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Bauer J.,Geriatric Center Oldenburg | Biolo G.,University of Trieste | Cederholm T.,Uppsala University | Cesari M.,French Institute of Health and Medical Research | And 9 more authors.
Journal of the American Medical Directors Association | Year: 2013

New evidence shows that older adults need more dietary protein than do younger adults to support good health, promote recovery from illness, and maintain functionality. Older people need to make up for age-related changes in protein metabolism, such as high splanchnic extraction and declining anabolic responses to ingested protein. They also need more protein to offset inflammatory and catabolic conditions associated with chronic and acute diseases that occur commonly with aging. With the goal ofdeveloping updated, evidence-based recommendations for optimal protein intake by older people, theEuropean Union Geriatric Medicine Society (EUGMS), in cooperation with other scientific organizations, appointed an international study group to review dietary protein needs with aging (PROT-AGE Study Group). To helpolder people (>65 years) maintain and regain lean body mass and function, the PROT-AGE study group recommends average daily intake at least in the range of 1.0 to 1.2 g protein per kilogram of body weight per day. Both endurance- and resistance-type exercises are recommended at individualized levels that are safe and tolerated, and higher protein intake (ie, ≥;1.2 g/kg body weight/d) is advised for those who are exercising and otherwise active. Most older adults who have acute or chronic diseases need even more dietary protein (ie, 1.2-1.5 g/kg body weight/d). Older people with severe kidney disease (ie, estimated GFR <30 mL/min/1.73m2), but who are not on dialysis, are an exception to this rule; these individuals may need to limit proteinintake. Protein quality, timing of ingestion, and intake of other nutritional supplements may be relevant, but evidence is not yet sufficient tosupport specific recommendations. Older people are vulnerable to losses in physical function capacity, and such losses predict loss of independence, falls, and even mortality. Thus, future studies aimed at pinpointing optimal protein intake in specific populations of older people need to include measures of physical function. © 2013 American Medical Directors Association, Inc.


Kosse N.M.,University of Groningen | Brands K.,University of Groningen | Bauer J.M.,Geriatric Center Oldenburg | Hortobagyi T.,University of Groningen | Lamoth C.J.C.,University of Groningen
International Journal of Medical Informatics | Year: 2013

Background: Falls are a serious health problem in old adults especially in nursing home residents and hospitalized patients. To prevent elderly from falling, sensors have been increasingly used in intramural care settings. However, there is no clear overview of the current used technologies and their results in fall prevention. Objectives: The present study reviews sensor systems that prevent falls in geriatric patients living in an intramural setting and describe fall rates, fall-related injuries, false alarms, and user experience associated with such systems. Methods: We conducted a systematic search for studies that used sensor technologies with the aim to prevent falls in institutionalized geriatric patients. Results: A total of 12 studies met the search criteria. Three randomized clinical trials reported no reductions in fall rate but three before-after studies reported significant reductions of 2.4-37 falls per 1000 patient days. Although there was up to 77% reduction in fall-related injuries and there was relatively low, 16%, rate of false alarms, the current data are inconsistent whether current sensor technologies are effective in reducing the number of falls in institutionalized geriatric patients. The occurrence of false alarms (16%) was too high to maintain full attention of the nursing staff. Additionally including the users opinion and demands in developing and introducing sensor systems into intramural care settings seems to be required to make an intervention successful. Conclusion: The evidence is inconsistent whether the current sensor systems can prevent falls and fall-related injuries in institutionalized elderly. Further research should focus more comprehensively on user requirements and effective ways using intelligent alarms. © 2013 Elsevier Ireland Ltd.


