Sarcopenia and malnutrition: impact on the outcome in hospitalized patients

Sarcopenia is a condition caused by a progressive loss of lean body mass and muscle strength, related to aging; this leads to a progressive decrease of physical performance. Sarcopenia is inherently connected with a major risk of disability, hospitalization and mortality. Prevalence of sarcopenia increases with increasing age, in particular among hospitalized geriatric patients, with male dominance. Malnutrition is also very frequent condition in elderly patients during hospital stay and it is involved in the development of sarcopenia. The most common therapeutic approach for both malnutrition and sarcopenia is an increased nutritional support with a protein-rich diet. This narrative review summarises the biological mechanism linking sarcopenia and malnutrition in older hospitalized patients and examines evidence supporting the use of oral nutritional support for the prevention and treatment of malnutrition an sarcopenia in acutely ill medical patients

Delirium in hip fractured patients

The current clinical case concerns the mixed delirium in a 70-year-old man with hip fracture, following a fall at home. In his medical history, the patient reported several comorbidities, among which also sarcopenia. Delirium was already diagnosed by the geriatrician on hospital admission. The patient underwent hip endoprosthesis surgery after 24 hours without any intra-operative complications. However, in the post-operative period delirium persisted, causing a prolonged hospital stay, a delayed physio-therapy rehabilitation with poor functional recovery, and subsequent insti-tutionalization. The prevalence of delirium in older people with hip fracture is extremely high and it is associated with several negative outcomes. Delirium is considered a multifactorial disorder, and, in particular, sarcopenia appears directly linked to the development of delirium. The systematic assessment of sarcopenia should be performed in hospitalized older patients with hip fracture, together with the other predisposing risk factors for delirium, to timely identify people at higher risk for both delirium and disability

Prevalence and impact of polypharmacy in older patients with type 2 diabetes

Background: Polypharmacy is a prevalent condition in older adults, especially those with multiple chronic diseases, and has been largely associated with adverse outcomes, including disability, hospitalizations, and death. Aims: This systematic review focused on diabetes and aimed to investigate the prevalence and impact of polypharmacy in older adults affected by such disease. Methods: Observational (either cross-sectional or longitudinal) or experimental studies investigating the frequency and impact of polypharmacy in older adults with diabetes were identified from scientific databases and grey literature until August 2021. The prevalence and the 95% Confidence Interval (95% CI) of polypharmacy in older people with diabetes were summarized by a random-effects meta-analysis. Results: From a total of 1465 records, 9 were selected for the qualitative synthesis, and 8 for the quantitative synthesis. Most studies defined polypharmacy using a cut-off for the minimum number of medications ranging from 4 to 6 drugs/day. The pooled prevalence of polypharmacy in older people with diabetes was 64% (95% CI 45–80%). Considering studies that used the same definition of polypharmacy (i.e. ≥ 5 drugs/day), the pooled prevalence was 50% (95% CI 37–63%). The between-studies heterogeneity was high. Across the selected studies, polypharmacy seemed to negatively influence both diabetes-specific (poor glycemic control and risk of hypoglycemia) and health-related (risk of incident falls, syncope, hospitalization, and death) outcomes. Conclusion: This systematic review confirms the high prevalence of polypharmacy in older people with diabetes and its strong impact on several health-related outcomes, including mortality. These results strengthen the need to improve care strategies for management of these patients

A drug-induced microscopic colitis in an older woman: a case report

We presented a case of a 87-year-old woman hospitalized for chronic watery diarrhea, affected by multimorbidities. After excluding other caus-es of diarrhea by biohumoral and microbiological tests, endoscopy was performed without revealing any macroscopic abnormalities, but, at histological examination of random biopsies, the characteristic features of collagenous colitis were found. Lansoprazolo and sertraline, chronically taken by the patient, was discontinued, and budesonide was started with prompt clinical improvement. Collagenous colitis is a rare cause of chronic diarrhea in advanced age, but it should be suspected in patients with polypharmacotherapy, after an accurate differential diagnosis

