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Background: The strength, assistance walking, rise from a chair, climb stairs, and falls (SARC-F) questionnaire is a well-established instrument for screening of sarcopenia and sarcopenia-related functional impairments. As it is based on self-reporting, its use precludes patients who are unable to answer the questionnaire as a consequence of severe acute diseases or cognitive impairment. Therefore, we aimed to validate a proxy-reported version of the SARC-F for both ad-hoc as well as retrospective screening for severe sarcopenia-related functional impairments., Methods: Patients aged ≥60 years completed the SARC-F and performed the short physical performance battery (SPPB) at baseline (T1). Proxies in Cohort A gave a simultaneous assessment of the patients' functional status with the proxy-reported SARC-F at T1 and again, retrospectively, after 3 months (T2). Proxies in Cohort B only completed the SARC-F retrospectively at T2. The questionnaires' performances were assessed through sensitivity/specificity analyses and receiver operating characteristic (ROC) curves. For non-inferiority analyses, results of both the patient-reported and proxy-reported SARC-F were correlated with the SPPB total score as well as the results of the chair-rise test subcategory; the respective correlation coefficients were tested against each other., Results: One hundred and four patients and 135 proxies participated. Using a SPPB score < 9 points as the reference standard, the proxy-reported SARC-F identified patients at high risk for sarcopenia-related functional impairment with a sensitivity of 0.81 (ad-hoc), 0.88 (retrospective Cohort A), and 0.87 (retrospective Cohort B) as well as a specificity of 0.89 (ad-hoc), 0.78 (retrospective Cohort A), and 0.64 (retrospective Cohort B). Areas under the ROC curves were ≥ 0.9 for the ad-hoc proxy-reported SARC-F and the retrospective proxy-reported SARC-F in both cohorts. The proxy-reported SARC-F showed a non-inferior correlation with the SPPB compared with the patient-reported SARC-F for ad-hoc (P = <0.001) as well as retrospective screening for severe sarcopenia-related functional impairment in both Cohorts A (P = 0.007) and B (P = 0.026)., Conclusions: Proxy-reported SARC-F is a valid instrument for both ad-hoc as well as retrospective screening for sarcopenia-related functional impairment and could become the standard tool for evaluating this risk in older adults with severe acute disease, for example, in patients with quickly evolving haematological conditions., (© 2021 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf of Society on Sarcopenia, Cachexia and Wasting Disorders.)

Introduction: Sarcopenia has been recognised as a disease that is consistently associated with a range of geriatric syndromes and negative health consequences. The prevalence of sarcopenia is high among nursing home residents. Several systematic reviews have assessed the efficacy of a range of treatment strategies against sarcopenia. However, no systematic review discussing specifically the treatment options for sarcopenic nursing home residents has been conducted so far. The objective of this scoping review, therefore, is to identify and map existing studies that assessed the feasibility and effectiveness of interventions that were conducted with the aim to treat sarcopenic nursing home residents., Methods and Analysis: The protocol was developed using an established scoping review methodological framework. A systematic search of relevant literature databases will be conducted. We will also conduct a search of ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform Search Portal for ongoing and recently completed trials, and will search for grey literature. Two reviewers will independently screen titles and abstracts for inclusion, followed by screening of the full text of potentially relevant articles to determine final inclusion. A data extraction sheet will be developed including key study characteristics that will be relevant for collating, summarising and reporting the results of the scoping review., Ethics and Dissemination: The proposed scoping review will undertake a secondary analysis of publicly available data, and therefore does not require ethical approval. The results will be disseminated to researchers in the field by submitting the review to a peer-reviewed international journal and by presenting our findings at relevant conferences. We expect that the results of the final review will help to guide future research in the field of sarcopenia treatment for nursing home residents., Competing Interests: Competing interests: JMB reported personal fees from Fresenius, personal fees from Nestlé, personal fees from Novartis, personal fees from Pfizer, personal fees from Bayer, grants and personal fees from Nutricia DANONE. He has gained no personal income from these activities and all income received has been