Publications by authors named "Ellen Freiberger"

66 Publications

24-Months Cluster-Randomized Intervention Trial of a Targeted Fall Prevention Program in a Primary Care Setting.

J Gen Intern Med 2021 Jul 8. Epub 2021 Jul 8.

Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstr. 60, 90408, Nuremberg, Germany.

Background: Falls and fall-related injuries are common in community-dwelling older persons. Longitudinal data on effective fall prevention programs are rare.

Objective: Therefore, we evaluated a 4-months multi-component exercise fall prevention program in a primary care setting on long-term effects over 24 months on falls and concomitant injuries in older community-dwelling persons with high risk of falling.

Design And Setting: In the Prevention of Falls (PreFalls) study, forty general practitioners in Germany were cluster-randomized (1:1) into an intervention group (IG) or control group (CG). Three hundred seventy-eight independently living people with high risk of falling (78.1 ± 5.9 years, 75% women) were assigned to IG (n = 222) or CG (n = 156).

Intervention And Measurements: Patients in IG took part in a 4-months multi-component exercise program comprising strength and balance exercises (28 sessions); patients in CG received no intervention. Primary outcome measure was number of falls over 24 months, analyzed by a patient-level, linear mixed Poisson model. Secondary endpoints were number of fall-related injuries, changes in physical function, fear of falling, and mortality.

Results: After 24 months, the IG demonstrated significantly fewer falls (IRR = 0.63, p = 0.021), injurious falls (IRR = 0.69, p = 0.034), and less fear of falling (p = 0.005). The mortality rate was 5.0% in IG and 10.3% in CG (HR = 0.51, 95% CI: 0.24 to 1.12; p = 0.094).

Conclusions: In older community-dwelling persons with high risk of falling, a short-term multi-component exercise intervention reduced falls and injurious falls, as well as fear of falling over 24 months.
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http://dx.doi.org/10.1007/s11606-021-06944-wDOI Listing
July 2021

Domain-specific self-perceptions of aging are associated with different gait patterns in older adults: a cross-sectional latent profile analysis.

BMC Geriatr 2021 06 29;21(1):392. Epub 2021 Jun 29.

Department of Prevention Research and Social Medicine, Institute for Community Medicine, University Medicine Greifswald, Walther-Rathenau-Str. 48, 17475, Greifswald, Germany.

Background: Previous studies have pointed to the impact of self-perceptions of aging (SPA) on self-reported physical function in later life. However, less is known about associations of SPA with objectively measured physical function, especially gait. Research that examined other psychological variables and objectively measured gait has focused on single gait parameters such as gait speed, which seems to fall short for the complexity of this movement. Some approaches have proposed ways to identify gait patterns in specific patient groups, but not in community samples. Our goal was (a) to identify gait patterns based on a combination of important gait parameters in a community sample, and (b) to investigate differential associations of gain- and loss-related SPA with these gait patterns.

Methods: The study used an electronic walkway to assess gait parameters of 150 community dwelling adults aged 71-93 years (61.0% women) at their usual and maximum gait speed. SPA were assessed with a questionnaire. We used latent profile analysis (LPA) to identify groups exhibiting distinct gait patterns and binary logistic regression to investigate associations of SPA with these groups, controlling for personality traits, number of illnesses, age, gender, and education. To compare overall function between groups, a t-test for scores in the Short Physical Performance Battery was used.

Results: LPA revealed two distinct groups in both gait speed conditions. The fit group exhibited a stable, well-coordinated and faster gait pattern, while the functionally limited group's gait pattern was less stable, less coordinated and slower. The odds of belonging to the functionally limited group were increased by loss-related SPA at usual gait speed, while the odds of belonging to the fit group were increased by gain-related SPA at individual maximum speed.

Conclusions: The findings (a) suggest LPA as a useful approach to investigate complex gait patterns considering several gait parameters simultaneously, and (b) provide first evidence for differential associations of gain- and loss-related SPA with gait patterns at usual and maximum gait speed. Intervention studies addressing gait in older adults should additionally address gain-related views on aging.
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http://dx.doi.org/10.1186/s12877-021-02320-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8243892PMC
June 2021

The course of gait speed during a 400m walk test of mobility limitations in community-dwelling older adults.

Z Gerontol Geriatr 2021 Jun 11. Epub 2021 Jun 11.

Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Nuremberg, Germany.

Background: The 400‑m walk test (400MWT) of usual gait speed is an assessment of mobility limitations in geriatric medicine and sarcopenic research.

Objective: The aim of this study was to describe the course of gait speed during a 400MWT in community-dwelling older adults in terms of physical, psychological and general health-related outcomes. Possible plateau phases during the 400MWT could enable integrated measurements of short distance walk tests.

Methods: In this study 148 community-dwelling older adults (mean age 80.4 ± 4.4 years, 61% women) performed a 400MWT at comfortable gait speed. Additionally, an 8m walk test was carried out and history of falling, sex, comorbidities, fear of falling, executive function and gait variability were determined as covariates.

Results: Gait speed was higher in the beginning and the end of the 400MWT compared to the middle part with respect to all analyzed covariates. Mean gait speed of the 8 m walk test was significantly faster than mean gait speed of the 400MWT (t (df = 147) = 0.07, p = 0.001).

Conclusion: The course of gait speed during a 400MWT performed by community-dwelling older adults was not affected by sex, gait variability, comorbidity, history of falling, fear of falling or executive function. Gait speed measurements of the 400MWT do not fully represent assessment of supervised short distance gait speed in community-dwelling adults.
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http://dx.doi.org/10.1007/s00391-021-01908-5DOI Listing
June 2021

Short distance analysis of the 400-meter walk test of mobility in community-dwelling older adults.

Gait Posture 2021 Jul 14;88:60-65. Epub 2021 May 14.

Institute for Biomedicine of Aging, Friedrich-Alexander-University of Erlangen-Nürnberg, Kobergerstr. 60, 90408, Nürnberg, Germany.

Background: The 400-meter walk test (400MWT) is used to assess cardiovascular and pulmonary fitness or to predict adverse outcomes such as mobility disability. Additionally, short tests of walking such as the 4- or 8-meter walk test are administered to predict mortality, falls and other events. It remains uncertain if and how an integrated measurement of a short distance during 400MWT can replace an additional short distance measurement which would be clinically useful.

Research Question: How do short distance (i.e. segment) measurements of gait speed and walk ratio during a 400MWT of mobility compare to those from an additional 8-meter walk test?

Methods: A 400MWT and a separate 8-meter walk test were performed by 148 community-dwelling older adults (mean age 80.4 ± 4.4 years) using an instrumented walkway.

Results: Gait speed and walk ratio (i.e. step length divided by step frequency) of single segments of the 400MWT were strongly associated with gait speed (r ≥ 0.91) and walk ratio (r ≥ 0.93) of an 8-meter walk test with best agreement in the middle part 20-meter walk during the 400MWT. Mean gait speed of all single walks on the instrumented walkway during the 400MWT was faster than the mean gait speed of the total 400MWT.

