Medicine (RMH) - Research Publications
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ItemNo Preview AvailableUnresolved inflammation during hospitalization is associated with post-discharge institutionalization and mortality in geriatric rehabilitation inpatients: The RESORT cohort(PERGAMON-ELSEVIER SCIENCE LTD, 2021-12)BACKGROUND: Inflammation contributes to adverse health outcomes in community-dwelling populations. Little is known about inflammation in hospitalized older adults and its association with adverse outcomes. This study aimed to evaluate the association of the inflammatory markers C-reactive protein (CRP) and albumin measured during acute and geriatric rehabilitation hospitalization with institutionalization and mortality in geriatric rehabilitation inpatients. METHODS: Within the REStORing health of acutely unwell adulTs (RESORT) cohort, CRP and albumin were measured as part of usual care during acute and geriatric rehabilitation hospitalization. Inflammatory markers are presented as median, peak (CRP: maximum; albumin: minimum), variation (interquartile range) and direction of change (increased CRP or decreased albumin: positive or negative difference between last measurement and median of preceding measurements). Logistic regression was used to determine the associations between inflammatory markers and institutionalization at three-month and all-cause mortality at three- and twelve-month post-discharge. RESULTS: Geriatric rehabilitation inpatients (n = 1846) with a median age of 83.3 years (interquartile range 77.6-88.3) and 56.6% of female were included. Increased CRP during geriatric rehabilitation was associated with institutionalization. Higher median, peak and increased levels of CRP during geriatric rehabilitation but not during acute hospitalization were associated with higher mortality. Lower CRP variation during acute hospitalization but higher CRP variation during geriatric rehabilitation was associated with higher mortality. Lower median level of albumin during both hospitalizations were associated with higher mortality. CONCLUSIONS: Inflammation characterized by lower albumin during acute hospitalization and, higher CRP and lower albumin during geriatric rehabilitation was associated with mortality in geriatric rehabilitation inpatients. Increased CRP during geriatric rehabilitation was associated with institutionalization. Unresolved inflammation in geriatric rehabilitation might indicate ongoing disease activity leading to adverse outcomes.
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ItemNo Preview AvailablePhysical, motivational and environmental factors influencing physical activity promotion during hospitalization: Older patients' perspective(MOSBY-ELSEVIER, 2021)Better understanding of older patients' perspective on physical, motivational and environmental barriers and enablers in physical activity promotion during hospitalization contributes to the development of strategies to increase in hospital physical activity. Using a mixed method approach, barriers and enablers from patients (in)dependent in physical activity (Functional Ambulation Categories ≥4 versus <4) were identified. Forty-nine patients (median age 77 years IQR:75-83, female: n = 25) were interviewed. Barriers reported as most important were feeling weak (n = 10), having lines/drains (n = 9) and pain (n = 7) and enablers reported as most important were feeling physically independent (n = 19), sense of importance of physical activity (n = 12), and maintaining physical strength (n = 10). Physically dependent patients were more frequently encouraged by professionals to be physically active compared to independent patients. Focus on physical barriers and motivational enablers for older patients may help to increase their physical activity during hospitalization and encouragement by health care professionals should also encompass physically independent patients.
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ItemNo Preview AvailableTargeting impaired nutrient sensing with repurposed therapeutics to prevent or treat age-related cognitive decline and dementia: A systematic review(ELSEVIER IRELAND LTD, 2021-05)BACKGROUND: Dementia is a debilitating syndrome that significantly impacts individuals over the age of 65 years. There are currently no disease-modifying treatments for dementia. Impairment of nutrient sensing pathways has been implicated in the pathogenesis of dementia, and may offer a novel treatment approach for dementia. AIMS: This systematic review collates all available evidence for Food and Drug Administration (FDA)-approved therapeutics that modify nutrient sensing in the context of preventing cognitive decline or improving cognition in ageing, mild cognitive impairment (MCI), and dementia populations. METHODS: PubMed, Embase and Web of Science databases were searched using key search terms focusing on available therapeutics such as 'metformin', 'GLP1', 'insulin' and the dementias including 'Alzheimer's disease' and 'Parkinson's disease'. Articles were screened using Covidence systematic review software (Veritas Health Innovation, Melbourne, Australia). The risk of bias was assessed using the Cochrane Risk of Bias tool v 2.0 for human studies and SYRCLE's risk of bias tool for animal studies. RESULTS: Out of 2619 articles, 114 were included describing 31 different 'modulation of nutrient sensing pathway' therapeutics, 13 of which specifically were utilized in human interventional trials for normal ageing or dementia. Growth hormone secretagogues improved cognitive outcomes in human mild cognitive impairment, and potentially normal ageing populations. In animals, all investigated therapeutic classes exhibited some cognitive benefits in dementia models. While the risk of bias was relatively low in human studies, this risk in animal studies was largely unclear. CONCLUSIONS: Modulation of nutrient sensing pathway therapeutics, particularly growth hormone secretagogues, have the potential to improve cognitive outcomes. Overall, there is a clear lack of translation from animal models to human populations.
