Skilful communication prompts quality patient care. Informal caregivers occupy a crucial role when caring for hospitalised older patients living with frailty. However, skilful communication with both patients and informal caregivers during ward rounds has not been studied. Thus, we aimed to explore communication preferences of patients and informal caregivers during ward rounds. We conducted semi-structured interviews with hospitalized patients and informal caregivers until information redundancy occurred. We used inductive coding of the transcribed interviews followed by a reflexive thematic analysis. The study included 15 patients and 15 informal caregivers. Patients had a median age of 85years (range 75-100years) and seven patients were females. Informal caregivers' median age were 45years (range 38-80years) and 13 were females. Three themes were generated: (1) building relationships and conveying information, (2) alleviating informal caregiver strain and (3) sharing the decision-making process. Themes highlighted the importance of collaborative and empathetic approaches in healthcare interactions, emphasizing interpersonal communication skills, such as fostering professional relationships. The interviews unveiled informal caregiver burden stemming from disempowerment during hospital discharge process and managing mistrust within the healthcare system. The shared decision-making process should address patients' and informal caregivers' needs and circumstances. Communication preferences of a population of older patients living with frailty and informal caregivers during ward rounds encompass interpersonal communication, demonstrating ample time, and being seen as a human being. Informal caregivers value being included in the decision-making process. Skilful communication includes for doctors to recognize informal caregivers' narratives and burdens.

Muscle ultrasound is increasingly popular thanks to its advantages over other techniques. However, its usefulness in the diagnosis of sarcopenia in older adults with aortic stenosis (AS) has not been studied to date. to analyze the prevalence of sarcopenia using muscle ultrasound and its impact on the health outcomes in older patients with AS. The single-center FRESAS (FRailty-Evaluation-in-Severe-Aortic-Stenosis) registry was used to study patients over 75years with severe AS susceptible to valve replacement. Sarcopenia was suspected in those individuals with diminished grip strength, and the diagnosis was confirmed in the presence of reduced ultrasound quadriceps muscle thickness, following the recommendations of the EWGSOP2 (European-Working-Group-on-Sarcopenia-in-Older-People). The primary composite endpoint was urgent hospital admission and mortality of cardiac cause 6months after the diagnosis. Of the 150 patients studied, 55.3% were females, and only 17.3% were frail; the mean age was 83.4years. Sarcopenia was diagnosed in 42 patients (28%). The overall survival rate at 6months was 92%. The primary endpoint was recorded in 23.2% of the cases and was more frequent in the sarcopenic patients (33.3%) than in the non-sarcopenic individuals (17.6%) (p = 0.01). The regression analysis found that sarcopenia was associated with an increased risk of the primary endpoint (HR: 2.25; 95% CI 1.19-4.45; p = 0.02), adjusting for potential confounding factors. The incidence of serious cardiac complications in older patients with sarcopenia and severe AS is significant. The present study describes a noninvasive, ultrasound-guided diagnostic technique that may prove efficient in its predictive capacity.

The COVID-19 pandemic magnified pre-existing socioeconomic, operational, and structural challenges in long-term care across the world. In Canada, the long-term care sector's dependence on caregivers as a supplement to care workers became apparent once restrictive visitation policies were employed. We conducted a scoping review to better understand the associations between caregiving and resident, formal and informal caregiver health in long-term care before and during the COVID-19 pandemic. A literature search was performed using MEDLINE, AgeLine, Google Advanced, ArXiv, PROSPERO, and OSF. Pairs of independent reviewers screened titles and abstracts followed by a review of full texts. Studies were included if they reported biological, psychological, or social health outcomes associated with caregiving (or lack thereof). After screening and reviewing 252 records identified by the search strategy, a total of 20 full-text records were eligible and included in this review. According to our results, research on caregiving increased during the pandemic, and researchers noted restrictive visitation policies had an adverse impact on health outcomes for residents and formal and informal caregivers. In comparison, caregiving in long-term care prior to the pandemic, and once visitation policies became less restrictive, led to mostly beneficial health outcomes. Caregiver interventions, for the most part, appear to promote better health outcomes for long-term care residents and formal and informal caregivers. Suggestions to better support caregiving in long-term care settings are offered.