transferred to his institution., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: The aim of this systematic review was to identify methods used to assess medication preferences in older adults and evaluate their advantages and disadvantages with respect to their applicability to the context of multimorbidity and polypharmacy., Material and Methods: Three electronic databases (PubMed, Web of Science, PsycINFO) were searched. Eligible studies elicited individual treatment or outcome preferences in a context that involved long-term pharmacological treatment options. We included studies with a study population aged ≥ 65 years and/or with a mean or median age of ≥ 75 years. Qualitative studies, studies assessing preferences for only two different treatments, and studies targeting preferences for life-sustaining treatments were excluded. The identified preference measurement methods were evaluated based on four criteria (time budget, cognitive demand, variety of pharmacological aspects, and link with treatment strategies) judged to be relevant for the elicitation of patient preferences in polypharmacy., Results: Sixty articles met the eligibility criteria and were included in the narrative synthesis. Fifty-five different instruments to assess patient preferences, based on 24 different elicitation methods, were identified. The most commonly applied preference measurement techniques were "medication willingness" (description of a specific medication with inquiry of the participant's willingness to take it), discrete choice experiments, Likert scale-based questionnaires, and rank prioritization. The majority of the instruments were created for disease-specific or context-specific settings. Only three instruments (Outcome Prioritization Tool, a complex intervention, "MediMol" questionnaire) dealt with the broader issue of geriatric multimorbidity. Only seven of the identified tools showed somewhat favorable characteristics for a potential use of the respective method in the context of polypharmacy., Conclusion: Up to now, few instruments have been specifically designed for the assessment of medication preferences in older patients with multimorbidity. To facilitate valid preference elicitation in the context of geriatric polypharmacy, future research should focus on suitable characteristics of existing techniques to develop new measurement approaches for this increasingly relevant population., Competing Interests: Dr Annette Eidam reports grants from the State Ministry of Baden-Wuerttemberg (Germany) for Sciences, Research and Arts, during the conduct of the study. Ms Anja Roth reports grants from the State Ministry of Baden-Wuerttemberg (Germany) for Sciences, Research and Arts, during the conduct of the study. Dr André Lacroix reports grants from the State Ministry of Baden-Wuerttemberg (Germany) for Sciences, Research and Arts, during the conduct of the study. Dr Sabine Goisser reports grants from the State Ministry of Baden-Wuerttemberg (Germany) for Sciences, Research and Art, during the conduct of the study. Dr Hanna M. Seidling reports grants from the State Ministry of Baden-Wuerttemberg (Germany) for Sciences, Research and Arts, during the conduct of the study; non-financial support from VKliPha; AkdÄ; GSASA, APS e.V., NHS, ESCP, BAK, ÄZQ, SFPC, Dosing GmbH, Karolinska Institutet, University of Bonn, University Hospital Hamburg, personal fees from Universitätsklinikum Heidelberg IMBI, Govi Verlag, Deutscher Apotheker Verlag, Wissenschaftliche Verlagsgesellschaft Stuttgart, Bundesgesundheitsblatt, personal fees, non-financial support from ADKA e.V.; EAHP; Chamber of Pharmacists, Hessen; Chamber of Pharmacists, Baden-Württemberg, Chamber of Pharmacists, Westfalen-Lippe, Chamber of Pharmacists Nordrhein, Chamber of Pharmacists Bavaria, DPhG, AD REM TEAM München, ABDA - Bundesvereinigung Deutscher Apotheker e.V., Omnicell, Chamber of Pharmacists Niedersachsen, Chamber of Pharmacists Thüringen, grants from Chambers of Pharmacists Baden-Württemberg, Nordrhein, Hessen and Niedersachsen, Klaus Tschira Stiftung gGmbH, Dosing GmbH, ABDA - Bundesvereinigung Deutscher Apotheker e.V., g-BA, BMBF, European Commission Horizon 2020, outside the submitted work. Prof. Dr. Walter E. Haefeli reports grants from the State Ministry of Baden-Wuerttemberg (Germany) for Sciences, Research and Arts, during the conduct of the study; grants from ADIR, travel expenses from AID Berlin, grants from AOK BW, personal fees from Apoth.kammer Schlesw., grants from Basilea Ltd., grants from Bayer AG, speaker fees and traveling expenses from Berlin-Chemie AG, grants from BMBF, speaker fees and traveling expenses from Boehringer GmbH, grants, speaker fees and traveling expenses from Bristol-Myers Squibb, grants from Chiesi GmbH, personal fees from COCS/DGD, grants, personal fees from Daiichi-Sankyo, grants from DFG No. 79, personal fees from DiakonissenKH MA, research funding from DKFZ, he is a shareholder of Dosing