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ItemNo Preview AvailableCan anthropometric measures be used as proxies for body composition and physical function in geriatric outpatients?(ELSEVIER IRELAND LTD, 2021)OBJECTIVES: The study aimed to evaluate the associations between anthropometric measures with body composition, in particular skeletal muscle mass, and with physical function in a cohort of geriatric outpatients. METHODS: We included 572 outpatients who attended geriatric clinics at Amsterdam UMC, location VUmc, Netherlands from January 2014 to December 2015. Anthropometric measures (height, weight, body circumferences, body mass index (BMI), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR)), and physical function measures (handgrip strength (HGS), Short Physical Performance Battery (SPPB) and Timed Up and Go test (TUG)) were obtained. Body composition was analysed using bioimpedance analysis (BIA) in a subgroup of 78 patients. Gender-stratified regression analyses were performed to test associations between anthropometric measures with body composition and physical function, adjusted for age. RESULTS: In females, BMI, WHtR and all measured body circumferences were positively associated with body fat mass (BFM) (all β≥0.64, all p≤0.001). BMI and mid-upper arm circumference were also associated with fat-free mass (FFM) (β=0.49, p=0.001; β=0.53, p=0.01), skeletal muscle mass (SMM) (β=0.39, p=0.01; β=0.44, p=0.02) and skeletal muscle index (SMI) (β=0.44, p=0.003; β=0.44, p=0.02). In males, BMI, WHR, WHtR and waist circumference were positively associated with BFM (all β≥0.54, all p≤0.02). Calf circumference was associated with FFM (β=0.46, p=0.01), SMM (β=0.47, p=0.01) and SMI (β=0.50, p=0.01). BMI and central fat anthropometric measures were inversely associated with physical function. CONCLUSIONS: Mid-upper arm circumference and calf circumference could serve as practical proxy measures for skeletal muscle mass in geriatric outpatient setting, but their associations with physical function were weak.
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ItemNo Preview AvailableThe association of objectively measured physical activity and sedentary behavior with skeletal muscle strength and muscle power in older adults: A systematic review and meta-analysis(ELSEVIER IRELAND LTD, 2021-05)BACKGROUND: Engaging in physical activity (PA) and avoiding sedentary behavior (SB) are important for healthy ageing with benefits including the mitigation of disability and mortality. Whether benefits extend to key determinants of disability and mortality, namely muscle strength and muscle power, is unclear. AIMS: This systematic review aimed to describe the association of objective measures of PA and SB with measures of skeletal muscle strength and muscle power in community-dwelling older adults. METHODS: Six databases were searched from their inception to June 21st, 2020 for articles reporting associations between objectively measured PA and SB and upper body or lower body muscle strength or muscle power in community dwelling adults aged 60 years and older. An overview of associations was visualized by effect direction heat maps, standardized effect sizes were estimated with albatross plots and summarized in box plots. Articles reporting adjusted standardized regression coefficients (β) were included in meta-analyses. RESULTS: A total of 112 articles were included representing 43,796 individuals (range: 21 to 3726 per article) with a mean or median age from 61.0 to 88.0 years (mean 56.4 % female). Higher PA measures and lower SB were associated with better upper body muscle strength (hand grip strength), upper body muscle power (arm curl), lower body muscle strength, and lower body muscle power (chair stand test). Median standardized effect sizes were consistently larger for measures of PA and SB with lower compared to upper body muscle strength and muscle power. The meta-analyses of adjusted β coefficients confirmed the associations between total PA (TPA), moderate-to-vigorous PA (MVPA) and light PA (LPA) with hand grip strength (β = 0.041, β = 0.057, and β = 0.070, respectively, all p ≤ 0.001), and TPA and MVPA with chair stand test (β = 0.199 and β = 0.211, respectively, all p ≤ 0.001). CONCLUSIONS: Higher PA and lower SB are associated with greater skeletal muscle strength and muscle power, particularly with the chair stand test.