Proponents argue that a high waist-to-calf ratio (WCR) may indicate an imbalance between muscle and fat in the body, making it a potential predictor for sarcopenic obesity (SO). The WCR is a new index incorporating both measurements, providing a reliable approach for assessing the imbalance between abdominal fat and leg muscle mass. The present study aimed to examine the association of WCR with SO and reveal the predictive effect of SO in community-dwelling older adults. The study population was composed of 234 geriatric outpatients with obesity. WCR was calculated by dividing the waist circumference (in cm) by the calf circumference (in cm). SO was defined according to the ESPEN and EASO Consensus Statement. The mean age was 72.7 ± 5.8years, and 78.7% (n = 175) were female. Eighty-one patients (34.6%) were considered as sarcopenic obese. The WCR was 3.04 [Interquartile range (IQR), 2.88-3.32] in the sarcopenic obese group, and in the nonsarcopenic obese group, it was 2.82 [IQR, 2.7-3.0] (p < 0.001). Independent of age, sex, nutritional and frailty status WCR was associated with SO (OR 12.7, 95% CI 4.0-40.1 and p < 0.001). The cut-off value of WCR for SO was calculated as 2.94 with 72.8% sensitivity and 67.3% specificity (Area Under Curve: 0.72 and Positive likelihood ratio: 2.23, p < 0.001). WCR, a simple and accessible method, indicates promise as a possible and potential diagnostic tool for SO in community-dwelling older adults.

Falling is an important public health issue because of its prevalence and severe consequences. Evaluating muscle performance is important when assessing fall risk. The study aimed to identify factors [namely muscle capacity (strength, quality, and power) and spatio-temporal gait attributes] that best discriminate between fallers and non-fallers in older adults. The hypothesis is that muscle quality, defined as the ratio of muscle strength to muscle mass, is the best predictor of fall risk. 184 patients were included, 81% (n = 150) were women and the mean age was 73.6 ± 6.83years. We compared body composition, mean grip strength, spatio-temporal parameters, and muscle capacity of fallers and non-fallers. Muscle quality was calculated as the ratio of maximum strength to fat-free mass. Mean handgrip and power were also controlled by fat-free mass. We performed univariate analysis, logistic regression, and ROC curves. The falling patients had lower muscle quality, muscle mass-controlled power, and mean weighted handgrip than the non-faller. Results showing that lower muscle quality increases fall risk (effect size = 0.891). Logistic regression confirmed muscle quality as a significant predictor (p < .001, OR = 0.82, CI [0.74; 0.89]). ROC curves demonstrated muscle quality as the most predictive factor of falling (AUC = 0.794). This retrospective study showed that muscle quality is the best predictor of fall risk, above spatial and temporal gait parameters. Our results underscore muscle quality as a clinically meaningful assessment and may be a useful complement to other assessments for fall prevention in the aging population.

Drug-drug interactions (DDIs) are prevalent among multimorbid and polymedicated older adults and can increase the risk of adverse drug reactions (ADRs), hospital admissions, and mortality. This study describes the incidence and prevalence of 66 clinically relevant DDIs and analyses the occurrence of 12 corresponding predefined ADRs in older inpatients enrolled in the SENATOR trial. The sub-study of the SENATOR trial that involved 1537 multimorbid older inpatients, recruited from 2016 to 2018 in six academic teaching hospitals in Belgium, Iceland, Ireland, Italy, Scotland, and Spain respectively, and analysed 66 potentially clinically significant DDIs. Descriptive analysis determined DDI and corresponding ADR prevalence/incidence. At baseline (median age: 78 [72, 84], 52.8% male), the prevalence of patients with DDIs was high (50.9%), increased during hospitalisation (55.2%) and reduced to 49.7% after 12weeks. The most common DDIs were: ≥ 2potassium reducing drugs (17.1%), ≥ 3centrally acting drugs (9.0%), and SSRI + loop/thiazide diuretic (7.2%). Of all participants, one-third experienced a prevalent (36.6%)/incident (35.8%) ADR. Major serum electrolyte disturbance had the highest incidence (10.7%)/prevalence (11.5%). Incident ADRs were more common in patients with DDIs (p = 0.013). A higher prevalence of new onset falls (p = 0.013), major constipation (p = 0.004), and major serum electrolyte disturbances (p = 0.006) was observed in patients with related and thus potentially causal DDIs. Clinicians should, be aware of DDIs and the involved drug classes that can lead to an increased rate of ADRs in older multimorbid inpatients. Regularly reevaluating the appropriateness of the frequently prescribed drug classesand initiating judicious deprescribing is recommended.

