutritional interventions for care homes. Forty-seven respondents (50.5%) evaluated the new feedback system (the dashboard and the decision tree) as feasible. The content and design were perceived to be very useful. Half of the participating institutions had already started working with improvement activities. CONCLUSION The developed feedback system was evaluated as useful for improving nutritional patient care in the future. This system will also be developed for other health care settings.

Muscle, Health and Costs: A Glance at their Relationship

ObjectiveTo assess the association between muscle parameters (mass, strength, physical performance) and activities of daily living (ADL), quality of life (QoL), and health care costs.DesignCross-sectional Maastricht Sarcopenia Study (MaSS).SettingCommunity-dwelling, assisted-living, residential living facility.Participants227 adults aged 65 and older.MeasurementsMuscle mass, hand grip strength and physical performance were assessed by bio-electrical impedance, JAMAR dynamometer and the Short Physical Performance Battery, respectively. Health outcomes were measured by the Groningen Activity Restriction Scale (disability in ADL) and the EQ-5D-5L (QoL). Health care costs were calculated based on health care use in the past three months.ResultsMuscle strength and physical performance showed a strong correlation with ADL, QoL, and health care costs (P<.01); for muscle mass no significant correlations were observed. Regression analyses showed that higher gait speed (OR 0.06, 95%CI 0.01-0.55) was associated with a lower probability of ADL disability. Furthermore, slower chair stand (OR 1.23, 95%CI 1.08-1.42), and more comorbidities (OR 1.58, 95%CI 1.23-2.02) were explanatory factors for higher ADL disability. Explanatory factors for QoL and costs were: more disability in ADL (OR 1.26, 95%CI 1.12-1.41 for QoL; B = 0.09, P<.01 for costs) and more comorbidities (OR 1.44, 95%CI 1.14-1.82 for QoL; B = 0.35, P<.01 for costs).ConclusionLower gait speed and chair stand were potential drivers of disability in ADL. Disability in ADL and comorbidities were associated with QoL and health care costs in community-dwelling older adults. Improving physical performance may be a valuable target for future intervention and research to impact health burden and costs.

PP032-MON ASSESSMENT OF NUTRIENT INTAKE AND STATUS IN SARCOPENIA – A PILOT STUDY

PP032-MON ASSESSMENT OF NUTRIENT INTAKE AND STATUS IN SARCOPENIA A PILOT STUDY S. ter Borg1, D.M. Mijnarends2, S. Verlaan1, J.H. de Vries3, J.M. Meijers2, J.M. Schols4, L.C. de Groot3, Y.C. Luiking1. 1Nutricia Advanced Medical Nutrition, Danone Research, Utrecht, 2School CAPHRI, Department of Health Services Research, Maastricht University, Maastricht, 3Division of Human Nutrition, Wageningen University, Wageningen, 4School CAPHRI, Department of General Practice, Maastricht University, Maastricht, Netherlands