Significance: A single walk of the 6 to 10 20-meter walk during the 400MWT can be used as a substitute to an additional short distance trial. Furthermore, the awareness of being measured is higher on an instrumented walkway and possibly increases the motivation to overperform.
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http://dx.doi.org/10.1016/j.gaitpost.2021.05.002DOI Listing
July 2021

Laying the foundation for an ICF core set for community dwelling older adults in primary care: an expert survey.

Z Gerontol Geriatr 2021 Jul 18;54(4):365-370. Epub 2021 Mar 18.

Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Kobergerstraße 60, 90408, Nuremberg, Germany.

Background: A holistic biopsychosocial model focused on functioning in individual contexts (environment, task) is better suited to meet the needs of older patients than disease only based models. The International Classification of Functioning, Disability and Health (ICF) is the official standard for describing functional health. As the ICF is too detailed to be used in practice, brief core sets have been developed.

Objective: This study aimed to identify relevant aspects of functioning for older primary care patients from the perspective of healthcare professionals in Germany.

Material And Methods: An internet-based cross-sectional expert survey was conducted in preparation for the development of an ICF core set for community-dwelling patients aged 75 years and older. Open-ended questions to identify the most important aspects of functioning and disability in old age were used. Responses were analyzed based on a content analysis approach to identify relevant concepts in the care of the target population. These concepts were then linked to ICF categories according to established linking rules.

Results: A total of 63 experts participated in this survey. Across all responses, 2240 meaningful concepts were identified. A total of 75 ICF categories (4 first level categories, 67 second level categories, 4 code combinations) were identified by at least 5% of respondents and will thus be considered as candidate categories for the final ICF core set. Most of concepts were associated with the environmental factors component. The most frequently identified categories were immediate family and family relationships.

Conclusion: This survey provides a list of relevant ICF categories from the experts' perspective and together with other preparatory studies will be used for developing an ICF core set for community-dwelling older adults in primary care.
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http://dx.doi.org/10.1007/s00391-021-01872-0DOI Listing
July 2021

Laying the foundation for a Core Set of the International Classification of Functioning, Disability and Health for community-dwelling older adults in primary care: relevant categories of their functioning from the research perspective, a scoping review.

BMJ Open 2021 02 17;11(2):e037333. Epub 2021 Feb 17.

Institute for Biomedicine of Aging, Friedrich-Alexander University Erlangen-Nuremberg, Nuremberg, Germany.

Objectives: The objective of this study was to find relevant concepts of functioning in community-dwelling older adults within frequently used assessment instruments published in the scientific literature. This was part of a larger project to develop an International Classification of Functioning, Disability and Health (ICF) Core Set for use in primary care.

Design: A scoping review was conducted. Articles dealing with functioning in older adults were searched and assessed for eligibility. The study population included community-dwelling adults (≥75 years) without dementia, living in high-resource countries. Relevant concepts were extracted from assessment instruments and linked to the ICF using standardised linking rules. Finally, a frequency analysis was conducted.

Setting: Home, primary care.

Participants: Community-dwelling adults aged 75 years and above.

Results: From 5060 identified publications, 68 were included and 30 assessment instruments extracted. Overall, 1182 concepts were retrieved. Most were linked to the 'activities and participation' component. The most frequently identified categories were memory functions', 'dressing' and 'changing basic body position'.

Conclusions: This review provides a list of relevant ICF categories from the research perspective that will be used for developing an ICF Core Set for older primary care patients.

Trial Registration Numbers: PROSPERO (CRD42017067784), (VfD_17_003833) and ClinicalTrials.gov (NCT03384732).
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http://dx.doi.org/10.1136/bmjopen-2020-037333DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7893647PMC
February 2021

Improvement of transitional care from hospital to home for older patients, the TIGER study: protocol of a randomised controlled trial.

BMJ Open 2021 02 8;11(2):e037999. Epub 2021 Feb 8.

Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany.

Introduction: In Germany, an efficient and feasible transition from hospital to home for older patients, ensuring continuous care across healthcare settings, has not yet been applied and evaluated. Based on the transitional care model (TCM), this study aims to reduce preventable readmissions of patients ≥75 years of age with a transitional care intervention performed by geriatric-experienced care professionals. The study investigates whether the intervention ensures continuous care during transition and stabilises the care situation of patients at home.

Methods And Analyses: Randomised controlled clinical trial, recruiting between 25 April 2018 and 31 December 2019 in one German hospital in the city of Regensburg. The intervention group is supported by care professionals in the transition process from hospital to home for up to 12 months. Based on TCM, the intervention includes an individual care plan according to a patient's symptoms, risks, needs and values. The plan is advanced in the domestic situation via personal visits and telephone contacts. All necessary care actions regarding, for example, mobility, residence adjustments, or nutrition, are initiated to be executed by ambulant care services, and are monitored, evaluated and adapted if necessary. In supervising the care plan, the care professionals do not administer active care services themselves but coordinate them. Patients and their caregivers are actively engaged in the care planning and execution. In contrast, the control group receives only usual discharge planning in the hospital and usual ambulatory care.The primary outcome is the all-cause readmission rate assessed using health insurance data within a follow-up of up to 12 months after hospital discharge. Secondary outcomes include care quality, mobility, nutritional and wound situation, and health-related quality of life. They are assessed at baseline, after 1 month, 3 months, 6 months, and at the end of study visit. Additionally, the economic efficiency of the intervention will be evaluated.

Ethics And Dissemination: Ethics approval for the trial was obtained from the Ethics Committee of the Friedrich-Alexander-Universität Erlangen-Nürnberg. Results will be published in peer-reviewed, open-access scientific journals and disseminated at national and international research conferences and through public presentations in the geriatric and healthcare community.

Trial Registration: ClinicalTrials.gov identifier: NCT03513159.
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http://dx.doi.org/10.1136/bmjopen-2020-037999DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7871673PMC
February 2021

A volunteer-supported walking programme to improve physical function in older people (the POWER Study): study protocol for a randomised controlled trial.

BMC Geriatr 2021 01 13;21(1):45. Epub 2021 Jan 13.

Department of General Practice and Family Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria.

Background: Currently 21% of the German population is older than 65 years. Above this age, the risk of suffering from chronic disease and mental disorders increases rapidly. Therefore, physical inactivity is one of the most important public health concerns among older people. To address this issue, we have conceptualised and evaluated a simple and low-threshold intervention, which requires only minimal demand on the participants, targeting older people with inadequate activity levels. The aim of the POWER Study is to investigate whether volunteer-supported outdoor-walking improves physical function and quality of life in older people.

Methods/design: In a randomised, controlled interventional superiority-trial, individuals older than 65 years of age living in the community or nursing homes will be randomised into two groups. The study will be conducted in two study centres with assessments at baseline, 6 and 12 months. The intervention group will participate in a supported physical activity intervention for 6 months. An assigned volunteer will visit them three times a week for an outdoor walk between 30 and 50 min, or equivalent indoor activity. Persons in the control group will be invited to two lectures covering topics related to health. Primary endpoint is the physical function measured by the Short Physical Performance Battery (SPPB) at baseline, after 6 and 12 months. Secondary and safety endpoints will be quality of life (EQ. 5D), fear of falling (Falls Efficacy Scale), physical activity (activity diary), cognitive executive function (clock drawing test), falls requiring medical attention, hospitalisation and death. Primary analysis will be carried out by intention to treat.