Drey M.,Friedrich - Alexander - University, Erlangen - Nuremberg | Krieger B.,Friedrich - Alexander - University, Erlangen - Nuremberg | Sieber C.C.,Friedrich - Alexander - University, Erlangen - Nuremberg | Bauer J.M.,Friedrich - Alexander - University, Erlangen - Nuremberg | And 3 more authors.
Journal of the American Medical Directors Association | Year: 2014

Objectives: Sarcopenia, age-related muscle wasting, is associated with increased morbidity and mortality in the affected individuals. The pathogenesis of sarcopenia is not yet fully understood. A multifactorial concept is currently favored. The reduced number of motor units as a potential mechanism of muscle mass loss is explored in the present study. Design: This is a cross-sectional study. Setting: The participants were community-dwelling older adults. Participants: The participants were sarcopenic (75) and nonsarcopenic (74) according to the criteria of the European Working Group on Sarcopenia in Older People aged 65 to 94 years. Measurements: The motor unit number index (MUNIX) of the hypothenar muscle was used to assess the number and size [motor unit size index (MUSIX)] of motor units. Results: The participants with pathologic MUNIX and MUSIX (n= 23) are significantly more frequently sarcopenic (n= 17, P= .029) than nonsarcopenic (n= 6). The participants with pathologic MUNIX and MUSIX (n= 23) had significantly less muscle mass than the nonsarcopenic controls (P < .001). After adjusting for age and sex, only gait speed has shown no difference between the 2 groups. Pearson's correlation coefficient between MUSIX and the reciprocal value of MUNIX is 0.87 (P < .001). Conclusions: Sarcopenia induced by a small number of motoneurons can be identified by applying the MUNIX method to the hypothenar muscle. An enlargement of motor units because of motoneuron loss seems to preserve physical performance. © 2014 American Medical Directors Association, Inc.


Drey M.,Friedrich - Alexander - University, Erlangen - Nuremberg | Zech A.,University of Hamburg | Freiberger E.,Friedrich - Alexander - University, Erlangen - Nuremberg | Bertsch T.,Institute for Clinical Chemistry | And 4 more authors.
Gerontology | Year: 2012

Background: It has been unclear which training mode is most effective and feasible for improving physical performance in the risk group of prefrail community-dwelling older adults. Objective: The purpose of the present study was to compare the effects of strength training (ST) versus power training (PT) on functional performance in prefrail older adults. This study was registered at clinicaltrials.gov as NCT00783159. Methods: 69 community-dwelling older adults (>65 years) who were prefrail according to the definition of Fried were included in a 12-week exercise program. The participants were randomized into an ST group, a PT group and a control group. All participants were supplemented with vitamin D 3 orally before entering the intervention period. The primary outcome was the global score on the Short Physical Performance Battery (SPPB). Secondary outcomes were muscle power, appendicular lean mass (aLM) measured by dual energy X-ray absorptiometry and self-reported functional deficits (Short Form of the Late-Life Function and Disability Instrument, SF-LLFDI). Results: Regarding changes in the SPPB score during the intervention, significant heterogeneity between the groups was observed (p = 0.023). In pair-wise comparisons, participants in both training groups significantly (PT: p = 0.012, ST: 0.009) increased their SPPB score (PT: Δ mean = 0.8, ST: Δ mean = 1.0) compared to the control group, with no statistical difference among training groups (p = 0.301). No statistical differences were found in changes in aLM (p = 0.769), muscle power (p = 0.308) and SF-LLFDI (p = 0.623) between the groups. Muscle power significantly increased (p = 0.017) under vitamin D 3 intake. Conclusions: In prefrail community-dwelling adults, PT is not superior to ST, although both training modes resulted in significant improvements in physical performance. With regard to dropout rates, ST appears to be advantageous compared to PT. The high prevalence of vitamin D 3 deficiency and the slight improvement of physical performance under vitamin D 3 supplementation among study participants underline the relevance of this approach in physical exercise interventions. © 2011 S. Karger AG, Basel.


