Search

Background: Sarcopenia is an age-associated skeletal muscle condition characterized by low muscle mass, strength, and physical performance. There is no international consensus on a sarcopenia definition and no contemporaneous clinical and research guidelines specific to Australia and New Zealand. The Australian and New Zealand Society for Sarcopenia and Frailty Research (ANZSSFR) Sarcopenia Diagnosis and Management Task Force aimed to develop consensus guidelines for sarcopenia prevention, assessment, management and research, informed by evidence, consumer opinion, and expert consensus, for use by health professionals and researchers in Australia and New Zealand. Methods: A four-phase modified Delphi process involving topic experts and informed by consumers, was undertaken between July 2020 and August 2021. Phase 1 involved a structured meeting of 29 Task Force members and a systematic literature search from which the Phase 2 online survey was developed (Qualtrics). Topic experts responded to 18 statements, using 11-point Likert scales with agreement threshold set a priori at >80%, and five multiple-choice questions. Statements with moderate agreement (70%–80%) were revised and re-introduced in Phase 3, and statements with low agreement (80%) were confirmed by the Task Force in Phase 4. Conclusions: The ANZSSFR Task Force present 17 sarcopenia management and research recommendations for use by health professionals and researchers which includes the recommendation to adopt the EWGSOP2 sarcopenia definition in Australia and New Zealand. This rigorous Delphi process that combined evidence, consumer expert opinion and topic expert consensus can inform similar initiatives in countries/regions lacking consensus on sarcopenia.

Background: Falls risk assessment tools are used in hospital inpatient settings to identify patients at increased risk of falls to guide and target interventions for fall prevention. In 2022, Western Health, Melbourne, Australia, introduced a new falls risk assessment tool, the Western Health St. Thomas’ Risk Assessment Tool (WH-STRATIFY), which adapted The Northern Hospital’s risk tool (TNH-STRATIFY) by adding non-English speaking background and falls-risk medication domains to reflect patient demographics. WH-STRATIFY replaced Peninsula Health Risk Screening Tool (PH-FRAT) previously in use at Western Health. This study compared the predictive accuracy of the three falls risk assessment tools in an older inpatient high-risk population. Aims: To determine the predictive accuracy of three falls risk assessment tools (PH-FRAT, TNH-STRATIFY, and WH-STRATIFY) on admission to Geriatric Evaluation Management (GEM) units (subacute inpatient wards where the most frail and older patients rehabilitate under a multi-disciplinary team). Method: A retrospective observational study was conducted on four GEM units. Data was collected on 54 consecutive patients who fell during admission and 62 randomly sampled patients who did not fall between December 2020 and June 2021. Participants were scored against three falls risk assessment tools. The event rate Youden (Youden IndexER) indices were calculated and compared using default and optimal cut points to determine which tool was most accurate for predicting falls. Results: Overall, all tools had low predictive accuracy for falls. Using default cut points to compare falls assessment tools, TNH-STRATIFY had the highest predictive accuracy (Youden IndexER = 0.20, 95% confidence interval CI = 0.07, 0.34). The PH-FRAT (Youden IndexER = 0.01 and 95% CI = −0.04, 0.05) and WH-STRATIFY (Youden IndexER = 0.00 and 95% CI = −0.04, 0.03) were statistically equivalent and not predictive of falls compared to TNH-STRATIFY. When calculated optimal cut points were applied, predictive accuracy improved for PH-FRAT (Cut point 17, Youden IndexER = 0.14 and 95% CI = 0.01, 0.29) and WH-STRATIFY (Cut point 7, Youden IndexER = 0.18 and 95% CI = 0.00, 0.35). Conclusions: TNH-STRATIFY had the highest predictive accuracy for falls. The predictive accuracy of WH-STRATIFY improved and was significant when the calculated optimal cut point was applied. The optimal cut points of falls risk assessment tools should be determined and validated in different clinical settings to optimise local predictive accuracy, enabling targeted fall risk mitigation strategies and resource allocation.

