Screening for sarcopenia using calf muscle circumference in older adults requiring long-term care.

SARC-F and SARC-CalF in screening for sarcopenia in older adults with Parkinson's disease.

Although the numbers of aged populations have risen considerably in the last few decades, the current coronavirus disease 2019 (COVID-19) has revealed an extensive vulnerability among these populations. Sarcopenia is an age-related disorder that increases hospitalization, dependencies, and mortality in older adults. It starts to develop in midlife or even earlier as a result of unbalanced diet/poor nutrition and low levels of physical activity, in addition to chronic disorders such as obesity and diabetes mellitus. Given that social isolation is adopted as the most protective measure against COVID-19, the level of physical activity and the intake of adequate diet have considerably declined, especially among older adults—denoting an increased possibility for developing sarcopenia. Research also shows a higher vulnerability of sarcopenic people to COVID-19 as well as the development of wasting disorders such as sarcopenia and cachexia in a considerable proportion of symptomatic and recovering COVID-19 patients. Muscular wasting in COVID-19 is associated with poor prognosis. Accordingly, early detection and proper management of sarcopenia and wasting conditions in older adults and COVID-19 patients may minimize morbidity and mortality during the current COVID-19 crisis. This review explored different aspects of screening for sarcopenia, stressing their relevance to the detection of altered muscular structure and performance in patients with COVID-19. Current guidelines recommend prior evaluation of muscle strength by simple measures such as grip strength to identify individuals with proven weakness who then would be screened for muscle mass loss. The latter is best measured by MRI and CT. However, due to the high cost and radiation risk entailed by these techniques, other simpler and cheaper techniques such as DXA and ultrasound are given preference. Muscle loss in COVID-19 patients was measured during the acute phase by CT scanning of the pectoralis muscle simultaneously during a routine check for lung fibrosis, which seems to be an efficient evaluation of sarcopenia among those patients with no additional cost. In recovering patients, muscle strength and physical performance have been evaluated by electromyography and traditional tests such as the six-minute walk test. Effective preventive and therapeutic interventions are necessary in order to prevent muscle loss and associated physical decline in COVID-19 patients.

Screening for Frailty and Sarcopenia Among Older Persons in Medical Outpatient Clinics and its Associations With Healthcare Burden

Sarcopenia is a progressive and widespread musculoskeletal disorder characterized by the decline of muscle strength and muscle mass. In this letter, we provide a critical appraisal of the study "Screening for Sarcopenia in Older Adults Living in Kırıkkale Province: A Pilot Study" by Akdağlı et al., published in Volume 27, Issue 1 of your journal. The study offers valuable insights into the prevalence of sarcopenia among older adults in Turkey and contributes significantly to geriatric health screening literature. However, methodological clarity regarding the sequence of assessments, classification criteria, and the use of established EWGSOP2 cut-off values for sarcopenia diagnosis is crucial for enhancing reproducibility and alignment with international standards. Highlighting these aspects can strengthen future research in this critical area. We commend the authors for their important contribution to raising sarcopenia awareness and developing preventive strategies for the aging population.

Optimizing sarcopenia screening in type 2 diabetes mellitus: A ROC curve evaluation of the SARC-F and the SARC-CalF

ObjectiveThis study was designed to establish the cut-off value and diagnostic utility of the Ishii test, which gauges the odds of severe sarcopenia based on the results of an equation based upon age, grip strength, and calf circumference among middle-aged and older adults in Western China.MethodsThis study incorporated adults ≥ 50 years of age from the West China Health and Aging Trend (WCHAT) study. Severe sarcopenia was defined as per the Asian Working Group for Sarcopenia: 2019 Consensus (AWGS2019) recommendations, with the odds of severe sarcopenia being estimated with the Ishii test score chart. The diagnostic utility of the Ishii test in this patient cohort was assessed by analyzing its sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the area under the ROC curve (AUC).ResultsIn total, 4,177 individuals ≥ 50 years of age were included in this study including 2668 females (63.9%) and 1,509 males (36.1%). These included 568 (13.6%) participants affected by severe sarcopenia, of whom 237 were male (15.7%) and 331 were female (12.4%). Optimal Ishii test cut-off values established based on Youden’s index were ≥ 114 for males and ≥ 120 for females when using the AWGS2019 reference standard. The sensitivity/specificity/PPV/NPV of the Ishii test when screening for severe sarcopenia were 89.45%/77.15%/0.42/0.98 in males and 90.03%/77.05%/0.36/0.98 in females. The AUC values for the Ishii test in males and females were 0.899 (95% CI, 0.883–0.916) and 0.905 (95% CI, 0.892–0.917), respectively.ConclusionThese data indicate that the Ishii test offers value as a candidate diagnostic test that can be used to screen for severe sarcopenia, with recommended diagnostic cut-off values of ≥ 114 for males and ≥ 120 for females.