Bollwein J.,IBA University | Diekmann R.,IBA University | Kaiser M.J.,IBA University | Bauer J.M.,Geriatric Center Oldenburg | And 3 more authors.
Journals of Gerontology - Series A Biological Sciences and Medical Sciences | Year: 2013

Background.The etiology of the geriatric syndrome frailty is multifactorial. Besides hormonal and inflammatory processes, nutritional influences may be of major relevance. In this cross-sectional study, the association between dietary quality and frailty was investigated.Methods.In 192 community-dwelling older volunteers (>75 years), an interview-based food frequency questionnaire was used to assess nutritional data. A Mediterranean diet (MED) score (maximum 9 points) was used to evaluate dietary quality. Frailty was defined as the presence of at least three and prefrailty as the presence of one or two of the following criteria: weight loss, exhaustion, low physical activity, low handgrip strength, and slow walking speed. Older adults without any of these attributes were defined as "nonfrail" Binomial logistic regression analysis was used to assess the risk of being frail (vs prefrail and nonfrail) in each quartile (vs lowest quartile) of the MED score.Results.The mean (SD) age of the participants was 83 (4) years; 41.1% were prefrail and 15.1% were frail. The risk of being frail was significantly reduced in the highest quartile of the MED score (OR 0.26; 95% CI 0.07-0.98).Conclusions.A healthy dietary pattern is associated with a lower risk of being frail. Larger, prospective and interventional studies are needed to clarify the association between dietary quality and frailty. © The Author 2012. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved.


Drey M.,Friedrich - Alexander - University, Erlangen - Nuremberg | Sieber C.C.,Friedrich - Alexander - University, Erlangen - Nuremberg | Bauer J.M.,Friedrich - Alexander - University, Erlangen - Nuremberg | Bauer J.M.,Geriatric Center Oldenburg | And 9 more authors.
Experimental Gerontology | Year: 2013

Introduction: Sarcopenia is considered to be an enormous burden for both the individuals affected and for society at large. A multifactorial aetiology of this geriatric syndrome has been discussed. Amongst other pathomechanisms, the degeneration of the neuromuscular junction (NMJ) may be of major relevance. The intact balance between the pro-synaptic agent agrin and the anti-synaptic agent neurotrypsin ensures a structurally and functionally intact NMJ. Excessive cleavage of the native motoneuron-derived agrin by neurotrypsin into a C-terminal Agrin Fragment (CAF) leads to functional disintegration at the NMJ and may consecutively cause sarcopenia. The present study evaluates the hypothesis that CAF serum concentration is a potential marker for the loss of appendicular lean mass in older adults. It also explores how CAF concentration is influenced by vitamin D supplementation and physical exercise. Method: Serum was taken from 69 (47 female) prefrail community-dwelling older adults participating in a training intervention study to measure the CAF concentration using the Western blot technique. All participants were supplemented orally with vitamin D3 before the training intervention period commenced. Appendicular lean mass (aLM) was evaluated by dual energy X-ray absorptiometry. Multiple linear regression models were used to identify factors significantly associated with CAF concentration. Results: Appendicular lean mass, age and sex were identified as significant explanatory factors for CAF concentration. Gait speed and hand grip strength were not associated with CAF concentration. Male participants showed a strong correlation (r = - 0.524) between CAF serum concentration and aLM, whereas this was not the case (r = - 0.219) in females. Vitamin D supplementation and physical exercise were significantly associated with a reduction in CAF concentration, especially in participants with initially high CAF concentrations. Conclusions: C-terminal Agrin Fragment could be a potential marker for identifying sarcopenia in a subgroup of affected individuals in the future. The decline of muscle mass seems to be a CAF-associated process in males, whereas the situation in females may be more complex and multifactorial. CAF concentration is reduced by vitamin D supplementation and physical exercise and therefore suggests a potentially positive effect on NMJs. Further prospective studies of sarcopenic patients in addition to muscle biopsy and electromyographical investigations are planned to verify the external validity of the CAF concept. © 2012 Elsevier Inc.