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ItemNo Preview AvailableSarcopenia, Low Handgrip Strength, and Low Absolute Muscle Mass Predict Long-Term Mortality in Older Hospitalized Patients: An Observational Inception Cohort Study(ELSEVIER SCIENCE INC, 2021-04)OBJECTIVE: Sarcopenia is highly prevalent in hospitalized older patients and associated with short-term mortality. This study aimed to investigate whether sarcopenia and its measures handgrip strength (HGS) and muscle mass at hospital admission were associated with long-term mortality in a cohort of hospitalized older patients. DESIGN: Observational, prospective, longitudinal inception cohort study. SETTING AND PARTICIPANTS: Academic teaching hospital; patients age ≥70 years admitted to the internal medicine, acute admission, trauma, or orthopedic wards. METHODS: HGS and muscle mass were measured at admission using a hand dynamometer and bioelectrical impedance analysis. Sarcopenia was determined based on the European Working Group on Sarcopenia in Older People definition. HGS and muscle mass (skeletal muscle mass index, appendicular lean mass, relative skeletal muscle mass) were expressed as sex-specific tertiles. The associations of sarcopenia, HGS, and muscle mass with mortality (during a follow-up of 3.4-4.1 years) were analyzed using Cox regression, adjusted for age, sex, comorbidity, and weight or height. Associations of HGS and muscle mass were stratified by sex. RESULTS: Out of 363 patients [mean age: 79.6 years (standard deviation: 6.4), 49.9% female] 49% died. Probable sarcopenia (prevalence of 53.7%) and sarcopenia (prevalence of 20.8%) were significantly associated with long-term mortality [hazard ratio (HR) 1.53, 95% confidence interval (CI) 1.08‒2.17 and 1.71 95% CI 1.12‒2.61, respectively]. Low HGS, skeletal muscle mass index, and appendicular lean mass were associated with a higher mortality risk (lowest tertile vs highest tertile: HR 2.660, 95% CI 1.40‒5.05; HR 1.95, 95% CI 1.06‒3.58 and HR 1.99 (95% CI 1.12‒3.53) in male patients. No statistically significant associations of relative muscle mass with mortality were found. CONCLUSIONS AND IMPLICATIONS: Sarcopenia and its measures (low HGS and low absolute muscle mass at admission) predict long-term mortality in older hospitalized patients.
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ItemLongitudinal Changes in Muscle Mass, Muscle Strength, and Physical Performance in Acutely Hospitalized Older Adults(ELSEVIER SCIENCE INC, 2021-04)OBJECTIVES: Acute hospitalization may lead to a decrease in muscle measures, but limited studies are reporting on the changes after discharge. The aim of this study was to determine longitudinal changes in muscle mass, muscle strength, and physical performance in acutely hospitalized older adults from admission up to 3 months post-discharge. DESIGN: A prospective observational cohort study was conducted. SETTING AND PARTICIPANTS: This study included 401 participants aged ≥70 years who were acutely hospitalized in 6 hospitals. All variables were assessed at hospital admission, discharge, and 1 and 3 months post-discharge. METHODS: Muscle mass in kilograms was assessed by multifrequency Bio-electrical Impedance Analysis (MF-BIA) (Bodystat; Quadscan 4000) and muscle strength by handgrip strength (JAMAR). Chair stand and gait speed test were assessed as part of the Short Physical Performance Battery (SPPB). Norm values were based on the consensus statement of the European Working Group on Sarcopenia in Older People. RESULTS: A total of 343 acute hospitalized older adults were included in the analyses with a mean (SD) age of 79.3 (6.6) years, 49.3% were women. From admission up to 3 months post-discharge, muscle mass (-0.1 kg/m2; P = .03) decreased significantly and muscle strength (-0.5 kg; P = .08) decreased nonsignificantly. The chair stand (+0.7 points; P < .001) and gait speed test (+0.9 points; P < .001) improved significantly up to 3 months post-discharge. At 3 months post-discharge, 80%, 18%, and 43% of the older adults scored below the cutoff points for muscle mass, muscle strength, and physical performance, respectively. CONCLUSIONS AND IMPLICATIONS: Physical performance improved during and after acute hospitalization, although muscle mass decreased, and muscle strength did not change. At 3 months post-discharge, muscle mass, muscle strength, and physical performance did not reach normative levels on a population level. Further research is needed to examine the role of exercise interventions for improving muscle measures and physical performance after hospitalization.
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ItemEvery step counts: synthesising reviews associating objectively measured physical activity and sedentary behaviour with clinical outcomes in community-dwelling older adults(ELSEVIER, 2021-11)It is unclear which parameters of physical activity and sedentary behaviour are important for healthy ageing, and to what extent. This Review aimed to synthesise, quantify, and compare the strength of the associations between physical activity and sedentary behaviour with clinically relevant outcomes. Systematic reviews describing community-dwelling adults older than 60 years and reporting standardised associations of objectively measured physical activity and sedentary behaviour with mortality, activities of daily living, frailty, falls and fear of falling, muscle strength and power, and global cognition, were included. Standardised associations were expressed as standardised regression coefficients (βs) and compared within and across outcome domains. Six systematic reviews were included with sample sizes ranging from 7696 to 43 796 (mean or median age 60-92 years). Higher physical activity and lower sedentary behaviour were most strongly associated with better chair stand test performance and lower body muscle strength, and least with falls and hand grip strength. Number of steps was the most strongly and most consistently associated with clinical outcomes. Conferring to a wide array of positive outcomes, steps provide a clinically relevant target that shows practical ease. Future recommendations should promote steps regardless of ability, encouraging that some physical activity is better than none, or, as the present findings show, that every step counts.