Discussion: We expect the intervention to improve the overall health status of the participants in a wide range of health-related outcomes. If effectiveness can be shown, the intervention will close an important gap in current services for older people. We will disseminate our experiences and results in the form of informational documents (training manual) to allow municipalities and health care organisations to implement a similar intervention.

Trial Registration: The trial was registered on 31 Aug 2018; German Clinical Trials Register (www.germanctr.de), Deutsches Register Klinischer Studien: DRKS00015188 .
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http://dx.doi.org/10.1186/s12877-020-01988-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7805201PMC
January 2021

"EduKation demenz® Nursing" in the acute hospital setting : Evaluation of a dementia training program: a pilot study.

Z Gerontol Geriatr 2021 Jan 12. Epub 2021 Jan 12.

Department of Social Services, Catholic University of Applied Sciences of North Rhine-Westphalia, Campus Paderborn, Paderborn, Germany.

Background: An increasing number of people with dementia (PwD) are being hospitalized due to acute conditions. The surrounding conditions and procedures in acute hospitals are not oriented to the special needs of this vulnerable patient group. The behavior of PwD poses particular challenges and burdens for nursing staff.

Objective: The aim of this pilot study was to evaluate the effectiveness of a 2-day dementia training program with a self-reflection component compared to a standard 1.5‑h training of nursing staff caring for PwD in acute hospitals.

Methods: A nonrandomized pretest-posttest study with a control group was conducted in three German acute hospitals. Through a questionnaire, nursing staff caring for PwD were examined for potential changes in attitude, strain and confidence levels. The intervention group (n = 32) received a 2-day training program, "EduKation demenz® Nursing", the control group (n = 36) participated in a short,1.5‑h dementia training.

Results: Compared to the control group, the intervention group demonstrated statistically significant improvement in perceived strain (p = 0.007) and in confidence in caring for PwD (p < 0.001). There were positive but not significant changes in attitude (p = 0.176).

Conclusion: "EduKation demenz® Nursing", a 2-day training program with a self-reflection component, could provide more effective support for nursing staff in acute hospitals caring for PwD than a 1.5‑h training. Results indicate, however, that general conditions in acute hospitals should be changed to allow nursing staff to apply the knowledge gained.
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http://dx.doi.org/10.1007/s00391-020-01838-8DOI Listing
January 2021

Laying the foundation for a primary care core set of the International Classification of Functioning, Disability and Health (ICF) for community-dwelling older adults: A qualitative study.

J Rehabil Med 2021 Feb 10;53(2):jrm00150. Epub 2021 Feb 10.

Institute of General Practice, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany. E-mail:

Objective: To explore relevant areas of functioning from the perspective of community-dwelling adults aged 75 years and over, in order to develop a Core Set of the International Classification of Functioning, Disability and Health (ICF) for community-dwelling older adults for use in primary care.

Design: Qualitative study using semi-structured interviews and focus groups.

Participants: A total of 27 community-dwelling older adults participated in the interviews and 24 of them in the focus groups.

Methods: Following the proposed methodology of the ICF Research Branch, this is 1 of 4 preparatory studies in the Core Set development process. Within the transcripts, concepts of functioning were identified, based on Mayring's qualitative content analysis using deductive category assignment with the ICF being the category system.

Results: Overall 6,667 concepts were identified. Most were linked to the Activities and Participation component. The most frequently identified categories were "recreation and leisure" and "family relationships".

Conclusion: Categories from all ICF chapters were identified, demonstrating the complexity and multidimensionality of the ageing process, with a special emphasis on the component Activities and Participation. This qualitative study provides a list of relevant categories from the perspective of community--dwelling elderly people, which will be used to develop a Core Set for older primary care patients.
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http://dx.doi.org/10.2340/16501977-2779DOI Listing
February 2021

Laying the foundation for an International Classification of Functioning, Disability and Health Core Set for community-dwelling elderly adults in primary care: the clinical perspective identified in a cross-sectional study.

BMJ Open 2020 11 23;10(11):e038434. Epub 2020 Nov 23.

Center for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.

Objectives: Having more information about the biopsychosocial functioning of their geriatric patients might help physicians better balance medical interventions according to patients' needs. For this reason, we aimed to develop an easy-to-handle International Classification of Functioning, Disability and Health (ICF) Core Set for community-dwelling geriatric patients aged 75 and older in primary care. In this empirical study, we describe the functioning and health of community-dwelling patients aged 75 and older in primary care in Germany and identify the most common problems encountered by these individuals when using the ICF.

Design: In this exploratory, cross-sectional study, a health professional conducted semi-structured interviews.

Setting: Community-dwelling older adults aged 75 and older in Germany.

Participants: 65 participants (mean age=80.2, SD=3.6).

Outcome Measures: Extended ICF Checklist V.2.1a, patients prioritised chapters of the 'activities and participation' component.

Results: The three most common impairments for 'body functions' were (ICF-code ; 89%), (; 80%) and (). For 'body structures', they were (; 81%), (; 74%) and (; 49%). For the 'activities and participation' component, adequate aids compensated for activity limitations to a certain degree. Still, after having adequate aids, the category in which the participants had the most difficulty was ( 35%). Participants rated the 'mobility' chapter as the most important of all chapters. 'Environmental factors' were facilitators of participants' functioning.

Conclusions: This empirical study provides a list of ICF categories relevant to older adults from the clinical perspective. Along with lists from the other three preparatory studies, it will form the basis for the development of an ICF Core Set for community-dwelling older adults in primary care.

Trial Registration Details: The trial is registered in ClinicalTrials.gov (NCT03384732).
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http://dx.doi.org/10.1136/bmjopen-2020-038434DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7684806PMC
November 2020

Mobility in Older Community-Dwelling Persons: A Narrative Review.

Front Physiol 2020 15;11:881. Epub 2020 Sep 15.

Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany.

Due to the demographic changes and the increasing awareness of the role of physical function, mobility in older age is becoming an important topic. Mobility limitations have been reported as increasingly prevalent in older persons affecting about 35% of persons aged 70 and the majority of persons over 85 years. Mobility limitations have been associated with increased fall risk, hospitalization, a decreased quality of life, and even mortality. As concepts of mobility are multifactorial and complex, in this narrative review, definitions, physical factors, and their age-related changes associated with mobility will be presented. Also, areas of cognitive decline and their impact on mobility, as well as neuromuscular factors related to mobility will be addressed. Another section will relate psychological factors such as Fall-related psychological concerns and sedentary behavior to mobility. Assessment of mobility as well as effective exercise interventions are only shortly addressed. In the last part, gaps and future work on mobility in older persons are discussed.
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http://dx.doi.org/10.3389/fphys.2020.00881DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7522521PMC
September 2020

Is kidney function associated with cognition and mood in late life? : The Screening for CKD among Older People across Europe (SCOPE) study.