This study evaluated the relationship between sarcopenia and the trajectories of depressive symptoms among Chinese older adults and verified the mediating role of social participation. The sample included 1832 participants aged ≥ 60years from five waves of the China Health and Retirement Longitudinal Study (CHARLS). The optimal trajectory class of depressive symptoms was identified using the latent growth mixture model (LGMM). The association between sarcopenia and the trajectories of depressive symptoms was assessed by multinomial logistic regression. The potential mediating effect of social participation was evaluated through mediation analysis. Subgroup and interaction analyses were also carried out. The results showed that the depressive symptom score trajectory of the sarcopenia group was higher than that of the normal group. The depressive symptoms of the general participants had three trajectories: "Anterior high level," "Posterior high level," and "Stable low level". Sarcopenia was related to the increased odds of adverse trajectory of depressive symptoms ("Anterior high level" trajectory) (adjusted OR = 1.53, 95% CI: 1.02-2.30). Social participation mediated 10.69% of the association between sarcopenia and adverse trajectory of depressive symptoms. Sex, education, marital status, chronic disease, self-rated health status, and self-rated standard of living were modifiable factors affecting the relationship of sarcopenia and adverse trajectory of depressive symptoms. Comprehensive measures including early screening and treatment for sarcopenia, the strengthening of social participation levels, and formulating targeted intervention strategies are recommended to alleviate depressive symptoms and enhance mental health.

Since the initial scientific statement on Secondary Prevention of Coronary Heart Disease (CHD) in the Elderly was published in 2002,1 several trends have continued that make an update highly appropriate. First, the graying of the US population and those of other industrialized countries has progressed unabated because more adults are surviving into their senior years. The number of Americans aged ≥75 years was estimated at 18.6 million in 2010, representing ≈6% of the population,2 and it is expected to double by 2050. The population aged ≥85 years is growing the most rapidly, with numbers expected to reach 19.5 million by 2040. In 2008, 67% of the 811 940 cardiovascular deaths in the United States occurred in people aged ≥75 years.3 In parallel to this increase in the older adult demographic, the number of Americans with CHD has increased to an estimated 16.3 million, more than half of whom are >65 years of age.3 Similarly, 7 million have had a stroke, the incidence of which approximately doubles with successive age decades after 45 to 54 years.3 Peripheral artery disease (PAD) affects 8 to 10 million Americans, the majority of whom are >65 years of age. Between 2015 and 2030, annual US costs related to atherosclerotic cardiovascular disease (ASCVD) are projected to increase from $84.8 billion to $202 billion.3 Moreover, given that ASCVD often undermines functional capacity and independence and increases reliance on long-term care, indirect expenses related to ASCVD are also expected to increase. Thus, the need for effective secondary prevention measures in the older adult population with known ASCVD has never been greater. Notably, the 2011 American Heart Association (AHA)/American College of Cardiology Foundation (ACCF) updated guidelines for secondary prevention of CHD broadened …

Pragmatic Trials and Improving Long-Term Care: Recommendations From a National Institutes of Health Conference.

Quantity versus quality: Age-related differences in muscle volume, intramuscular fat, and mechanical properties in the triceps surae.

We thank Malas et al for their interest in our study1 and for their constructive criticism. We also thank the editor for this opportunity to respond to the issues raised in their letter and to clarify aspects of our study. As the title of our study suggests, our aim was to describe the use of SARC-F (Strength, Assistance in Walking, Rising From a Chair, Climbing Stairs, and Falls) as a screening instrument and to identify characteristics and adverse outcomes associated with a positive screen using standard cutoffs.2 As we describe in the Limitations section of our article, no objective measurement of sarcopenia was included in this study as a confirmatory test; hence, a comparison with established measures of sarcopenia is warranted. Furthermore, on the basis of prior research demonstrating minimal correlation between computed tomography–based muscle measures and physical performance, it is very likely that those screening positive for sarcopenia via SARC-F are very different from those identified as sarcopenic via computed tomography–based thresholds (typical within oncology).3 We agree that published validation studies in nononcology settings have shown low to moderate sensitivity and high specificity; as a result, this tool may miss patients in the earlier stages of sarcopenia.4 However, the validity of this tool among older patients with cancer remains to be evaluated. In fact, our group is currently seeking to validate the SARC-F scoring instrument against more established measures of sarcopenia among older adults with cancer; additional results from this analysis are eagerly awaited. We, however, argue that the routine assessment of sarcopenia with tools such as anterior thigh muscle mass measurements by ultrasound may be impractical to incorporate into routine oncology practice in an all-comer population. Hence, more practical screening tools such as the SARC-F questionnaire warrant further evaluation among patients with cancer. Recognizing the challenges of measuring sarcopenia in routine care, the European Working Group on Sarcopenia in Older People now recommends use of SARC-F for rapid screening of sarcopenia in older adults.5 To that end, we regard our work as a preliminary experience of using such a tool among older adults with cancer, and we readily admit that more work needs to be done on establishing the feasibility and validation of such tools within oncology. Supported in part by the National Cancer Institute of the National Institutes of Health (K08CA234225-GRW). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors made no disclosures.