PurposeTo compare the diagnostic value of relative sit-to-stand muscle power with grip strength or gait speed for identifying a history of recurrent falls and fractures in older adults.MethodsData from an outpatient clinic included anthropometry (height/weight), bone density, 5 times sit-to-stand time (stopwatch and standardized chair), grip strength (hydraulic dynamometer), and gait speed (4 m). Relative sit-to-stand muscle power (W.kg−1, normalised to body mass) was calculated using a validated equation. Outcomes of falls (past 1 year) and fractures (past 5 years) were self-reported and verified by medical records wherever possible. Binary logistic regression considering for potential confounders (age, sex, BMI, Charlson comorbidity index, femoral neck bone density) and receiver operating characteristics (ROC) curves were used in statistical analysis.Results508 community-dwelling older adults (median age: 78 years, interquartile range: 72, 83, 75.2% women) were included. Compared to greater relative sit-to-stand muscle power (1.62–3.78W.kg−1 for women; 2.03–3.90W.kg−1 for men), those with extremely low relative sit-to-stand muscle power were 2.35 (95% CI 1.54, 3.60, p ConclusionRelative sit-to-stand muscle power performed slightly (but not statistically) better than grip strength or gait speed for identifying a history of recurrent falls and fractures in older adults. However, all tests showed low diagnostic power.

Objectives Sarcopenia Definitions and Outcomes Consortium (SDOC) provides cut-points based on muscle weakness (low grip strength) and slowness (poor gait speed) for low-risk populations; however, it is unknown if these criteria apply to high-risk populations. We examined the association between SDOC criteria and important health status indicators in high-risk older persons. Design Cross-sectional study. Setting and Participants 356 community-dwelling older persons (median age: 79 years, interquartile range: 73, 83; 75.2% women) attending a falls and fractures clinic in Melbourne, Australia. Methods Grip strength (hydraulic dynamometer) and gait speed (over 4 m) were used to define sarcopenia using SDOC cut-points. Health measures included falls (past 1 year) and fractures (past 5 years) by self-report, and malnutrition, depression, balance confidence, fear of falling, static balance (limits of stability), dynamic balance (Four-Square Step Test), and body composition [body mass index and lean mass, fat mass, and bone density (via dual-energy x-ray absorptiometry)] were assessed using validated procedures. Fasting vitamin D and parathyroid hormone concentrations were measured by immunoassays. Participants were categorized as nonsarcopenic or sarcopenic based on the SDOC cut-points, and multivariate models were used to examine the association between sarcopenia and health status indicators while adjusting for confounding factors. Results After adjusting for covariates, sarcopenic older persons (n = 162, 45.5%) were positively associated with malnutrition [odds ratio (OR) 3.21, 95% confidence interval (CI) 1.63, 6.32], depression (OR 4.11, 95% CI 2.31, 7.29), fear of falling (OR 1.08, 95% CI 1.06, 1.10) as well as recurrent (2 or more) falls (OR 1.62, 95% CI 1.01, 2.59) and fractures (OR 2.26, 95% CI 1.17, 4.36), and negatively associated with poor balance confidence (OR 0.96, 95% CI 0.95, 0.97) (P Conclusions and Implications SDOC criteria are strongly associated with important health status indicators in high-risk older persons, which strengthens the clinical utility of the SDOC in these populations.

Advances in medicine have paved the way for older persons to live longer, but with more years spent living with disability and dependency. Many older persons are living with comorbidities such as osteoporosis (loss of bone mass) and sarcopenia (loss of muscle mass and function), two diseases that, when concurrent, form osteosarcopenia, a newly identified musculoskeletal syndrome. Osteosarcopenia impedes mobility and diminishes independence and thus quality of life. Evidence suggests the pathology of this syndrome comprises genetic polymorphisms, alterations in mechanotransduction, and localized or systemic crosstalk between growth factors and other proteins (myokines, osteokines, adipokines). As a direct result of an aging society, health outcomes such as falls and fractures will rise as the prevalence of osteosarcopenia increases. Two major risk factors for osteosarcopenia (other than age itself) are physical inactivity and poor nutrition. Addressing these modifiable risk factors can prevent, or at least delay, the onset of osteosarcopenia. Pharmaceutical treatments for osteosarcopenia are currently unavailable, although research trials are underway. This review provides an update from basic and clinical sciences on the biology, epidemiology (prevalence, risk factors and diagnosis) and treatments for osteosarcopenia, and recommends future research priorities to improve health outcomes for those living with or at risk of osteosarcopenia.

