Background. Insulin resistance is a risk factor for sarcopenia. The triglycerides (TG)/high-density lipoprotein cholesterol (HDL-C) ratio is an indirect indicator of insulin resistance. We aimed to assess the association between sarcopenia and the TG/HDL-C ratio in Japanese older adults. Methods: Older adults in Wakasa town, Fukui, Japan, were examined between June 2019 and November 2021. We collected data regarding age, sex, height, weight, body mass index, muscle mass, fat mass, muscle mass to fat mass ratio, appendicular lean muscle mass, skeletal muscle mass index, glycated haemoglobin, TG, HDL-C, low-density lipoprotein cholesterol, TG/HDL-C ratio, 5-m gait speed, and grip strength (both sides). Sarcopenia was defined in accordance with the 2019 criteria of the Asian Working Group for Sarcopenia via grip strength, gait speed, and skeletal muscle indices. In total, 65 men and 93 women (mean age, 78 years) were classified as normal (n=114), pre-sarcopenic (n=35), or sarcopenic (n=9). Compared with the normal and pre-sarcopenia groups, the sarcopenia group had the lowest HDL-C level (p=0.013) and highest TG/HDL-C ratio (p=0.008). Risk factors associated with sarcopenia were age (odds ratio=1.35, p=0.002) and the TG/HDL-C ratio (odds ratio=1.62, p=0.008). Older age and an elevated TG/HDL-C ratio are risk factors for sarcopenia. An elevated TG/HDL-C ratio may indicate progression from pre-sarcopenia to sarcopenia.

Decline in oral functions has a negative impact on healthy longevity because it causes frailty and disability through quantitative and qualitative declines in nutritional intake and inflammation, especially among older adults. Therefore, the public should recognise the importance of oral function in preventing health deterioration. Even minor abnormalities should not be left untreated; rather, they should be addressed in the context of multidisciplinary collaboration.

Her vital signs were within normal limits. Physical examination revealed a thin body build, diffuse alopecia, and mild conjunctival pallor. The results of cardiovascular, respiratory, and neurological examinations were unremarkable. There were no oral ulcers, gum hypertrophy, petechiae, skin rashes, or abnormal joint manifestations (eg, pain, swelling, stiffness, or deformity). Moreover, there were no palpable lymph nodes, breast lumps, sternal tenderness, hepatomegaly, or splenomegaly. Initial laboratory results revealed pancytopenia with autoimmune haemolytic anaemia, indicated by a positive direct Coombs test, low haptoglobin level, and high lactate dehydrogenase level (tablE 1 ). Peripheral blood test results showed red cell anisocytosis, occasional reactive lymphocytes, and thrombocytopenia. Bone marrow examination showed no evidence of haematological malignancies. Additional tests revealed antinuclear antibody positivity and anti-extractable nuclear antigen positivity (ie, dsDNA, anti-Ro, anti-La, anti-Sm, anti-ribonucleoprotein, and anti-Scl-70) The erythrocyte sedimentation rate was high and the levels of both complements were low. Serum protein electrophoresis findings were unremarkable. The levels of tumour markers (alpha-fetoprotein, cancer antigen [CA] 125, CA 19-9, and CA 15-3) were not elevated.

to 6.5 g/dL (tablE), and the surgical team was consulted for an urgent review.

Background.Older people with life-limiting conditions often have dysphagia.The Department of Medicine and Rehabilitation of Tung Wah East Hospital initiated a careful hand feeding (CHF) programme for patients with feeding problems.We aimed to evaluate the effectiveness of the CHF programme as well as the completeness and appropriateness of CHF discussions with in-patients.Methods.This retrospective observational study was conducted from May 2021 to October 2022.All patients who had CHF were recruited.Demographic data, feeding information, follow-up survey records, and data regarding subsequent readmission or death were retrieved.The primary outcome was 6-month survival.Secondary outcomes were hospital readmission, change from CHF to tube feeding, and support from healthcare staff.Results.A total of 94 patients (36 women and 58 men) aged 49 to 100 (mean, 85) years were included.Of these, 46% had advanced dementia as the principal diagnosis.Overall, 48% of patients died during the index admission; 39% of discharged patients were readmitted within 1 month.Moreover, 2% and 41% of patients died within 1 and 6 months, respectively.Among discharged patients, 80% followed dietary recommendations, whereas the remaining patients added foods they liked.Common feeding problems were refusal to open the mouth and occasional choking. Conclusions.Structured management protocols and training can facilitate CHF implementation.Communication with the family is important, as is documentation of the communication process.Telephone follow-up ensures continuous support from the hospital to community settings.Future enhancements include dietitian recommendations for soft meal choices and recipes.