Our objective was to perform an external validity study of the clinical frailty scale (CFS) classification tree by determining the agreement of the CFS when attributed by a senior geriatrician, a junior geriatrician, or using the classification tree. Additionally, we evaluated the predictive value of the CFS for 6-month mortality after admission to an acute geriatric unit. This prospective study was conducted in two acute geriatric units in Belgium. The premorbid CFS was determined by a senior and a junior geriatrician based on clinical judgment within the first 72h of admission. Another junior geriatrician, who did not have a treatment relationship with the patient, scored the CFS using the classification tree. Intra-class correlation coefficient (ICC) was calculated to assess agreement. A ROC curve and Cox regression model determined prognostic value. In total, 97 patients were included (mean age 86 ± 5.2; 66% female). Agreement of the CFS, when determined by the senior geriatrician and the classification tree, was moderate (ICC 0.526, 95% CI [0.366-0.656]). This is similar to the agreement between the senior and junior geriatricians' CFS (ICC 0.643, 95% CI [0.510-0.746]). The AUC for 6-month mortality based on the CFS by respectively the classification tree, the senior and junior geriatrician was 0.719, 95% CI [0.592-0.846]; 0.774, 95% CI [0.673-0.875]; 0.774, 95% CI [0.665-0.882]. Cox regression analysis indicated that severe or very severe frailty was associated with a higher risk of mortality compared to mild or moderate frailty (hazard ratio respectively 6.274, 95% CI [2.613-15.062] by the classification tree; 3.476, 95% CI [1.531-7.888] by the senior geriatrician; 4.851, 95% CI [1.891-12.442] by the junior geriatrician). Interrater agreement in CFS scoring on clinical judgment without Comprehensive Geriatric Assessment is moderate. The CFS classification tree can help standardize CFS scoring.

The Achilles tendon (AT) is the largest and strongest tendon in the human body, and its elasticity is known to be affected by the aging process. However, the relation between AT stiffness and frailty in older individuals remains uncertain. This study aims to explore the potential of Achilles tendon shear wave elastography (AT-SWE) as a tool for assessing physical frailty in older adults. A total of 148 patients aged 65years and over were included in this cross-sectional study. Patients with heart failure, AT injury, stroke history, active malignancy, and claudication were excluded. All patients underwent a comprehensive geriatric assessment. Physical frailty assessment was performed with the fried frailty phenotype. Achilles tendon elastography was measured by ultrasound. The mean age of the participants was 73.8years and 62.2% were female. 30.4% of the participants were defined as frail. Achilles tendon shear wave elastography measurements were statistically lower in the frail group (p < 0.05). In the multivariate regression analysis, AT-SWE demonstrated a statistically significant association with frailty independent of confounding factors (OR 0.982, 95% CI 0.965-0.999, p value = 0.038). In the ROC curve analysis, the area under the curve for AT-SWE was 0.647 (95% CI, 0.564-0.724, p < 0.01) and the optimum cut-off point was 124.1kilopascals. These findings highlight the value of AT-SWE as a non-invasive and objective tool for predicting frailty in older adults.

Structured aftercare programs are implemented to facilitate the transition from rehabilitation centers to patients' home environments. Taking the program GeRas as an example, this paper aims to evaluate the influence of patient-related factors on the implementation of the geriatric aftercare program GeRas from patients' and providers' perspectives. To capture patients' and providers' perspectives, qualitative interviews were conducted using a semi-structured interview guide. The analysis was inductive-deductive and based on the thematic analysis by Braun and Clarke and guided by Domain IV of the CFIR. 16 participants (10 patients, 4 providers, 2 family members) were interviewed from May 2023 to November 2023. Patient-related factors were perceived as an important aspect during the implementation of the GeRas program. The results were allocated to the four Constructs of Domain IV of the CFIR (Motivation, Opportunity, Capability, Needs). Especially patients' intrinsic motivation, social environment, and physical capabilities seemed to be crucial for successful implementation. While extrinsic motivation can mitigate missing personal capabilities, it cannot replace the presence of intrinsic motivation and capabilities. The results showed that patient-related factors are interlinked. The relevance of patient-related factors during the implementation of the GeRas program shows that such programs must consider these factors during intervention planning.

The purpose of the present study was to comprehensively examine the association between inadequate physical activity (PA), cognitive activity (CA), and social activity (SA) and the development of sarcopenia. We conducted a two-wave survey. In the first-wave survey, we asked participants five questions for each of the three categories-PA, CA, and SA. The low-activity group was defined as those who fell into the decline category for one or more of the five questions. In both Wave 1 and Wave 2, we assessed the sarcopenia status of our participants. The revised definition of the European Working Group on Sarcopenia in Older People 2 was used to determine sarcopenia, and the Asian Working Group for Sarcopenia criteria were used for cut-off points for muscle mass, grip strength, and walking speed. In the second wave, we were able to follow 2,530 participants (mean age 75.0 ± 4.7years, 47.8% men). A multivariable logistic regression showed that low-PA participants face a higher risk of incident sarcopenia, both before and after multiple imputations (odds ratio [OR] 1.62, 95%confidence interval (CI) 1.22-2.15 before imputation; OR 1.62, 95% CI 1.21-2.18 after imputation); the low-SA group also showed a higher risk of incident sarcopenia both before and after multiple imputations (OR 1.31, 95% CI 1.05-1.64 before imputation; OR1.33, 95% CI 1.07-1.65 after imputation). Each low PA and SA independently led to incident sarcopenia late in life. Encouraging not only PA, but also SA, may be effective to prevent sarcopenia among older adults.