Osteosarcopenia is commonly accepted as the presence of low muscle mass and function (sarcopenia) and low bone mineral density (osteopenia and osteoporosis). Osteosarcopenia remains a topic of controversy as researchers worldwide seek to elucidate whether osteosarcopenia is associated with greater risk of negative outcomes than its component parts. This review examines the latest research and controversies, and charts a path forward. Osteosarcopenia may occur in 5–37% of community-dwelling adults over the age of 65. This wide range is driven by variation in population, setting, and definitions applied. These differences in study design have resulted in mixed findings in associations with adverse outcomes for older adults living with osteosarcopenia. Research into interventions to prevent or treat osteosarcopenia, such as exercise, protein supplementation, and pharmacotherapy, is in its infancy but examined herein. The absence of a consensus operational definition of sarcopenia, and inaccurate measures of muscle mass, has hampered global progress in the field. We present a case for the path forward by reflecting on our recent history.

We sought to examine the associations of osteosarcopenia with physical performance, balance, and falls and fractures in community-dwelling older adults. Additionally, we aimed to determine which clinical outcomes are associated with specific components of osteosarcopenia.Cross-sectional study.253 participants (77% women; aged 77.9 ± 0.42 years) who presented for a falls and fractures risk assessment in Melbourne, Australia.Participants were mobile, community-dwelling older adults (≥65 years) free of cognitive impairment. Body composition (via dual-energy x-ray absorptiometry), physical performance [via Timed Up and Go (TUG) and Short Physical Performance Battery (SPPB)], and balance [via Four-Square Step test (FSS) and posturography] were examined. Falls in the past year and fractures in the past 5 years were self-reported. Osteosarcopenia was defined as (1) low bone mineral density (BMD) [T score-1 standard deviation (SD)] combined with sarcopenia and (2) osteoporosis (BMD T score ≤-2.5 SD) combined with severe sarcopenia. For sarcopenia, we employed the criteria of the European Working Group on Sarcopenia in Older People (EWGSOP1), the revised criteria (EWGSOP2), and that of the Foundation for the National Institutes for Health (FNIH). Kruskal-Wallis and logistic regression tests were used for statistical analysis.Osteosarcopenia was associated with worse SPPB, TUG, FSS, limit of stability, and falls and fractures history. Additionally, osteosarcopenia (using the severe sarcopenia classification) conferred an increased rate of falls [odds ratios (ORs) from 2.83 to 3.63; P .05 for all] and fractures (ORs from 3.86 to 4.38; P .05 for all) when employing the EWGSOP2 and FNIH definitions, respectively.Compared with the nonosteosarcopenic group, those with osteosarcopenia had greater impairment of physical performance and balance. The EWGSOP2 and FNIH criteria resulted in the strongest associations with physical performance and self-reported falls and fractures.

Objectives: To develop guidelines, informed by health-care consumer values and preferences, for sarcopenia prevention, assessment and management for use by clinicians and researchers in Australia and New Zealand. Methods: A three-phase Consumer Expert Delphi process was undertaken between July 2020 and August 2021. Consumer experts included adults with lived experience of sarcopenia or health-care utilisation. Phase 1 involved a structured meeting of the Australian and New Zealand Society for Sarcopenia and Frailty Research (ANZSSFR) Sarcopenia Diagnosis and Management Task Force and consumer representatives from which the Phase 2 survey was developed. In Phase 2, consumers from Australia and New Zealand were surveyed online with opinions sought on sarcopenia outcome priorities, consultation preferences and interventions. Findings were confirmed and disseminated in Phase 3. Descriptive statistical analyses were performed. Results: Twenty-four consumers (mean ± standard deviation age 67.5 ± 12.8 years, 18 women) participated in Phase 2. Ten (42%) identified as being interested in sarcopenia, 7 (29%) were health-care consumers and 6 (25%) self-reported having/believing they have sarcopenia. Consumers identified physical performance, living circumstances, morale, quality of life and social connectedness as the most important outcomes related to sarcopenia. Consumers either had no preference (46%) or preferred their doctor (40%) to diagnose sarcopenia and preferred to undergo assessments at least yearly (54%). For prevention and treatment, 46% of consumers preferred resistance exercise, 2–3 times per week (54%). Conclusions: Consumer preferences reported in this study can inform the implementation of sarcopenia guidelines into clinical practice at local, state and national levels across Australia and New Zealand.