GmbH and his wife an employee of Dosing GmbH, personal fees from ESA Köln, grants from EU Projects, traveling expenses from Fresenius, research funding from Gem.Bundesausschuss, personal fees from GenPlus GmbH, personal fees, speaker fees and traveling expenses from Grünenthal GmbH, grants from GSK, grants from HDIT, grants from Hepatera Ltd., grants from IPMB, grants from Janssen GmbH, consultancy services and traveling expenses from LAK BW, personal fees from Ligatur Verlag, grants from MWK, grants from MYR GmbH, speaker fees and traveling expenses from Novartis, traveling expenses from Orphix Consulting, grants from PCI, speaker fees and traveling expenses from Pfizer, consultancy services and traveling expenses from PIQUR Basel, grants from QPS Netherlands B.V., grants from SFB 1389/1 TP C1.2, grants from Smooth Clin. Trial, grants from Sumaya Biotec, grants from K. Tschira Stiftung, consultancy and traveling expenses from Stiftung Warentest, personal fees from Thieme Verlag, traveling expenses from Uni Saarbrücken, grants from Vaximm GmbH, outside the submitted work. Prof. Dr. Jürgen M. Bauer reports grants from the Ministry for Research, Baden-Württemberg, Germany, during the conduct of the study; personal fees from Nestlé, personal fees from Nutricia, personal fees from Novartis, personal fees from Fresenius, personal fees from Daiichi Sankyo, personal fees from Bayer, outside the submitted work. The authors report no other conflicts of interest in this work., (© 2020 Eidam et al.)

Objectives: To evaluate patients' preferences for sarcopenia outcomes., Design: Discrete-choice experiment (DCE) SETTING AND PARTICIPANTS: Community-dwelling individuals older than 65 years suffering from sarcopenia recruited in Belgium, France, Germany, Italy, Spain, and Switzerland, who visited the clinic and were cognitively able to understand and fill out the survey., Methods: In the DCE survey, participants were repetitively asked to choose which one of the 2 patients suffering from sarcopenia deserves treatment the most. The 2 patients presented different levels of risk for 5 preselected sarcopenia outcomes: quality of life, mobility, domestic activities, fatigue, and falls. The DCE included 12 choice sets. Mixed logit panel model was used to estimate patients' preferences and latent class model was conducted to identify profiles of responses., Results: A total of 216 sarcopenic persons were included for the analysis (68% women; mean age 78 years). All 5 preselected sarcopenia outcomes were shown to be significant. Overall, the most important sarcopenia outcome was mobility (30%), followed by the ability to manage domestic activities (22%), the risk of falls (18%), fatigue (17%), and quality of life (14%). The latent class model identified 2 classes of respondents. In the first class (probability of 56%), participants valued mobility the most (42%), followed by the ability to manage domestic activities (23%) and risk of falls (17%). In the second class, fatigue was the most important outcome (27%) followed by domestic activities (19%) and risk of falls (19%). No statistically significant associations between the latent classes and sociodemographic characteristics were found., Conclusions and Implications: This study suggests that all 5 preselected outcomes were important for sarcopenic older individuals. Overall, the most important outcomes were mobility and the ability to manage domestic activities, although variations in preferences were observed between respondents. This could help in incorporating patient preferences when designing appropriate solutions for individuals with sarcopenia., (Copyright © 2019 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Background & Aims: Malnutrition is widespread among older people and related to poor outcome. Reported prevalences vary widely, also because of different diagnostic criteria used. This study aimed to describe prevalences in several populations of older persons in different settings using harmonized definitions., Methods: Available studies within the Joint Programming Initiative (JPI) Knowledge Hub 'Malnutrition in the Elderly' (MaNuEL) were used to calculate and compare prevalences of malnutrition indicators: low BMI (<20 kg/m 2 ; age-specific BMI <20 if age 65-<70 and <22 kg/m 2 if age ≥70 years), previous weight loss (WL), moderate and severe decrease in food intake, and combined BMI <20 kg/m 2 and/or WL in participants aged ≥65 years., Results: Fifteen samples with in total 5956 participants (59.3% women) were included: 7 consisting of community-dwelling persons, 2 studies in geriatric day hospitals, 3 studies in hospitalized patients and 3 in nursing homes. Mean age of participants ranged between 67 and 87 years. Up to 4.2% of community-dwelling persons had a BMI <20 kg/m 2 , 1.6 and 9% of geriatric day hospital patients, 4.5-9.4% of hospital patients and 3.8-18.2% of nursing home residents. Using age-specific cut-offs doubled