BMC Geriatr 2020 10 2;20(Suppl 1):297. Epub 2020 Oct 2.

Department of Internal Medicine, Section of Geriatric Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.

Background: Chronic kidney disease (CKD), cognitive impairment and depression share common risk factors. Previous studies did not investigate the possible association between kidney function and cognitive and mood disorders in older persons in a broad range of kidney function. The present study explored associations between kidney function, cognition and mood in outpatients of 75 years and over.

Methods: Baseline data of 2252 participants of the SCOPE study, an international multicenter cohort observational study,were used in which community-dwelling persons of 75 years and over were enrolled to screen for CKD Kidney function was estimated with the BIS1-eGFR equation, cognition was assessed with the Mini-Mental State Examination (MMSE) and mood with the Geriatric Depression Scale 15 items (GDS-15). Characteristics were compared across stages of CKD. Mean eGFR values were also compared across categories of MMSE (< 24, 24-26, ≥27) and between groups with high and low score on the GDS-15 (> 5/≤5).

Results: In total, 63% of the population had an eGFR < 60 mL/min. In advanced stages of CKD, participants were older and more often men than in earlier stages (p < 0.001). Cardiovascular diseases and diabetes mellitus were more often found in those in advanced stages of CKD (p < 0.001), and also cumulative comorbidity scores were higher than in those in earlier stages (p < 0.001). Median MMSE was 29 in CKD stage 1-2 and 3, and 30 in CKD stage 4, whereas median GDS-15 score was 2 in all stages of CKD. Mean values of eGFR did not differ across categories of MMSE or between groups with high and low score on the GDS-15. Stratification for albuminuria did not change these results.

Conclusions: Older persons in more advanced stages of CKD did not have lower cognitive scores or higher rates of depressive symptoms than older persons in earlier stages. Future longitudinal studies might give information on the possible effect of kidney function on cognition and mood in late life.

Trial Registration: This study was registered prospectively on 25th February 2016 at clinicaltrials.gov ( NCT02691546 ).
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http://dx.doi.org/10.1186/s12877-020-01707-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7531080PMC
October 2020

The screening for chronic kidney disease among older people across Europe (SCOPE) project: findings from cross-sectional analysis.

BMC Geriatr 2020 10 2;20(Suppl 1):316. Epub 2020 Oct 2.

Italian National Research Center on Aging (IRCCS INRCA), Ancona, Fermo and Cosenza, Cosenza, Italy.

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http://dx.doi.org/10.1186/s12877-020-01701-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7531078PMC
October 2020

Prevalence of sarcopenia in community-dwelling older adults using the updated EWGSOP2 definition according to kidney function and albuminuria : The Screening for CKD among Older People across Europe (SCOPE) study.

BMC Geriatr 2020 10 2;20(Suppl 1):327. Epub 2020 Oct 2.

Geriatric Unit, Internal Medicine Department, Hospital Universitari de Bellvitge, Systemic Diseases and Ageing Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.

Background: Loss of muscle mass and function may be more pronounced in older adults with chronic kidney disease (CKD) and with albuminuria. Thus, we investigated the prevalence of sarcopenia among community-dwelling older adults according to kidney function and grade of albuminuria. We also explored differences in the prevalence of sarcopenia according to three different equations for the estimation of glomerular filtration rate (eGFR).

Methods: A cross-sectional analysis of 1420 community-dwelling older adults (≥75 years old) included in the SCOPE study, a multicenter prospective cohort study, was conducted. Comprehensive geriatric assessment including short physical performance battery (SPPB), handgrip strength test and bioelectrical impedance analysis (BIA) was performed. Sarcopenia was defined using the updated criteria of the European Working Group on Sarcopenia in Older People (EWGSOP2). eGFR was calculated using Berlin Initiative Study (BIS), Chronic Kidney Disease Epidemiological Collaboration (CKD-EPI) and Full Age Spectrum (FAS) equations, and urinary albumin-to-creatinine ratio (ACR) was collected to categorize CKD according to Kidney Disease Improving Global Outcomes guidelines.

Results: Median age was 79.5 years (77.0-83.0), 804 (56.6%) were women. Using EWGSOP2 definition, 150 (10.6%) participants met diagnostic criteria for sarcopenia. Moreover, 85 (6%) participants had severe sarcopenia. Sarcopenia was more prevalent in participants with more advanced stages of CKD according to BIS eq. (9.6% in stages 1 and 2 and 13.9% in stages 3a, 3b and 4, p = 0.042), and also according to CKD-EPI (9.8% vs. 14.2%, p = 0.042) and FAS although not reaching statistical signification (9.8% vs. 12.7%, p = 0.119). Thus, differences in prevalence are observed among CKD categories as estimated by different equations. Prevalence of sarcopenia was also higher with increasing albuminuria categories: 9.3% in normoalbuminuric, 13.2% in microalbuminuric and 16.8% in macroalbuminuric participants, (p = 0.019).

Conclusions: Sarcopenia is common among community-dwelling older adults, especially among those with more advanced CKD categories, with prevalence estimates differing slightly depending on the equation used for the estimation of eGFR; as well as among those with higher albuminuria categories.
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http://dx.doi.org/10.1186/s12877-020-01700-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7531109PMC
October 2020

Association between kidney function, nutritional status and anthropometric measures in older people : The Screening for CKD among Older People across Europe (SCOPE) study.

BMC Geriatr 2020 10 2;20(Suppl 1):366. Epub 2020 Oct 2.

Department of Geriatrics, Healthy Ageing Research Centre, Medical University of Lodz, Łódź, Poland.

Background: Different mechanisms connect the nutritional status with the occurrence and the course of chronic kidney disease (CKD). The end-stage renal disease is complicated by catabolic inflammatory reactions and cachexia which leads to malnutrition (undernutrition). On the other hand, obesity is an important risk factor for the development and acceleration of CKD.

Methods: In the SCOPE study, community-dwelling persons aged 75 years and over, from 6 European countries and Israel were examined at the baseline phase. We assessed the relationship between anthropometric measures (Body Mass Index (BMI), circumferences of arm (AC), waist (WC), hip (HC), and calf (CC), waist-to-hip ratio - WHR, waist-to-height ratio - WHtR, risk of malnutrition (Mini Nutritional Assessment - MNA), serum albumin) and estimated glomerular filtration rate (eGFR) calculated by Berlin Initiative Study (BIS) equation.