IntroductionImmunosenescence leads to increased morbidity and mortality associated with viral infections and weaker vaccine responses. This has been well documented for seasonal influenza and the current pandemic with Sars-Cov2, which disproportionately impact older adults, particularly those in residential aged care facilities. Inadequate nutrient intake associated with impaired immunity, respiratory and muscle function are likely to augment the effects of immunosenescence. In this study, we test whether the effects of inadequate nutrition can be reversed by multi-nutrient supplementation, consequently enhancing vaccine responses, reducing the risk of viral infections, and improving respiratory and muscle function.Methods and analysisThe Pomerium Study is a 12-week, single-blinded, randomised, placebo-controlled trial testing the effects of two daily servings of an oral multi-nutrient supplement (330 kcal, 20g protein, 1.2g CaHMB, 449mg calcium, 520IU vitamin D3, and 25 vitamins and minerals) on the immune system and muscle and respiratory function of older adults in aged-care in Melbourne, Australia. 160 older adults (≥75 years old) will be recruited from aged-care facilities and randomised to treatment (multi-nutrient supplement) or control (usual care). Primary outcome is the change in T-cell subsets CD8+ and CD28null counts at 4 and 12 weeks post-intervention. Secondary outcomes measured at baseline and after 12 weeks post-intervention are multiple markers of immunosenescence, body composition (bioimpedance), handgrip strength (dynamometer), physical function (short physical performance battery), respiratory function (spirometry), and quality of life (EQ-5D-3L). Incidence and complications of COVID-19 and/or viral infections (i.e., hospitalisation, complications, or death) will be recorded throughout the trial.DiscussionIf the Pomerium Study demonstrates efficacy and safety of a multi-nutrient supplement on immune, muscle and respiratory function, it may be suitable as a strategy to reduce the adverse outcomes from seasonal influenza and viral infections such as COVID-19 in older adults in aged-care.Funding, Ethics, Registration and DisseminationThe study is funded by the Australian Medical Research Future Fund. It is approved by Melbourne Health Human Research Ethics Committee (Ref No. HREC/73985/MH-2021, ERM Ref No. RMH73985, Melbourne Health Site Ref No. 2021.115), and registered at ANZCTR (12621000420842). Results will be published in peer-reviewed journals and made available to aged-care stakeholders, including providers, residents, and government bodies.Article Summary Strengths and LimitationsThis is the first study performing a comprehensive immune, respiratory and functional assessment in aged care residents after receiving a multi-nutrient solution that is commercially available.Our design and tested intervention assure that the results of the study will be rapidly translated into practice.The main limitation is that any biological effect observed cannot be attributed to one component of the multi-nutrient supplement.Another limitation is that the potential effect of group differences in energy intake on outcomes can only be monitored by assessing regular dietary intake and weight changes during the study period.