these prevalences. WL was reported in 2.3-10.5% of community-dwelling persons, 6% and 12.6% of geriatric day hospital patients, 5-14% of hospitalized patients and 4.5-7.7% of nursing home residents. Severe decrease in food intake was recorded in up to 9.6% of community-dwelling persons, 1.5% and 12% of geriatric day hospital patients, 3.4-34.2% of hospitalized patients and 1.5-8.2% of nursing home residents. The criteria age-specific BMI and WL showed opposing prevalences across all settings. Compared to women, low BMI and moderate decrease in food intake showed low prevalences in men but similar prevalences were observed for weight loss and severe decrease in food intake. In half of the study samples, participants in a younger age group had a higher prevalence of WL compared to those of an older age group. Prevalence of BMI <20 kg/m 2 and WL at the same time did not exceed 2.6% in all samples. The highest prevalences were observed based on combined definitions when only one of the three criteria had to be present., Conclusions: Prevalences for different criteria vary between and within the settings which might be explained by varying functional status. The criteria used strongly affect prevalence and it may be preferable to look at each criterion separately as each may indicate a nutritional problem., (Copyright © 2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background & Aims: Studies have shown that omega-3 polyunsaturated fatty acids (PUFAs) are associated with brain, cardiovascular and immune function, as well as physical performance and bone health in older adults. So far, few studies have highlighted the associations between PUFA status and performance-based tests of physical function. To study the associations between the omega-3 index (red blood cell (RBC) membrane content of omega-3 PUFAs, such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)) and physical performance measured with the Short Physical Performance Battery (SPPB) in a sample of community-dwelling older adults., Design: Cross-sectional study using the baseline data of the Multidomain Alzheimer's Disease Trial (MAPT), a randomized, placebo-controlled trial., Participants and Measurements: 1449 participants with available data on PUFAs were included. Omega-3 index and Short Physical Performance Battery (SPPB) scores were measured at enrollment and the omega-3 index expressed as the percentage of total fatty acid content was calculated. We also dichotomized the omega-3 index as low (lowest quartile) vs. high (three upper quartiles)., Results: Participants were 75.2 (±4.4) years old, 64.5% were female. Bivariate analyses found that participants who were in the lowest omega-3 index quartile (Q1) had a SPPB score significantly lower than participants in the three other quartiles (Q2-Q4). However, adjusted (for age, gender, cognitive function, depressive status, Body Mass Index and grip strength) multiple linear regression showed that the omega-3 index-SPPB score association did not reach statistical significance [β = -0.166; (-0.346; 0.013); p = 0.07] in our sample., Conclusion: This cross-sectional study found that participants with a low omega-3 index had worse performance-based test results of physical function than people with a high omega-3 index, but this association did not reach statistical significance once confounders were controlled for. Studies looking at the over-time associations between PUFA status and physical performance changes may shed more light on this topic., (Copyright © 2017 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Accurate assessment of dietary intake is essential in clinical practice and research. While energy intake (EI) misreporting has been extensively studied in the general population, relatively little is known about misreporting among older people. This cross-sectional study used clinical data routinely collected in 127 participants, aged 70-96 years, from the Toulouse Frailty Clinic. EI was assessed by diet history interview and three-day food record. Misreporters were identified with the Goldberg cut-off method, using the Harris-Benedict equation to estimate total energy expenditure. The response rate was 66% for three-day food record and 93% for diet history interviews. EI from diet history interviews (1799 ± 416 kcal/day) was significantly higher than from food records (1400 ± 381 kcal/day; p < 0.001) and closest to total energy expenditure (1758 ± 437 kcal/day; (p > 0.05). Thirty percent of participants were identified as underreporters with three-day food records vs. 9% with diet history interviews. Overreporters were found with diet history interviews only (11% of participants). In older people, the diet history interview has the advantage of obtaining a higher response rate and a lower underreporting rate, compared to three-day food record. Nevertheless, with this method, overreporting was observed and interpreting results should be done with caution.