Results: We studied 2151 subjects (932 men and 1219 women) with a mean age of 79.5 ± 5.9 years. A total of 1333 (62%) participants had CKD (GRF < 60 ml/min/1.73 m). Negative correlations between eGFR and weight, AC, WC, HC, CC, BMI, WHtR were observed. Positive correlation occurred between eGFR and MNA score (Spearman's rho = 0.11) and albumin concentration (rho = 0.09). Higher weight, AC, WC, HC, CC, BMI and WHtR increased the odds ratio of CKD; higher MNA (OR = 0.98, 95% CI 0.94-1.0) and higher serum albumin (OR = 0.73, 95% CI 0.53-1.0) were weakly associated with reduced odds. The risk of malnutrition was the highest with eGFR < 30 as compared to eGFR > 60 (OR = 2.95, 95%CI = 1.77-4.94 for MNA < 24; OR = 5.54, 95%CI = 1.66-18.5 for hypoalbuminemia < 3.5 g/dL).

Conclusion: The population of community dwelling people aged 75+ with CKD shows general features of overweight and obesity with a small prevalence of malnutrition. For anthropometric measures, the strongest association with eGFR and the highest odds of CKD were identified using WC, HC, CC and WHtR. Albumin level and MNA, but not MNA Short Form, indicated an increased odds of malnutrition with a decrease in eGFR.
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http://dx.doi.org/10.1186/s12877-020-01699-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7531088PMC
October 2020

Kidney function and other factors and their association with falls : The screening for CKD among older people across Europe (SCOPE) study.

BMC Geriatr 2020 10 2;20(Suppl 1):320. Epub 2020 Oct 2.

Department of Internal Medicine-Geriatrics, Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.

Background: Reduced kidney function has become a major public health concern, especially among older people, as Chronic Kidney Disease (CKD) is associated with increased risk of end stage renal disease and mortality. Falls are a serious negative health outcome in older persons with one third of people aged 65 years experiencing a fall per year and increasing fall rates with increasing age. The impact of CKD on falls in older community-dwelling persons is not well investigated. Additionally, lower urinary tract symptoms (LUTS) may also increase the risk of falls. Therefore, our aim was to investigate the impact of CKD and LUTS on falls as well as on injurious falls.

Methods: The SCOPE study is an observational, multinational, multicenter, prospective cohort study involving community-dwelling older persons aged 75 years and more recruited from August 2016 to March 2018 in seven European countries. The main outcomes of the present study were any falls and any injurious falls during the 12 months before enrolment. The cross-sectional association of estimated glomerular filtration rate (eGFR) and LUTS with study outcomes was investigated by logistic regression analysis adjusted for baseline characteristics of enrolled subjects.

Results: Our series consisted of 2256 SCOPE participants (median age = 79.5 years, 55.7% female). Of them, 746 participants experienced a fall and 484 reported an injurious fall in the 12 months prior to baseline assessment. CKD was not significantly associated with falls (OR = 0.95, 95%CI = 0.79-1.14 for eGFR< 60; OR = 1.02, 95%CI = 0.81-1.28 for eGFR< 45; OR = 1.08, 95%CI = 0.74-1.57 for eGFR< 30) or injurious falls (OR = 0.91, 95%CI = 0.67-1.24 for eGFR< 60; OR = 0.93, 95%CI = 0.63-1.37 for eGFR< 45; OR = 1.19, 95%CI = 0.62-2.29 for eGFR< 30). LUTS were found significantly associated with both falls (OR = 1.56, 95%CI = 1.29-1.89) and injurious falls (OR = 1.58, 95%CI = 1.14-2.19), and such associations were confirmed in all multivariable models.

Conclusions: Cross-sectional data suggest that CKD may not be associated with history of falls or injurious falls, whereas LUTS is significantly associated with the outcomes.

Trial Registration: This study was registered on 25th February 2016 at clinicaltrials.gov ( NCT02691546 ).
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http://dx.doi.org/10.1186/s12877-020-01698-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7531089PMC
October 2020

Impaired kidney function is associated with lower quality of life among community-dwelling older adults : The screening for CKD among older people across Europe (SCOPE) study.

BMC Geriatr 2020 10 2;20(Suppl 1):340. Epub 2020 Oct 2.

Department of Physical Therapy, Recanati School for Community Health Professions at the faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-sheva, Israel.

Background: Quality of life (QoL) refers to the physical, psychological, social and medical aspects of life that are influenced by health status and function. The purpose of this study was to measure the self-perceived health status among the elderly population across Europe in different stages of Chronic Kidney Disease (CKD).

Methods: Our series consisted of 2255 community-dwelling older adults enrolled in the Screening for Chronic Kidney Disease (CKD) among Older People across Europe (SCOPE) study. All patients underwent a comprehensive geriatric assessment (CGA), including included demographics, clinical and physical assessment, number of medications taken, family arrangement, Geriatric Depression Scale (GDS), Cumulative Illness Rating Scale, History of falls, Lower urinary tract symptoms, and Short Physical Performance Battery (SPPB). Estimated glomerular filtration rate (eGFR) was calculated by Berlin Initiative Study (BIS) equation. Quality of life was assessed by Euro Qol questionnaire (Euro-Qol 5D) and EQ-Visual Analogue Scale (EQ-VAS). The association between CKD (eGFR < 60, < 45 ml or < 30 ml/min/1.73m) and low EQoL-VAS was investigated by multivariable logistic regression models.

Results: CKD was found to be significantly associated with low EQoL-VAS in crude analysis (OR = 1.47, 95%CI = 1.16-1.85 for eGFR< 60; OR = 1.38, 95%CI = 1.08-1.77 for eGFR< 45; OR = 1.57, 95%CI = 1.01-2.44). Such association was no longer significant only when adjusting for SPPB (OR = 1.20, 95%CI = 0.93-1.56 for eGFR< 60; OR = 0.87, 95%CI = 0.64-1.18 for eGFR< 45; OR = 0.84, 95%CI = 0.50-1.42), CIRS and polypharmacy (OR = 1.16, 95%CI = 0.90-1.50 for eGFR< 60; OR = 0.86, 95%CI = 0.64-1.16 for eGFR< 45; OR = 1.11, 95%CI = 0.69-1.80) or diabetes, hypertension and chronic obstructive pulmonary disease (OR = 1.28, 95%CI = 0.99-1.64 for eGFR< 60; OR = 1.16, 95%CI = 0.88-1.52 for eGFR< 45; OR = 1.47, 95%CI = 0.92-2.34). The association between CKD and low EQoL-VAS was confirmed in all remaining multivariable models.

Conclusions: CKD may significantly affect QoL in community-dwelling older adults. Physical performance, polypharmacy, diabetes, hypertension and COPD may affect such association, which suggests that the impact of CKD on QoL is likely multifactorial and partly mediated by co-occurrent conditions/risk factors.
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http://dx.doi.org/10.1186/s12877-020-01697-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7530949PMC
October 2020

Chronic kidney disease in the context of multimorbidity patterns: the role of physical performance : The screening for CKD among older people across Europe (SCOPE) study.

BMC Geriatr 2020 10 2;20(Suppl 1):350. Epub 2020 Oct 2.

Italian National Research Center on Aging (IRCCS INRCA), Ancona, Fermo and Cosenza, Italy.

Background: Chronic kidney disease (CKD) is known to be associated with several co-occurring conditions. We aimed at exploring multimorbidity patterns associated with CKD, as well as the impact of physical performance and CKD severity on them in a population of older outpatients.