Background: Globally there are several operational definitions for sarcopenia, complicating clinical and research applications. Objective: The objective of the Australian and New Zealand Society for Sarcopenia and Frailty Research (ANZSSFR) Task Force on Diagnostic Criteria for Sarcopenia was to reach consensus on the operational definition of sarcopenia for regional use by clinicians and researchers. Method: A four-Phase modified Delphi process was undertaken in which 24 individuals with expertise or a recognised interest in sarcopenia from different fields across Australia and New Zealand were invited to be Task Force members. An initial face-to-face meeting was held in Adelaide, South Australia, in November 2017, followed by two subsequent online Phases conducted by electronic surveys. A final Phase was used to approve the final statements. Responses were analysed using a pre-specified strategy. The level of agreement required for consensus was 80%. Results: In Phase 2, 94.1% of Task Force respondents voted in favour of adopting an existing operational definition of sarcopenia. In Phase 3, 94.4% of respondents voted in favour of adopting the European Working Group on Sarcopenia in Older People (EWGSOP) definition as the operational definition for sarcopenia in Australia and New Zealand. Conclusion: With consensus achieved, the ANZSSFR will adopt, promote and validate the EWGSOP operational definition of sarcopenia for use by clinicians and researchers in Australia and New Zealand.

Osteoporosis is the most common bone disease in humans. Older persons are at higher risk of osteoporotic fractures that also result in poor quality of life, disability, loss of independence, institutionalization, and higher mortality. Osteoporosis shares a distinct pathophysiologic relationship with sarcopenia, an age-related disease comprising declines in muscle mass, strength, or function. The combination of these two diseases is known as osteosarcopenia. Understanding the pathophysiology of osteosarcopenia, in addition to its diagnostic and therapeutic approaches, is key in providing older adults with the best falls and fractures prevention strategies. This review provides updated information on new discoveries on the combined pathophysiology of osteoporosis and sarcopenia that have led to the development of novel therapeutic approaches. New recommendations for the use of risk calculators and densitometry are also presented in this review as well as evidence on current and upcoming pharmacologic treatments to prevent falls and fractures in older persons. J Am Geriatr Soc 67:831-840, 2019.

IntroductionImmunosenescence leads to increased morbidity and mortality associated with viral infections and weaker vaccine responses. This has been well documented for seasonal influenza and the current pandemic with SARS-CoV-2 (COVID-19), which disproportionately impact older adults, particularly those in residential aged care facilities. Inadequate nutrient intakes associated with impaired immunity, respiratory and muscle function are likely to augment the effects of immunosenescence. In this study, we test whether the impact of inadequate nutrition can be reversed using multi-nutrient supplementation, consequently enhancing vaccine responses, reducing the risk of viral infections and improving respiratory and muscle function.Methods and analysisThe Pomerium Study is a 3-month, single-blind, randomised, controlled trial testing the effects of two daily servings of an oral multi-nutrient supplement (330 kcal, 20 g protein, 1.5 g calcium 3-hydroxy-3-methylbutyrate monohydrate (CaHMB), 449 mg calcium, 500 IU vitamin D3 and 25 vitamins and minerals) on the immune system and muscle and respiratory function of older adults in aged care in Melbourne, Australia. 160 older adults (≥75 years old) will be recruited from aged care facilities and randomised to treatment (multi-nutrient supplement) or control (usual care). The primary outcome is a change in T-cell subsets CD8 + and CD28null counts at months 1 and 3. Secondary outcomes measured at baseline and month 3 are multiple markers of immunosenescence (also at 1 month), body composition (bioimpedance), handgrip strength (dynamometer), physical function (short physical performance battery), respiratory function (spirometry) and quality of life (EQ-5D-5L). Incidence and complications of COVID-19 and/or viral infections (ie, hospitalisation, complications or death) will be recorded throughout the trial, including 3 months after supplementation is ceased.Ethics and disseminationThis study was approved by Melbourne Health Human Research Ethics Committee (Ref No. HREC/73985/MH-2021, ERM Ref No. RMH73985, Melbourne Health Site Ref No. 2021.115). Written informed consent will be obtained from participants. Results will be published in peer-reviewed journals and made available to key aged care stakeholders, including providers, residents, and government bodies.Trial registration numberACTRN12621000420842.