Studies have shown that omega-3 polyunsaturated fatty acids (PUFAs) are associated with brain, cardiovascular, and immune function, as well as physical performance and bone health in older adults. So far, few studies have investigated the associations between PUFA status and performance-based tests of physical function. The objective of this study was to investigate the associations between the omega-3 PUFA levels (eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA)) in red blood cell (RBC) membranes and physical performance, in a sample of community-dwelling older adults. This is a longitudinal observational study using data from the Multidomain Alzheimer's Disease Trial (MAPT), a randomized, placebo-controlled trial. Four hundred participants from MAPT placebo group with available PUFA data were included. Omega-3 PUFA levels in RBC membranes were measured at baseline, and their percentage of total RBC membrane fatty acid content was calculated. We dichotomized the standardized omega-3 PUFA levels in RBC membranes as low (lowest quartile) vs. high (three upper quartiles). Gait speed (in m/s) and short physical performance battery (SPPB) score (range from 0 to 12, higher is better) were used to assess physical performance at baseline and after 6, 12, 24, and 36 months. Participants were 75.2 (± 4.3) years old and 68% were female. Bivariate analyses found that the characteristic of the participants in the lowest quartile of omega-3 PUFA levels (Q1) and those in the three upper quartiles (Q2-Q4) was not different at baseline; only those in Q1 were slightly older. In an unadjusted model, the difference in gait speed after 3 years of follow-up was significant (- 0.09 ± 0.03 m/s; p = 0.008) between participants in Q1 and those in Q2-Q4. In a model adjusted for age, gender, educational level, cognitive function, depressive status, body mass index, physical activity, grip strength, and their time interaction, this difference remained clinically relevant (- 0.07 ± 0.04 m/s; p = 0.075). No difference between the two groups was found for the SPPB score development over 3 years. Older adults with subjective memory complaints and in the lower quartile of omega-3 have a faster decline on gait speed compared to people in the three upper quartiles. Other longitudinal studies are needed to explore this association and to examine mechanisms.

Inadequate nutritional intake is an important modifiable risk factor for frailty. Existing evidence supports the importance of adequate dietary quantity and especially quality to ensure sufficient intakes of energy, protein and micronutrients. However, to date no nutritional intervention or supplementation concept has emerged as being effective for the prevention or treatment of frailty. Further research, including specifically the group of frail older persons and those at risk of frailty, and focussing on functional benefits as an outcome, is needed to allow definite recommendations for optimal diet, i.e. food and nutrient intakes, for this population. This article aims to give a short overview on current knowledge concerning the role of nutrition for the prevention and treatment of frailty, while providing readers with references giving an overview for further reading.