Presepsin levels and COVID-19 severity: a systematic review and meta-analysis

Plasmatic presepsin (PSP) is a novel biomarker reported to be useful for sepsis diagnosis and prognosis. During the pandemic, only few studies highlighted a possible correlation between PSP and COVID-19 severity, but results remain inconsistent. The present study aims to establish the correlation between PSP and COVID-19 severity. English-language papers assessing a correlation between COVID-19 and PSP from MEDLINE, PubMed, Google Scholar, Cochrane Library, MeSH, LitCovid NLM, EMBASE, CINAHL Plus and the World Health Organization (WHO) website, published from January 2020 were considered with no publication date limitations. Two independent reviewers performed data abstraction and quality assessment, and one reviewer resolved inconsistencies. The protocol was registered on PROSPERO (CRD42022325971).Fifteen articles met our eligibility criteria. The aggregate study population included 1373 COVID-19 patients who had undergone a PSP assessment. The random-effect meta-analysis was performed in 7 out of 15 selected studies, considering only those reporting the mean PSP levels in low- and high-severity cases (n = 707).The results showed that the pooled mean difference of PSP levels between high- and low-severity COVID-19 patients was 441.70 pg/ml (95%CI: 150.40-732.99 pg/ml).Our data show that presepsin is a promising biomarker that can express COVID-19 severity

Patterns of multimorbidity in primary care electronic health records: A systematic review

Multimorbidity; Electronic health records; Primary careMultimorbilidad; Registros médicos electrónicos; Atención primariaMultimorbiditat; Registres mèdics electrònics; Atenció primàriaBackground Multimorbidity, the coexistence of multiple chronic conditions in an individual, is a complex phenomenon that is highly prevalent in primary care settings, particularly in older individuals. This systematic review summarises the current evidence on multimorbidity patterns identified in primary care electronic health record (EHR) data. Methods Three databases were searched from inception to April 2022 to identify studies that derived original multimorbidity patterns from primary care EHR data. The quality of the included studies was assessed using a modified version of the Newcastle-Ottawa Quality Assessment Scale. Results Sixteen studies were included in this systematic review, none of which was of low quality. Most studies were conducted in Spain, and only one study was conducted outside of Europe. The prevalence of multimorbidity (i.e. two or more conditions) ranged from 14.0% to 93.9%. The most common stratification variable in disease clustering models was sex, followed by age and calendar year. Despite significant heterogeneity in clustering methods and disease classification tools, consistent patterns of multimorbidity emerged. Mental health and cardiovascular patterns were identified in all studies, often in combination with diseases of other organ systems (e.g. neurological, endocrine). Discussion These findings emphasise the frequent coexistence of physical and mental health conditions in primary care, and provide useful information for the development of targeted preventive and management strategies. Future research should explore mechanisms underlying multimorbidity patterns, prioritise methodological harmonisation to facilitate the comparability of findings, and promote the use of EHR data globally to enhance our understanding of multimorbidity in more diverse populations

Frailty trajectories in ICU survivors: A comparison between the clinical frailty scale and the Tilburg frailty Indicator and association with 1 year mortality

Purpose: To test the agreement of the Clinical Frailty Scale (CFS) and the Tilburg Frailty Indicator (TFI), their association with 3, 6 months and 1-year mortality and the trajectory of frailty in a mixed population of ICU survivors. Material and methods: This is a prospective, multicenter, longitudinal study on ICU survivors ≥18 years old with an ICU stay >72 h. For each patient, sociodemographic and clinical data were collected. Frailty was assessed during ICU stay and at 3, 6, 12 months after ICU discharge, through both CFS and TFI. Results: 124 patients with a mean age of 66 years old were enrolled. The baseline prevalence of frailty was 15.3% by CFS and 44.4% by TFI. Baseline CFS and TFI correlated but showed low agreement (Cohen's K = 0.23, p < 0.001). Baseline CFS score, but not TFI, was significantly associated to 1 year mortality. Moreover, CFS score during the follow-up was independently associated 1-year mortality (OR = 1.43; 95% CI: 1.18-1.73). Conclusions: CFS and TFI identify different populations of frail ICU survivors. Frail patients before ICU according to CFS have a significantly higher mortality after ICU discharge. The CFS during follow-up is an independent negative prognostic factor of long-term mortality in the ICU population