Zech A.,University of Hamburg | Drey M.,Friedrich - Alexander - University, Erlangen - Nuremberg | Freiberger E.,Friedrich - Alexander - University, Erlangen - Nuremberg | Hentschke C.,Friedrich - Alexander - University, Erlangen - Nuremberg | And 3 more authors.
BMC Geriatrics | Year: 2012

Background: Although resistance exercise interventions have been shown to be beneficial in prefrail or frail older adults it remains unclear whether there are residual effects when the training is followed by a period of detraining. The aim of this study was to establish the sustainability of a muscle power or muscle strength training effect in prefrail older adults following training and detraining. Methods. 69 prefrail community-dwelling older adults, aged 65-94 years were randomly assigned into three groups: muscle strength training (ST), muscle power training (PT) or controls. The exercise interventions were performed for 60 minutes, twice a week over 12 weeks. Physical function (Short Physical Performance Battery=SPPB), muscle power (sit-to-stand transfer=STS), self-reported function (SF-LLFDI) and appendicular lean mass (aLM) were measured at baseline and at 12, 24 and 36 weeks after the start of the intervention. Results: For the SPPB, significant intervention effects were found at 12 weeks in both exercise groups (ST: p = 0.0047; PT: p = 0.0043). There were no statistically significant effects at 24 and 36 weeks. In the ST group, the SPPB declined continuously after stop of exercising whereas the PT group and controls remained unchanged. No effects were found for muscle power, SF-LLFDI and aLM. Conclusions: The results showed that both intervention types are equally effective at 12 weeks but did not result in statistically significant residual effects when the training is followed by a period of detraining. The unchanged SPPB score at 24 and 36 weeks in the PT group indicates that muscle power training might be more beneficial than muscle strength training. However, more research is needed on the residual effects of both interventions. Taken the drop-out rates (PT: 33%, ST: 21%) into account, muscle power training should also be used more carefully in prefrail older adults. Trial registration. This trial has been registered with clinicaltrials.gov (NCT00783159). © 2012 Zech et al.; licensee BioMed Central Ltd.


Diekmann R.,Friedrich - Alexander - University, Erlangen - Nuremberg | Winning K.,Friedrich - Alexander - University, Erlangen - Nuremberg | Bauer J.M.,Friedrich - Alexander - University, Erlangen - Nuremberg | Bauer J.M.,Geriatric Center Oldenburg | And 6 more authors.
Zeitschrift fur Gerontologie und Geriatrie | Year: 2013

Objective: Low vitamin D blood levels are highly prevalent in elderly people, particularly in nursing home residents (NHR). A relation between vitamin D levels and physical function (PF) is described in several studies in older adults; however, data on NHR are scarce and there is presently no information on the time course of vitamin D levels and PF in this population. The aim of the present study was to describe the 25-hydroxyvitamin D [25(OH)D] status of NHR at baseline (t1) and after 1 year (t2) to examine whether 25(OH)D blood levels are related to PF at t1 and at t2, and whether changes in 25(OH)D levels over 1 year are related to changes in PF. Methods: All NHR (≥ 65 years) without tube-feeding and severe acute or end-stage disease were asked to participate. At t1 and t2 fasting blood samples were taken for the analysis of 25(OH)D serum levels and PF was estimated by activities of daily living (Barthel ADL) and measured by handgrip strength (HGS) and timed 'up and go' test (TUG). Results: In total, 115 residents, aged 87 (82-93) years (all data in median and 1st-3rd quartile), showed the following values for PF: ADL 50 (20-65) points, HGS 40 (30-50) kPa and TUG 26 (18-31) s. Vitamin D deficiency (< 50 nmol/l) was present in 93.9 % (70.4 % < 25 nmol/l) at t1 and in 71.2 % (57.3 % < 25 nmol/l) at t2. At t1 and at t2 a weak correlation between vitamin D level and PF (Spearman's correlation coefficient t1: ADL r = 0.367, HGS r = 0.313; t2: ADL: r = 0.247; all p < 0.01) was observed. There was no correlation between changes in vitamin D levels over 1 year and changes in PF. Conclusions: Almost all NHR included in the study showed vitamin D deficiency. 25(OH)D levels were weakly correlated to PF at baseline and at follow-up, and an increase in vitamin D levels was not associated with positive effects on PF in this study. © 2013 Springer-Verlag Berlin Heidelberg.