Background: Although sarcopenia represents a challenging burden for health care systems around the world, its prevalence in the elderly population varies widely. The primary aim of the study was to determine the prevalence of sarcopenia in community-dwelling (CD) German women aged 70 years and older; the secondary aim was to assess the effect of osteoarthritis (OA) on sarcopenia prevalence in this cohort., Methods: A total of 689 Caucasian females 18-35 years old and 1,325 CD females 70 years+ living in Northern Bavaria, Germany, were assessed during the initial phase of the FORMoSA research project. Anthropometry, total and regional muscle mass, were assessed by segmental multifrequency Bioelectrical Impedance Analysis. Further 10 m walking speed and handgrip strength were evaluated to apply the European Working Group on Sarcopenia in Older People definition of sarcopenia. Covariates were determined by questionnaires and interviews., Results: Applying the algorithm of the European Working Group on Sarcopenia in Older People of two standard deviations below the mean value for appendicular skeletal muscle mass of a reference cohort of the young cohort (5.66 kg/m(2)), low gait speed (≤0.8 m/s), and low grip strength (<20 kg), the prevalence of sarcopenia in CD German females 70 years and older was 4.5% (70-79 years: 2.8% vs ≥80 years: 9.9%; P<0.001). Participants with OA at the hip and lower limbs (n=252) exhibited significantly higher rates of sarcopenia (OA: 9.1 vs non-OA: 3.5%). Of importance, anthropometric, demographic, health, and lifestyle parameters (except exercise participation) of our cohorts corresponded with Bavarian or German data for CD women 70 years+., Conclusion: The prevalence of sarcopenia in CD German females 70 years+ is relatively low. However, participants with OA at the hip or lower limbs were at increased risk for sarcopenia.

One of the many threats to independent life is the age-related loss of muscle mass and muscle function commonly referred to as sarcopenia. Another important health risk in old age leading to functional decline is obesity. Obesity prevalence in older persons is increasing, and like sarcopenia, severe obesity has been consistently associated with several negative health outcomes, disabilities, falls, and mobility limitations. Both sarcopenia and obesity pose a health risk for older persons per se, but in combination, they synergistically increase the risk for negative health outcomes and an earlier onset of disability. This combination of sarcopenia and obesity is commonly referred to as sarcopenic obesity. The present narrative review reports the current knowledge on the effects of complex interventions containing nutrition and exercise interventions in community-dwelling older persons with sarcopenic obesity. To date, several complex interventions with different outcomes have been conducted and have shown promise in counteracting either sarcopenia or obesity, but only a few studies have addressed the complex syndrome of sarcopenic obesity. Strong evidence exists on exercise interventions in sarcopenia, especially on strength training, and for obese older persons, strength exercise in combination with a dietary weight loss intervention demonstrated positive effects on muscle function and body fat. The differences in study protocols and target populations make it impossible at the moment to extract data for a meta-analysis or give state-of-the-art recommendations based on reliable evidence. A conclusion that can be drawn from this narrative review is that more exercise programs containing strength and aerobic exercise in combination with dietary interventions including a supervised weight loss program and/or protein supplements should be conducted in order to investigate possible positive effects on sarcopenic obesity.

We examined the relationship between postoperative dietary intake (DI) of geriatric hip fracture (HF) patients and their functional and clinical course until 6 months after hospital discharge. In eighty-eight HF patients ≥ 75 years, postoperative DI was estimated with plate diagrams of main meals over four postoperative days. DI was stratified as >50, >25-50, ≤ 25 % of meals served. Functional status according to Barthel index (activities of daily living) and patients' mobility level before fracture, postoperatively, at discharge and 6 months later were assessed and related to DI levels. In-hospital complications were recorded according to clinical diagnosis. Associations were evaluated using χ2 and Kruskal-Wallis tests, and repeated-measures ANOVA and ANCOVA. Postoperatively, 28 % of participants ate >50 %, 43 % ate >25-50 % and 28 % ≤ 25 % of meals served. Irrespective of pre-fracture functional status, patients with DI ≤ 25 % had significantly lower Barthel index scores at all times after surgery (all P50 % more often had regained their pre-fracture mobility level than those with DI ≤ 25 % at discharge (>50 %: 36 %; >25-50 %: 10 %; ≤ 25 %: 0 %; P= 0·001) and 6 months after discharge (88; 87; 68 %; P= 0·087) and had significantly less complications (median 2 (25th-75th percentile 1-3); 3 (25th-75th percentile 2-4); 3 (25th-75th percentile 3-4); P= 0·012). To conclude, geriatric HF patients had very low postoperative voluntary DI and thus need specific nutritional interventions to achieve adequate DI to support functional and clinical recovery.