Neurofilament-Light Chain and Glial Fibrillary Acidic Protein as Blood-Based Delirium Risk Markers: A Multicohort Study

Postoperative delirium (POD) is often under-recognized in clinical practice. Blood-based markers could facilitate delirium detection and risk stratification. Neurofilament-Light chain (NfL) and Glial Fibrillary Acidic Protein (GFAP) are promising blood-based markers for neurodegenerative diseases and potential candidates for delirium. This study explored their role as blood-based risk markers for POD in older patients undergoing hip fracture surgery. In this prospective multicohort study, preoperative blood and intraoperative cerebrospinal fluid (CSF) samples were collected from patients aged >= 65 years with hip fractures. POD was assessed daily using the 4AT scale. NfL and GFAP concentrations in both blood and CSF were compared between POD and Non-POD groups, further stratifying by dementia status. Logistic regression models adjusted for covariates were used to assess associations. A total of 143 patients (median age, 85 years; 76.9% female) were included, with POD occurring in 38 patients (26.6%). Blood NfL and GFAP concentrations were significantly higher in the POD group than in Non-POD (64.55 vs. 44.6 pg/mL and 22 vs. 14.8 pg/mL, P<0.001). CSF NfL levels were also elevated in POD (2154 vs. 1565 pg/mL, P=0.007), but no significant difference was observed for CSF GFAP levels. Higher preoperative blood NfL and GFAP levels independently predicted POD after adjusting for age, sex, dementia, frailty, and Interleukin-6 (Odds Ratio, OR: 3.21, 95% Confidence Interval, CI: 1.26-8.21, and OR: 3.66, 95% CI: 1.38-9.68, respectively). Although further research is needed, our findings support the role of NfL and GFAP as blood-based risk markers for POD in older patients undergoing hip fracture surgery

Changes in sleep quality and sleep disturbances in the general population from before to during the COVID-19 lockdown: A systematic review and meta-analysis

IntroductionThis systematic review and meta-analysis aims to explore changes in sleep quality and sleep disturbances in the general population from before to during the COVID-19 lockdown.MethodsThe protocol was registered in PROSPERO (CRD42021256378) and the PRISMA guidelines were followed. The major databases and gray literature were systematically searched from inception to 28/05/2021 to identify observational studies evaluating sleep changes in the general population during the lockdown with respect to the pre-lockdown period. A random effects meta-analysis was undertaken for studies reporting (a) the means of the Pittsburgh Sleep Quality Index (PSQI) global scores or the means of the sleep onset latency (SOL) times (minutes - min) before and during the lockdown, (b) the percentages of poor sleep quality before and during the lockdown, or (c) the percentages of changes in sleep quality. Subgroup analysis by risk of bias and measurement tool utilized was carried out. A narrative synthesis on sleep efficiency, sleep disturbances, insomnia and sleep medication consumption was also performed.ResultsSixty-three studies were included. A decline in sleep quality, reflected in a pooled increase in the PSQI global scores (standardized mean difference (SMD) = 0.26; 95% CI 0.17–0.34) and in SOL (SMD = 0.38 min; 95% CI 0.30–0.45) were found. The percentage of individuals with poor sleep quality increased during the lockdown (pooled relative risk 1.4; 95% CI 1.24–1.61). Moreover, 57.3% (95% CI 50.01–61.55) of the individuals reported a change in sleep quality; in 37.3% (95% CI 34.27–40.39) of these, it was a worsening. The studies included in the systematic review reported a decrease in sleep efficiency and an increase in sleep disturbances, insomnia, and in sleep medication consumption.DiscussionTimely interventions are warranted in view of the decline in sleep quality and the increase in sleep disturbances uncovered and their potentially negative impact on health. Further research and in particular longitudinal studies using validated instruments examining the long-term impact of the lockdown on sleep variables is needed.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021256378, identifier CRD42021256378