Methods: Our series consisted of 2252 patients enrolled in the Screening of CKD among Older People across Europe multicenter observational study. Hypertension, stroke, transient ischemic attack, cancer, hip fracture, osteoporosis, Parkinson's disease, asthma, chronic obstructive pulmonary disease, congestive heart failure, angina, myocardial infarction, atrial fibrillation, anemia, CKD (defined as GFR < 60, < 45 or < 30 ml/min/1.73 m), cognitive impairment, depression, hearing impairment and vision impairment were included in the analyses. Physical performance was assessed by the Short Physical Performance Battery (SPPB) and used as stratification variable. Pairs of co-occurring diseases were analyzed by logistic regression. Patterns of multimorbidity were investigated by hierarchical cluster analysis.

Results: CKD was among the most frequently observed conditions and it was rarely observed without any other co-occurring disease. CKD was significantly associated with hypertension, anemia, heart failure, atrial fibrillation, myocardial infarction and hip fracture. When stratifying by SPPB, CKD was also significantly associated with vision impairment in SPPB = 5-8 group, and hearing impairment in SPPB = 0-4 group. Cluster analysis individuated two main clusters, one including CKD, hypertension and sensory impairments, and the second including all other conditions. Stratifying by SPPB, CKD contribute to a cluster including diabetes, anemia, osteoporosis, hypertension and sensory impairments in the SPPB = 0-4 group. When defining CKD as eGFR< 45 or 30 ml/min/1.73 m, the strength of the association of CKD with hypertension, sensory impairments, osteoporosis, anemia and CHF increased together with CKD severity in pairs analysis. Severe CKD (eGFR< 30 ml/min/1.73 m) contributed to a wide cluster including cardiovascular, respiratory and neurologic diseases, as well as osteoporosis, hip fracture and cancer.

Conclusions: CKD and its severity may contribute significantly to specific multimorbidity patterns, at least based on the cluster analysis. Physical performance as assessed by SPPB may be associated with not negligible changes in both co-occurring pairs and multimorbidity clusters.

Trial Registration: The SCOPE study is registered at clinicaltrials.gov ( NCT02691546 ).
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http://dx.doi.org/10.1186/s12877-020-01696-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7532089PMC
October 2020

Preserving Mobility in Older Adults with Physical Frailty and Sarcopenia: Opportunities, Challenges, and Recommendations for Physical Activity Interventions.

Clin Interv Aging 2020 16;15:1675-1690. Epub 2020 Sep 16.

Institute for Biomedicine of Aging, FAU Erlangen-Nürnberg, Nürnberg, Germany.

One of the most widely conserved hallmarks of aging is a decline in functional capabilities. Mobility loss is particularly burdensome due to its association with negative health outcomes, loss of independence and disability, and the heavy impact on quality of life. Recently, a new condition, physical frailty and sarcopenia, has been proposed to define a critical stage in the disabling cascade. Physical frailty and sarcopenia are characterized by weakness, slowness, and reduced muscle mass, yet with preserved ability to move independently. One of the strategies that have shown some benefits in combatting mobility loss and its consequences for older adults is physical activity. Here, we describe the opportunities and challenges for the development of physical activity interventions in people with physical frailty and sarcopenia. The aim of this article is to review age-related physio(patho)logical changes that impact mobility in old age and to provide recommendations and procedures in accordance with the available literature.
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http://dx.doi.org/10.2147/CIA.S253535DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7508031PMC
January 2021

The effect of different test protocols and walking distances on gait speed in older persons.

Aging Clin Exp Res 2021 Jan 15;33(1):141-146. Epub 2020 Sep 15.

Institute for Biomedicine of Aging, Friedrich-Alexander-University of Erlangen-Nürnberg, Kobergerstr. 60, 90408, Nuremberg, Germany.

Background And Aims: Walking is the core physical activity of older persons. The assessment of walking capacity is increasingly important for clinical purposes and clinical research. Differences between assessment tools and protocols for short walks to obtain gait characteristics can be responsible for changes, e.g., in gait speed from 0.1 to 0.2 m/s. The purpose of this study was to generate further knowledge for the harmonization and/or standardization of short walk-test protocols for assessing gait characteristics under supervised conditions.

Methods: For this cross-sectional study, 150 community-dwelling older adults (mean age 80.5 ± 4.5 years) were recruited. Participants performed eight walks differing in the distance (8-versus 4-m), static versus dynamic trials and comparing different test speed instructions (usual versus maximal) on an electronic walkway.

Results: A meaningful significant difference in mean usual gait speed was documented comparing the 4-m dynamic and static test protocol (0.12 m/s; p = 0.001). For the same comparison over an 8-m distance (dynamic versus static) and for the comparison between usual gait speed over 4-and 8-m, the differences in gait speed were smaller, but still statistically significant (p = 0.001).

Conclusions: Gait speed was faster, if the test protocol did not include a static start or stop. The differences were greater for a shorter walking distance. This aspect should be considered for the comparison of study results and is particularly relevant for systematic reviews and meta-analyses.
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http://dx.doi.org/10.1007/s40520-020-01703-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7897617PMC
January 2021

Components of the transitional care model (TCM) to reduce readmission in geriatric patients: a systematic review.

BMC Geriatr 2020 09 11;20(1):345. Epub 2020 Sep 11.

Institute of Biomedicine of Aging, Nuremberg, Friedrich-Alexander-University Erlangen-Nuremberg, Kobergerstr. 60, 90408, Nuremberg, Germany.

Background: Demographic changes are taking place in most industrialized countries. Geriatric patients are defined by the European Union of Medical Specialists as aged over 65 years and suffering from frailty and multi-morbidity, whose complexity puts a major burden on these patients, their family caregivers and the public health care system. To counteract negative outcomes and to maintain consistency in care between hospital and community dwelling, the transitional of care has emerged over the last several decades. Our objectives were to identify and summarize the components of the Transitional Care Model implemented with geriatric patients (aged over 65 years, with multi-morbidity) for the reduction of all-cause readmission. Another objective was to recognize the Transitional Care Model components' role and impact on readmission rate reduction on the transition of care from hospital to community dwelling (not nursing homes).

Methods: Randomized controlled trials (sample size ≥50 participants per group; intervention period ≥30 days), with geriatric patients were included. Electronic databases (MEDLINE, CINAHL, PsycINFO and The Cochrane Central Register of Controlled Trials) were searched from January 1994 to December 2019 published in English or German. A qualitative synthesis of the findings as well as a systematic assessment of the interventions intensities was performed.

Results: Three articles met the inclusion criteria. One of the included trials applied all of the nine Transitional Care Model components described by Hirschman and colleagues and obtained a high-intensity level of intervention in the intensities assessment. This and another trial reported reductions in the readmission rate (p < 0.05), but the third trial did not report significant differences between the groups in the longer follow-up period (up to 12 months).