Background: China has the largest number of aging people in need of long-term care, among whom 70% have chronic diseases. For policy planners, it is necessary to understand the different levels of needs of long-term care and provide long-term care insurance to ensure the long-term care needs of all people can be met. Methods: This study combines the 2013 wave of CHARLS survey and the Life Course Survey of 2014. The combination allows us to factor in both childhood and adulthood data to provide life-course analysis. We identified 7,734 older adults with chronic diseases for analysis. The need for long-term care is defined by the presence of functional limitations based on the performance of basic activities of daily living (ADLs) and of instrumental activities of daily living (IADLs). Two dummy variables, ADLs disability and IADLs disability, and two count variables, ADLs score and IADLs score, were defined to measure incidence and severity of long-term care need, respectively. The concentration index was used to capture the inequality in long-term care need, and a decomposition method based on Probit Regression and Negative Binomial Regression was exploited to identify the contribution of each determination. Results: At least a little difficulty was reported in ADLs and IADLs in 20.44% and 19.25% of respondents, respectively. The concentration index of ADLs disability, ADLs score, IADLs disability, IADLs score were −0.085, −0.109, −0.095 and −0.120, respectively, all of which were statistically significant, indicating the pro-poor inequality in the incidence and severity of long-term care need. Decomposition analyses revealed that family income, education attainment, aging, and childhood experience played a significant role in explaining the inequalities. Conclusions: The long-term care need among older adults with chronic disease is high in China and low socioeconomic groups had a higher probability of needing long-term care or need more long-term care. It is urgent to implement long-term care insurance, especially for the individuals from lower socioeconomic groups.

Taiwan has a fast-aging population, and it is expected to see an associated increase in the number of older adults with disabilities. We aimed to understand whether Taiwanese older adults’ disability trajectories mediated the association between disablement process factors and later long-term care (LTC) service use. Data were from the nationally representative Taiwan Longitudinal Study on Aging Survey, 1996–2007 (N = 3,429). Trajectories of disability in activities of daily living and instrumental activities of daily living were identified by using growth mixture modeling. Structural equation modeling was applied to examine the effect of disability trajectory as mediator on disablement process factors, such as demographics, number of comorbidities, depression, and leisure activities (LAs), and on later LTC service use. Three distinct disability trajectories were identified among the group of surveyed older adults: healthy (N = 2,998, 87.43 %), progressive disability (N = 363, 10.59 %), and maintained disability (N = 68, 1.98 %). These disability trajectories, either progressive disability or maintained disability trajectory, were found to have a positive mediating effect on the association between disablement process factors (older, lower educational attainment, larger number of comorbidities, and depressive symptoms) and greater use of LTC services. However, encouraging older adults to engage in LAs reduced later use of LTC services through both total and significant mediating effect of postponing development of disability trajectory in older Taiwanese adults. These findings suggest that an active lifestyle is important for older adults’ physical health and to decrease the societal burden of LTC service use.

Almost 25% of Medicare beneficiaries live in residential long-term care (LTC) (eg, independent or assisted living facility or nursing home). There are few reliable statistics on completed suicide in LTC, in part because of data limitations. To estimate the number of suicides associated with residential LTC (ie, among persons in a facility, transitioning into or out of a facility, or otherwise associated with LTC) among adults 55 and older and, secondarily, to identify whether machine learning tools could improve the quality of suicide surveillance data. Cross-sectional epidemiologic study (conducted in 2018) of restricted-access data from the National Violent Death Reporting System (NVDRS) (2003-2015) using restricted-access case narratives from suicides and undetermined deaths among adults 55 years and older in 27 states. Participants were all suicides and undetermined deaths (N = 47 759) among persons 55 years and older. Long-term care cited in the coroner/medical examiner case narrative, whether as a reason for self-harm or the injury location, identified using machine learning natural language processing (NLP) algorithms plus manual review of texts. Number and characteristics (eg, demographics, health history, and means of injury) of suicides associated with LTC. The κ statistic was used to estimate the reliability of the existing NVDRS injury location codes relative to cases identified by the algorithm. Among 47 759 persons 55 years and older (median age, 64 years; 77.6% male; 90.0% non-Hispanic white), this study identified 1037 suicide deaths associated with LTC, including 428 among older adults living in LTC, 449 among older adults transitioning to LTC, and 160 otherwise associated with LTC. In contrast, there were only 263 cases coded with the existing NVDRS location code "supervised residential facility," which had poor agreement with cases that the algorithm identified as occurring in LTC (κ statistic, 0.30; 95% CI, 0.26-0.35). Over a 13-year period, approximately 2.2% of suicides among adults 55 years and older were associated with LTC in some manner. Clinicians, administrators, and policy makers should consider ways to promote the mental health and well-being of older adults experiencing functioning limitations and their families. Natural language processing may be a useful way to improve abstraction of variables in the NVDRS.

Evaluation of Four Methods for the Assessment of Sarcopenia in Older Adults in Nursing Homes.