Suchergebnisse

This study analyzes the incidence of falls for older adults who transitioned from institutions to the community through the Connecticut Money Follows the Person demonstration program, identifying intrinsic and extrinsic fall risk factors for this population. This prospective cohort study analyzed data from 648 Money Follows the Person participants aged 65 years and older, using 6- and 12-month posttransition surveys. Of the 648 participants, 161 (25.2%) fell in the first 6 months after transition, while 156 (24.5%) fell between 6 and 12 months after transition. Unmet medical care needs, depressive symptoms, mistreatment, and previous falls significantly predicted falls. Given the vulnerability of this population and increased use of fall-related health services, fall prevention represents a critical element in posttransition care. Beyond previously identified risk factors, care providers should consider issues such as unmet medical care needs, depressive symptoms, and mistreatment in assessing fall risk.

Abstract

Background
High psychological resilience is associated with improved functional outcomes for older adults recovering from hip fracture. The objective of this study was to identify factors associated with increased psychological resilience in older women after hip fracture.


Methods
129 women aged ≥65 years with recent surgically-repaired hip fracture were enrolled in a trial of exercise and testosterone therapy. The Brief Resilience Scale (BRS) measured baseline resilience, and was categorized as low (BRS<4) or high (BRS≥4). Sociodemographic (e.g., education), medical, and neuropsychological factors (e.g., cognition by Short Blessed Test, mental health by a Global Mental Health Score (PROMIS-GMH), and depressive symptoms by Geriatric Depression Score (GDS)) were considered as independent variables. Individual factors were evaluated for their association with resilience using bivariate regression, and those having a significance level of p≤0.10 were entered into age-adjusted multivariate logistic regression models.


Results
57 women (44%) reported high resilience. Neither education nor cognition was significantly associated with resilience. Lower GDS and better PROMIS-GMH scores were associated with high resilience in adjusted models. For every one-point worsening in GDS, the adjusted odds ratio (AOR) for high vs. low resilience was 0.76 (95% CI 0.61,0.93). In a model with GDS, PROMIS-GMH, and age, positive mental health remained significantly associated with higher resilience (AOR 1.34, 95% CI 1.14,1.58).


Conclusions
In older women after hip fracture, fewer depressive symptoms and better mental health were associated with higher psychological resilience. Addressing overall mental health when recovering from hip fracture could contribute to increasing psychological resilience thereby maximizing recovery potential.

Abstract

Background
Biomarkers for sarcopenia are lacking. We examined the diagnostic power of serum creatinine to cystatin C ratio for identifying low magnetic resonance imaging-muscle volume and low grip strength in a large observational study of UK Biobank older adults.


Methods
Serum creatinine and cystatin C were measured via immunoassays (Beckman Coulter AU5800 and Siemens Advia 1800, respectively) and grip strength by hydraulic hand dynamometer at baseline visit (2008–2010). magnetic resonance imaging-thigh fat-free muscle volume and DXA-derived appendicular lean mass were measured at imaging visit (2014–2018). Extreme outliers were removed, and covariates (demographic, lifestyle, and clinical factors, as well as time elapsed between baseline-imaging visit) were adjusted for in statistical models.


Results
12 873 older adults (mean age: 63.5 ± 2.7 years, 44.2% women) were included for fat-free muscle volume and appendicular lean mass/body mass index; 149 707 older adults (mean age: 64.0 ± 2.9 years, 50.5% women) for grip strength. Despite significant associations (p < .05), in fully adjusted models, creatinine to cystatin C showed poor to acceptable diagnostic power for identifying low fat-free muscle volume when using cutpoints of 20th percentile (area under the curve: 0.577 men; 0.622 women) and T scores of −2 (area under the curve: 0.596 men; 0.659 women) and −2.5 (area under the curve: 0.609 men; 0.722 women). In fully adjusted model, creatinine to cystatin C showed poor diagnostic power (area under the curves: <0.70) for identifying low appendicular lean mass/body mass index or low grip strength, irrespective of the cutpoint used.


Conclusions
Creatinine to cystatin C may not be a suitable biomarker for identifying low muscle volume or low strength in older adults. This finding, drawn from a large sample size and the use of advanced medical imaging, marks an important contribution to the sarcopenia field.