BACKGROUND: It is not known how measures of body composition, strength and physical performance are interrelated or how empirical groupings of these measures relate to disability and mobility disability. METHODS: Muscle mass was assessed by D(3)-creatine dilution (D(3)Cr muscle mass) in 1345 men (84.1±4.1 years) enrolled in the Osteoporotic Fractures in Men (MrOS) study. Participants completed anthropomorphic measures, walk speed, grip strength, chair stands, and dual x-ray absorptiometry (DXA) estimated appendicular lean mass (ALM) and body fat percentage. Men reported limitations in mobility, activities of daily living (ADLs) and instrumental ADLs at initial and over 2.2±0.3 years. Factor analysis reduced variables into related groups and negative binomial models calculated relative risk (RR) of factors with mobility and disability outcomes. RESULTS: Factor analysis reduced 10 variables into four factors: Factor 1, body composition, including ALM, body fat percentage, weight and muscle mass; Factor 2, body size and lean mass, including height, weight and ALM; Factor 3, muscle mass, strength and performance, including walk speed, chair stands, grip strength, and muscle mass; and Factor 4, lean mass and weight, including ALM and weight. Only Factor 3 was significantly associated (p-value

Background Sarcopenia is defined as the age-related loss of muscle mass, strength, and physical performance. The original European Working Group on Sarcopenia in Older Persons (EWGSOP1) definition, and its revision (EWGSOP2), provide new cut-points and alternate measures for sarcopenia diagnosis. However, sarcopenia is rarely diagnosed in clinical settings owing to its labor-intensive diagnostic process. Given the Short Physical Performance Battery (SPPB) is a quick, easily administrable, and objective measure of muscle strength and physical performance, both of which are key components of sarcopenia, this study examined the diagnostic value of the SPPB for this muscle disease. Methods A cross-sectional analysis of 294 community-dwelling older persons (≥65 years) was conducted. Appendicular lean body mass [(ALM) divided by height squared (ALM/h2)], muscle strength (handgrip/sit to stand), and physical performance [gait speed, timed up and go (TUG) and SPPB] were assessed using validated procedures, while participants were diagnosed with sarcopenia following the EWGSOP1 and EWGSOP2 criteria. Diagnostic ability of the SPPB independently and combined with ALM/h2 for sarcopenia was determined using area under the curve (AUC). Potential cut-points were identified, and sensitivity and specificity calculated. Results Prevalence of sarcopenia ranged from 4 to 16% depending on the definition. The SPPB demonstrated moderate (AUC = 0.644–0.770) value in diagnosing sarcopenia, and a cut-point of ≤8points in SPPB performance resulted in high sensitivity (82–100%) but low specificity (36–41%) for diagnosing those with severe sarcopenia. Conclusions The SPPB displayed acceptable value in diagnosing older adults with severe sarcopenia. Moreover, the high sensitivity of the SPPB when using the cut-point of ≤8 suggests it may be a favorable screening tool for sarcopenia in clinical settings where ALM measurements are not available.

Objectives It is unknown whether muscle mass measured by the D3-creatine dilution method is a superior predictor of incident mobility disability than traditional components of sarcopenia definitions (including grip strength, walking speed, appendicular lean mass). The objective of this study was to determine the relative importance of strength; physical performance; and lean, fat, and muscle mass in predicting incident mobility disability in older men. Design Longitudinal cohort study of participants in the Osteoporotic Fractures in Men (MrOS) study. Setting and Participants Muscle mass was assessed by D3-creatine dilution in 1098 men (aged 83.7 ± 3.7 years). Participants also completed anthropomorphic measures, 6-m walking speed (m/s), grip strength (kg), chair stands (seconds), and dual x-ray absorptiometry appendicular lean mass (ALM), and total body fat percentage. Men self-reported incident mobility disability defined by the development of an inability to complete at least one of walking 2-3 blocks, climbing 10 steps, or carrying 10 lb over 2.2 ± 0.3 years. Methods Classification and regression tree analysis was conducted to determine relative variable importance and algorithm cutpoints for predicting incident mobility disability. Given the proximity of walking speed with the primary outcome (mobility disability), analyses were conducted with and without walking speed. Results Walking speed followed by D3Cr muscle mass/weight were the most important variables (variable importance: 53% and 12%, respectively) in the prediction of self-reported incident mobility disability. D3Cr muscle mass was the most important variable in predicting incident mobility disability when walking speed was excluded, followed by chair stands (variable importance: 35% and 33%, respectively). Body fat percentage, ALM, and grip strength were not selected as nodes in either analysis and had low or negligible variable importance. Conclusions and Implications This study has provided valuable insights into the importance of different variables in predicting incident mobility disability in older men. Muscle mass by D3Cr may be a key tool for predicting the risk of negative outcomes in older adults in the future, particularly in post-acute and long-term care settings.