We present a case of deep vein thrombosis of the left lower limb secondary to May-Thurner syndrome in a 91-year-old woman.The diagnosis was made by computed tomography, which showed the focal, mildly dilated, distal right common iliac artery with eccentric mural thrombus compressing the proximal left common iliac vein.The patient was treated with oral rivaroxaban and subcutaneous therapeutic low molecular weight heparin.Invasive vascular intervention was deemed to be of limited value, as the patient was minimally symptomatic, of advanced age, with comorbidities, and with features of chronicity of the condition.

Background.Hospitalised older patients with coronavirus disease 2019 (COVID-19) have an increased risk of poor health outcomes.We aimed to determine the associations of length of stay (LOS) with frailty status and disease severity among older patients admitted to a community treatment facility (CTF) in Singapore.Methods.Medical records of consecutive patients admitted to the CTF were retrospectively reviewed.Data retrieved included demographics, frailty, LOS, 30-day readmission, disease severity, and functional statuses on admission and at discharge. Results.In total, 96 older patients (mean age, 80.3 years) were included.According to the Clinical Frailty Scale (CFS), 26.0% were robust (CFS 1-3), 27.1% were mildly frail (CFS 4-5), and 46.9% were moderately/ severely frail (CFS 6-9).Compared with the robust and mildly frail groups, the moderately/severely frail group had more severe COVID-19 cases (p=0.033),longer LOS at the CTF (p=0.005), and fewer patients discharged home (p=0.01).Greater disease severity was associated with poorer frailty status (p=0.033),worsening of functional status at discharge (p=0.02),higher International Severe Acute Respiratory and emerging Infection Consortium score (p=0.031), and receipt of <2 doses of COVID-19 vaccine (p=0.005).Risk factors for longer LOS at the CTF and overall LOS were basic ADL-assisted status on admission (p=0.09 and p=0.017, respectively), fully dependent status on admission (p=0.043 and p=0.002, respectively), presence of infective changes on chest X-ray (p=0.027 and p=0.003, respectively), and receipt of <2 doses of COVID-19 vaccine (p=0.007 and p=0.005, respectively). Conclusions.Risk factors for longer LOS in older patients with COVID-19 were basic ADL-assisted status and fully dependent status on admission, presence of infective changes on chest X-ray, and receipt of <2 doses of COVID-19 vaccine.High-risk patients should be identified through assessments of these characteristics.Identification of risk factors for longer LOS can help guide medical decisions and optimise healthcare resource utilisation.

Fragility fractures of the hip can be occult and undetected on plain radiographs.This results in delayed or missed diagnosis and treatment and thus poorer outcomes.We describe a case of 3-day delay in hip fracture treatment in an 85-year-old woman who presented with severe right hip pain without a history of trauma.Initial plain radiographs and computed tomography did not detect a hip fracture, but subsequent magnetic resonance imaging on day 3 detected an insufficiency fracture of the femoral neck.This case highlights the importance of using magnetic resonance imaging as the first-line investigation for hip pain in patients with clinical suspicion of fracture but with normal radiographs.

Between 2020 and 2022, the coronavirus disease 2019 (COVID-19) pandemic had devastating impacts worldwide. Countries adopted various policies to curtail these impacts: ranging from full lockdown with "dynamic zero" policy in China to policy of living with the virus in Western countries. Strategies were selected based on geopolitical situations. Nonetheless, older adults universally experienced the most adverse effects, with worse functional recovery and higher case fatality rates. In Hong Kong, the overall case fatality rate among older patients (16.8%) was associated with baseline Clinical Frailty Scale (CFS) score; the highest rate was 40% among patients with a CFS score ≥7. 1 In the current issue of the Asian Journal of Gerontology and Geriatrics, Chen et al 2 shared their experience from Singapore. They found that patients with greater frailty or more functional limitations had higher mortality rates, worse functional recovery, and longer hospital stays. They suggested that risk factors for longer length of stay should be identified to guide medical decisions and optimise healthcare resource utilisation. However, resources should not be the primary determinant of clinical management decisions, and ageism should be avoided. Optimal clinical care and management should consider biological status or frailty status. For robust individuals with adequate functional recovery, the goal of intervention should be restorative to achieve good health-related quality of life. For individuals near the end of life, the goal of intervention may be to achieve good quality of dying through an end-of-life care programme, 3 which is cost-effective without shortening the median survival. Nonetheless, the challenge is to identify older adults who are near the end of life and would benefit from optimised quality of dying (rather than restorative intervention). Mo et al 4 suggested possible solutions for this challenge. The use of Hospital Admission Risk Reduction Program for the Elderly score and/or CFS score can help guide management, not for medical resource allocation, but for optimising care towards restoration/maintenance of health-related quality of life or towards quality of dying. Although the impact of COVID-19 has diminished, its resurgence or the emergence of new infectious diseases will inevitably occur. It is time to plan ahead and initiate studies that can guide future clinical practice.