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ItemPrevalence of initial orthostatic hypotension in older adults: a systematic review and meta-analysis(OXFORD UNIV PRESS, 2021-09)BACKGROUND: Initial orthostatic hypotension (OH) is a clinical syndrome of exaggerated transient orthostasis associated with higher risks of falls, frailty and syncope in older adults. OBJECTIVE: To provide a prevalence estimate of initial OH in adults aged 65 years or older. METHODS: Literature search of MEDLINE (from 1946), Embase (from 1947) and Cochrane Central Register of Controlled Trials was performed until 6 December 2019, using the terms 'initial orthostatic hypotension', 'postural hypotension' and 'older adults'. Articles were included if published in English and participants were 65 years or older. Random effects models were used for pooled analysis. RESULTS: Of 5,136 articles screened, 13 articles (10 cross-sectional; 3 longitudinal) reporting data of 5,465 individuals (54.5% female) from the general (n = 4,157), geriatric outpatient (n = 1,136), institutionalised (n = 55) and mixed (n = 117) population were included. Blood pressure was measured continuously and intermittently in 11 and 2 studies, respectively. Pooled prevalence of continuously measured initial OH was 29.0% (95% CI: 22.1-36.9%, I2 = 94.6%); 27.8% in the general population (95% CI: 17.9-40.5%, I2 = 96.1%), 35.2% in geriatric outpatients (95% CI: 24.2-48.1%, I2 = 95.3%), 10.0% in institutionalised individuals (95% CI: 2.4-33.1%, I2 = 0%) and 21.4% in the mixed population (95% CI: 7.0-49.6, I2 = 0%). Pooled prevalence of intermittently measured initial OH was 5.6% (95% CI: 1.5-18.9%, I2 = 81.1%); 1.0% in the general population (95% CI: 0.0-23.9%, I2 = 0%) and 7.7% in geriatric outpatients (95% CI: 1.8-27.0%, I2 = 86.7%). CONCLUSION: The prevalence of initial OH is high in older adults, especially in geriatric outpatients. Proper assessment of initial OH requires continuous blood pressure measurements.
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ItemThe Association of Objectively Measured Physical Activity and Sedentary Behavior with (Instrumental) Activities of Daily Living in Community-Dwelling Older Adults: A Systematic Review(DOVE MEDICAL PRESS LTD, 2021)Up to 60% of older adults have a lifestyle characterized by low physical activity (PA) and high sedentary behavior (SB). This can amplify age-related declines in physical and cognitive functions and may therefore affect the ability to complete basic and instrumental activities of daily living (ADL and IADL, respectively), which are essential for independence. This systematic review aims to describe the association of objectively measured PA and SB with ADL and IADL in community-dwelling older adults. Six databases (PubMed, Embase, the Cochrane library, CINAHL, PsychINFO, SPORTDiscuss) were searched from inception to 21/06/2020 for articles meeting our eligibility criteria: 1) observational or experimental study, 2) participants' mean/median age ≥60 years, 3) community-dwelling older adults, 4) PA and SB were measured with a(n) accelerometer/pedometer, 5) PA and SB were studied in relation to ADL and/or IADL. Risk of bias was assessed in duplicate using modified versions of the Newcastle-Ottawa scale. Effect direction heat maps provided an overview of associations and standardized regression coefficients (βs) were depicted in albatross plots. Thirty articles (6 longitudinal; 24 cross-sectional) were included representing 24,959 (range: 23 to 2749) community-dwelling older adults with mean/median age ranging from 60.0 to 92.3 years (54.6% female). Higher PA and lower SB were associated with better ability to complete ADL and IADL in all longitudinal studies and overall results of cross-sectional studies supported these associations, which underscores the importance of an active lifestyle. The median [interquartile range] of βs for associations of PA/SB with ADL and IADL were, respectively, 0.145 [0.072, 0.280] and 0.135 [0.093, 0.211]. Our strategy to address confounding may have suppressed the true relationship of PA and SB with ADL or IADL because of over-adjustment in some included studies. Future research should aim for standardization in PA and SB assessment to unravel dose-response relationships and inform guidelines.
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