Falls in older people are a common problem and carry significant consequences for individuals and society. Falls can result in serious injury, hospitalization, death, anxiety and depression, and reduction in quality of life. The risk of falls and falls-related complications is associated with age, and given the population is aging, the incidence of falls is expected to rise. Older people living in long-term care facilities, or nursing homes, and those who are hospitalized are at significantly higher risk than the general population and commonly are cognitively impaired. This chapter will review the specific risk factors for falls in these populations focusing in cognitively impaired populations. Interventions to assess falls risk and initiate falls-prevention interventions will be discussed.

The effect of protein supplementation in attenuating loss of muscle mass, strength and function in community-dwelling older people has been promising, however, its benefits in pre-frail and frail older people remains unclear.To determine the effect of protein supplementation on muscle mass, strength and function in frail older people by reviewing and conducting meta-analysis of relevant randomized controlled trials (RCTs).This review was registered at PROSPERO (CRD42017079276) and conducted according to Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Using a pre-determined e-search strategy, we searched PubMed, Medline, EMBASE, CINAHL, LILACS, Web of Science, Cochrane and Scopus databases. Inclusion criteria were RCTs that assessed the effect of protein supplementation on muscle mass, strength and function in frail individuals aged ≥65 years. The main outcomes were lean body mass (LBM), handgrip, leg extension, leg press strength, short physical performance battery (SPPB) score, and gait velocity.Of the eight studies included in this review, 503 subjects were enrolled and four different protein supplements were assessed. Despite the variation in methodology, studies were homogenous with I-squared10.0%. The meta-analysis showed no significant effect of protein supplementation on LBM (mean difference 1.17 kg, 95% CI: -1.97-4.3), handgrip (mean difference 0.15, 95% CI: -0.95-1.24), leg extension (mean difference -3.68 kg, 95% CI: -12.72-5.36), leg press (mean standardized difference 0.26 kg, 95% CI: -0.30-0.82), SPPB (mean difference 0.61, 95% CI: -0.02-1.23), or gait velocity (mean difference -0.20 m/s, 95% CI: -0.95-0.55).Protein supplementation alone does not significantly improve muscle mass, strength or function in pre-frail or frail older people.

Beta-hydroxy-beta-methylbutyrate (HMB) has been shown to be effective and superior to other types of protein supplements to attenuate loss of muscle mass, strength and function, however, its benefits in sarcopenic and frail older people remain unclear. We seek to determine the effect of HMB on muscle mass, strength and function in older people with sarcopenia or frailty by reviewing results from available randomized controlled trials (RCTs). This review was registered at PROSPERO (University of York) with registration number CRD42018088462 and conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Using a pre-determined e-search strategy, we searched PubMed, Medline, EMBASE, CINAHL, LILACS, Web of Science, Cochrane and Scopus databases. Our inclusion criteria were RCTs that assessed the effect of HMB on muscle mass, strength and function in older people with sarcopenia and frailty aged ≥60 years. The main outcomes were lean body mass, handgrip, leg press strength, and Short Physical Performance Battery (SPPB) score. Three studies matched our eligibility criteria which enrolled 203 subjects through a variety of definitions of sarcopenia or frailty. Lean body mass increased and muscle strength and function were preserved following HMB supplementation. HMB improves lean muscle mass and preserves muscle strength and function in older people with sarcopenia or frailty.

A comprehensive geriatric assessment, combined with a battery of imaging and blood tests, should be able to identify those hip fracture patients who are at higher risk of short- and long-term complications. This comprehensive assessment should be followed by the implementation of a comprehensive multidimensional care plan aimed to prevent negative outcomes in the postoperative period (short and long term), thus assuring a safe and prompt functional recovery while also preventing future falls and fractures.