Conclusions: Our findings suggest that high intensity multicomponent and multidisciplinary interventions are likely to be effective reducing readmission rates in geriatric patients, without increasing cost. Components such as type of staffing, assessing and managing symptoms, educating and promoting self-management, maintaining relationships and fostering coordination seem to have an important role in reducing the readmission rate. Research is needed to perform further investigations addressing geriatric patients well above 65 years old, to further understand the importance of individual components of the TCM in this population.
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http://dx.doi.org/10.1186/s12877-020-01747-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7488657PMC
September 2020

[Mobility and Fall Prevention in older Community-dwelling Persons].

Dtsch Med Wochenschr 2020 07 2;145(13):932-943. Epub 2020 Jul 2.

An increasing proportion of oldest old persons (over 80 years) accompanies the demographic change. Furthermore, the gender ration will also change and the percentage of older men will increase. Mobility is an important factor for maintaining independence and for "healthy aging". Mobility has to be regarded in the context of individual and environmental factors. With increasing age, the risk of mobility limitation increases. Next to mobility, falls are also a drastic experience for older persons and cannot only have physical consequences like injuries but also psychological consequences as fall-related psychological concerns. These psychological consequences can produce negative behavior e. g. reducing physical activity.
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http://dx.doi.org/10.1055/a-0922-7535DOI Listing
July 2020

Safety of a Combined WB-EMS and High-Protein Diet Intervention in Sarcopenic Obese Elderly Men.

Clin Interv Aging 2020 24;15:953-967. Epub 2020 Jun 24.

Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany.

Purpose: Whole-body electromyostimulation (WB-EMS) especially in combination with a high-protein supplementation has been established as an efficient treatment against sarcopenia. However, there are several case reports of rhabdomyolysis after WB-EMS application. Thus, we asked if this training could potentially lead to deteriorations of the cardiac as well as the renal function.

Materials And Methods: One hundred sarcopenic obese men aged 70 years and older were randomly balanced (1-1-1) and allocated to one of the three study arms. During 16 weeks of intervention, these groups either performed WB-EMS and took a protein supplement (WB-EMS&P), solely received the protein supplement (Protein) or served as control group (CG). WB-EMS consisted of 1.5×20 min (85 Hz, 350 μs, 4 s of strain to 4 s of rest) applied with moderate-to-high intensity while moving. We further generated a daily protein intake of 1.7-1.8 g/kg/body mass per day. At baseline and 8-10 days after completion of the intervention, blood was drawn and biomarkers of muscle, cardiac and renal health were assessed.

Results: Hereby, we found slight but significant elevations of creatine kinase (CK) levels in the WB-EMS group pointing to minor damages of the skeletal muscle (140 U/l [81-210], p < 0.001). This was accompanied by a significant, low-grade increase of creatine kinase-muscle brain (CK-MB, 0.43 ng/mL [-0.29-0.96], p < 0.01) and high-sensitivity troponin T (hsTnT, 0.001 ng/mL. [0.000-0.003], p < 0.001) but without a higher risk of developing heart failure according to N-terminal prohormone of brain natriuretic peptide (NT-proBNP, -5.7 pg/mL [-38.8-24.6], p = 0.17). Estimated glomerular filtration rate (eGFR) was impaired neither by the high-protein supplementation alone nor in combination with WB-EMS (CG 76.0 mL/min/1.73 m [71.9-82.2] vs Protein 73.2 mL/min/1.73 m [63.0-78.9] vs WB-EMS&P 74.6 mL/min/1.73 m [62.8-84.1], p = 0.478).

Conclusion: In conclusion, even in the vulnerable group of sarcopenic obese seniors, the combination of WB-EMS with a high-protein intake revealed no short-term, negative impact on the eGFR, but potential consequences for the cardiovascular system need to be addressed in future studies.
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http://dx.doi.org/10.2147/CIA.S248868DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7322975PMC
October 2020

The Relationship Between Healthy Eating Motivation and Protein Intake in Community-Dwelling Older Adults With Varying Functional Status.

Nutrients 2020 Feb 28;12(3). Epub 2020 Feb 28.

Institute for Biomedicine of Aging, Friedrich-Alexander-University of Erlangen-Nürnberg, Kobergerstraße 60, 90408 Nürnberg, Germany.

In older adults, the relationship between healthy eating motivation (HEM) and protein intake as key component of a healthy diet is poorly understood. Therefore, we investigate the association of HEM with (1) total protein intake and (2) intake of different protein sources in older adults with varying functional status. In this cross-sectional study including 250 adults (≥70 years), we assessed HEM with "The Eating Motivation Survey" and protein intake by 7-day food records. In addition, gender, age, Body Mass Index (BMI), energy intake and functional status were considered. Regression analyses revealed that HEM was neither related to total ( = -0.02; = 0.723) nor to relative protein intake ( = 0.04; = 0.370). Notwithstanding this, participants with stronger HEM showed lower intake of protein from meat and meat products ( = -0.14 = 0.018), higher intake of overall plant-based protein ( = 0.11 = 0.032), protein from fruit and vegetables ( = 0.20 = 0.002) and from pulses, nuts an seeds ( = 0.16 = 0.016). Our findings suggest HEM as a valuable indicator for intake of distinct protein sources. However, since HEM is not related to total protein intake, the importance of sufficient protein consumption should be emphasized by promoting healthy eating, regardless of self-perceived HEM.
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http://dx.doi.org/10.3390/nu12030662DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7146591PMC
February 2020

German Version of SARC-F: Translation, Adaption, and Validation.

J Am Med Dir Assoc 2020 06 21;21(6):747-751.e1. Epub 2020 Jan 21.

Institut für Biomedizin des Alterns, FAU Erlangen-Nürnberg, Nürnberg, Germany.

Objectives: Translation, adaptation, and validation of the German version of the SARC-F for community-dwelling older adults in Germany.

Design: Cross-sectional.

Setting And Participants: 117 community-dwelling outpatients with a mean age of 79.1 ± 5.2 years were included in the study; 94 (80.4%) of them were female. Sixty-three (53.8%) had a positive SARC-F score of ≥4 points. According to the definition of sarcopenia from the European Working Group on Sarcopenia in Older People (EWGSOP2), 8 patients (6.8%) were identified as sarcopenic and 57 (48.7%) as probable sarcopenic.

Methods: According to EWGSOP2, probable sarcopenia was defined for patients with reduced hand grip strength (women: <16.0 kg; men: <27.0 kg) and/or impaired chair-rise time (both genders: >15 seconds). Patients with additional low skeletal muscle index were classified as sarcopenic (women: <5.5 kg/m; men: <7.0 kg/m). Translation and cultural adaption was composed of 7 different steps that were in general based on the guidelines put forward by the World Health Organization. Validation include test-retest and the inter-rater reliability (intraclass correlation coefficient) as well as internal consistency (Cronbach alpha). Furthermore, sensitivity, specificity, positive predictive value, and negative predictive value of the SARC-F were calculated. Receiver-operating characteristic analysis was performed to calculate the area under the curve.

Results: The translated and culturally adapted version of the SARC-F for the German language has shown excellent inter-rater reliability and good test-retest reliability. The internal consistency is acceptable. Sensitivity (63%) and specificity (47%) for sarcopenia is low. For detecting patients with probable sarcopenia, the SARC-F in the German version has shown 75% sensitivity and 67% specificity.

Conclusions And Implications: Because of a low sensitivity for detecting sarcopenia but an acceptable sensitivity for identifying probable sarcopenia, the German version of the SARC-F is a suitable tool for case finding of probable sarcopenia.
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http://dx.doi.org/10.1016/j.jamda.2019.12.011DOI Listing
June 2020

A systematic review on the influence of fear of falling on quality of life in older people: is there a role for falls?

Clin Interv Aging 2019 24;14:701-719. Epub 2019 Apr 24.

Institute for Biomedicine of Aging, Friedrich-Alexander University Erlangen-Nürnberg, Nuremberg, Germany.

Maintaining or improving quality of life (QoL) is a key outcome of clinical interventions in older people. Fear of falling (FoF) is associated with activity restriction as well as with poorer physical and cognitive functions and may be an important contributor to a diminished QoL. The objectives of this systematic review were to determine i) the effect of FoF on QoL in older people, ii) whether the association between these two constructs depends on the use of specific conceptualizations and measurement instruments, and iii) the role of fall events as mediating factor in this relationship. Four electronic databases (PubMed, EMBASE, CINAHL, and Cochrane Library) were searched from their inceptions to February 2018. Thirty mostly cross-sectional studies in nearly 30.000 people (weighted mean age 75.6 years (SD =6.1); 73% women) were included. FoF was associated with QoL in most studies, and this association appeared to be independent of the conceptualization of FoF. Moreover, this relationship was independent of falls people experienced which seemed to have a lower impact. FoF should be considered not only as by-product of falls and targeted interventions in parts different from those to reduce falls are likely required. Studies are needed showing that reducing FoF will lead to increased QoL.
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http://dx.doi.org/10.2147/CIA.S197857DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6514257PMC
September 2019

Balance and mobility in geriatric patients : Assessment and treatment of neurological aspects.

Z Gerontol Geriatr 2019 Jul 3;52(4):316-323. Epub 2019 Jun 3.

Molecular Neurology, University Hospital, Erlangen, Germany.

Background: Personal autonomy in advanced age critically depends on mobility in the environment. Geriatric patients are often not able to walk safely with sufficient velocity. In many cases, multiple factors contribute to the deficit. Diagnostic identification of single components enables a specific treatment.

Objective: This article describes the most common neurological causes of imbalance and impaired gait that are relevant for a pragmatic approach for the assessment of deficits in clinical and natural environments taking into account the physiology of balance and gait control, typical morbidities in older people and the potential of innovative assessment technologies.

Material And Methods: Expert opinion based on a narrative review of the literature and with reference to selected research topics.

Results And Discussion: Common neurological causes of impaired balance and mobility are sensory deficits (reduced vision, peripheral neuropathy, vestibulopathy), neurodegeneration in disorders with an impact on movement control and motoric functions (Parkinsonian syndromes, cerebellar ataxia, vascular encephalopathy) and functional (psychogenic) disorders, particularly a fear of falling. Clinical tests and scores in laboratory environments are complemented by the assessment in the natural environment. Wearable sensors, mobile smartphone-based assessment of symptoms and functions and adopted strategies for analysis are currently emerging. Use of these data enables a personalized treatment. Furthermore, sensor-based assessment ensures that effects are measured objectively.
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http://dx.doi.org/10.1007/s00391-019-01561-zDOI Listing
July 2019

Concern About Falling Is Associated With Gait Speed, Independently From Physical and Cognitive Function.

Phys Ther 2019 08;99(8):989-997

Neuroscience Research Australia, Margarete Ainsworth Building, University of New South Wales, Barker Street, Randwick NSW 2031, Australia.

Background: Higher levels of concern about falling in older people have been associated with slower walking speed and an increased risk of falls. However, it is unclear whether this relationship is independent or confounded by other fall risk factors, such as physical and cognitive function.

Objective: The aim of this study was to examine the effects of concern about falling on gait speed, adjusted for physiological fall risk and cognitive function.

Design: This was an observational, cross-sectional study.

Methods: A total of 204 community-dwelling older people aged 70 years or older were recruited from 2 sites (Germany, n = 94; Australia, n = 110). Walking speed was measured over 6 m under 4 conditions: preferred speed, fast speed, speed while carrying a tray (functional dual task), and speed while answering a question (cognitive dual task). The Falls Efficacy Scale-International was used to assess concern about falling, the Physiological Profile Assessment was used to assess physiological fall risk, and the Digit Symbol Substitution Test and Trail Making Test were used to assess attention and executive function.

Results: Higher levels of concern about falling were associated with slower gait speed. Following adjustment for age, history of falls, and female sex, and further adjustment for physical and cognitive function, the association between concern about falling and walking speed remained significant, with a considerable effect size (standardized β = 0.18 ± 0.08; P = .037).

Limitations: The use of walking speed as a sole measure of gait was a limitation of this study.

Conclusions: Gait speed, especially under dual-task conditions, was affected by concern about falling. Concern about falling was the strongest predictor of gait speed under all 4 conditions and should be included in routine geriatric assessments.
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http://dx.doi.org/10.1093/ptj/pzz032DOI Listing
August 2019

Measuring eating motives in older adults with and without functional impairments with The Eating Motivation Survey (TEMS).

Appetite 2019 06 15;137:1-20. Epub 2019 Feb 15.

Friedrich-Alexander-University of Erlangen-Nürnberg, Institute for Biomedicine of Aging, Kobergerstraße 60, 90408, Nürnberg, Germany.

Gaining a better understanding which motives play a role in daily eating is crucial in order to develop personalized interventions promoting adequate diet. The Eating Motivation Survey (TEMS) is a comprehensive tool to assess manifold reasons for eating but has not been specifically applied in an older sample including very old persons and persons differing in functional status. Therefore, the first step of the study was to investigate whether the basic motives of TEMS are consistent in an older sample and comparable across older adults with and without functional impairments. Second, the study aimed at describing which motives underlie eating behavior in older age most often as well as to analyze the relationship between eating motives and functional status. 376 community-dwelling older persons aged 70 years and older filled in the brief survey version (15 motives à 3 items) of TEMS. The sample comprises 149 unimpaired and 227 impaired participants in terms of physical function. Confirmatory factor analysis yielded good model fit with RMSEA 0.036 and SRMR 0.048. Furthermore, multi-group analysis revealed a generally invariant factor structure across participants with and without functional impairments. Liking was rated to underlie eating behavior most often, followed by Health and Natural Concerns. Considering gender, age and BMI, significant associations between functional status and the motive Sociability emerged. Since the results suggest that the fifteen basic eating motives are generalizable in older age and across different functional states, TEMS might be a valuable tool in nutrition-related health promotion to developing individualized approaches considering health aspects as well as hedonistic factors.
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http://dx.doi.org/10.1016/j.appet.2019.01.024DOI Listing
June 2019
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