Bollwein J.,IBA University | Diekmann R.,IBA University | Kaiser M.J.,IBA University | Bauer J.M.,Geriatric Center Oldenburg | And 3 more authors.
Nutrition Journal | Year: 2013

Background: To preserve muscle mass and therefore limit the risk of disability in older adults protein intake is seen as important factor. Besides the amount of protein, its distribution over the day is thought to affect protein anabolism. This cross-sectional study investigates the association between the amount and distribution of protein intake and frailty in older adults. Methods. In 194 community-dwelling seniors (≥75 years) amount of protein intake and its distribution over the day (morning, noon, evening) were assessed using a food frequency questionnaire. Unevenness of protein distribution was calculated as coefficient of variation (CV). Frailty was defined as the presence of at least three, pre-frailty as the presence of one or two of the following criteria: weight loss, exhaustion, low physical activity, low handgrip strength and slow walking speed. Results: 15.4% of the participants were frail, 40.5% were pre-frail. Median (min.-max.) daily protein intake was 77.5 (38.5-131.5) g, 1.07 (0.58-2.27) g/kg body weight (BW) and 15.9 (11.2-21.8) % of energy intake without significant differences between the frailty groups. The risk of frailty did not differ significantly between participants in the higher compared to the lowest quartile of protein intake. Frail participants consumed significantly less protein in the morning (11.9 vs. 14.9 vs. 17.4%, p = 0,007), but more at noon (61.4 vs. 60.8 vs. 55.3%, p = 0.024) than pre-frail and non-frail. The median (min.-max.) CV of protein distribution was highest in frail (0.76 (0.18-1.33)) compared to pre-frail (0.74 (0.07-1.29)) and non-frail (0.68 (0.15-1.24)) subjects (p = 0.024). Conclusions: In this sample of healthy older persons, amount of protein intake was not associated with frailty, but distribution of protein intake was significantly different between frail, pre-frail and non-frail participants. More clinical studies are needed to further clarify the relation between protein intake and frailty. © 2013 Bollwein et al.; licensee BioMed Central Ltd.


De Vita F.,University of Parma | Lauretani F.,University of Parma | Bauer J.,Geriatric Center Oldenburg | Bautmans I.,Vrije Universiteit Brussel | And 9 more authors.
Age | Year: 2014

In older persons, vitamin D insufficiency and a subclinical chronic inflammatory status frequently coexist. Vitamin D has immune-modulatory and in vitro anti-inflammatory properties. However, there is inconclusive evidence about the anti-inflammatory role of vitamin D in older subjects. Thus, we investigated the hypothesis of an inverse relationship between 25-hydroxyvitamin D (25(OH)D) and inflammatory markers in a population-based study of older individuals. After excluding participants with high-sensitivity C-reactive protein (hsCRP) ≥ 10 mg/dl and those who were on chronic anti-inflammatory treatment, we evaluated 867 older adults ≥65 years from the InCHIANTI Study. Participants had complete data on serum concentrations of 25(OH)D, hsCRP, tumor necrosis factor (TNF)-α, soluble TNF-α receptors 1 and 2, interleukin (IL)-1β, IL-1 receptor antagonist, IL-10, IL-18, IL-6, and soluble IL-6 receptors (sIL6r and sgp130). Two general linear models were fit (model 1—adjusted for age, sex, and parathyroid hormone (PTH); model 2—including covariates of model 1 plus dietary and smoking habits, physical activity, ADL disability, season, osteoporosis, depressive status, and comorbidities). The mean age was 75.1 ± 17.1 years ± SD. In model 1, log(25OH-D) was significantly and inversely associated with log(IL-6) (β ± SE = −0.11 ± 0.03, p = <0.0001) and log (hsCRP) (β ± SE = −0.04 ± 0.02, p = 0.04) and positively associated with log(sIL6r) (β ± SE = 0.11 ± 0.04, p = 0.003) but not with other inflammatory markers. In model 2, log (25OH-D) remained negatively associated with log (IL-6) (β ± SE = −0.10 ± 0.03, p = 0.0001) and positively associated with log(sIL6r) (β ± SE = 0.11 ± 0.03, p = 0.004) but not with log(hsCRP) (β ± SE = −0.01 ± 0.03, p = 0.07). 25(OH)D is independently and inversely associated with IL-6 and positively with sIL6r, suggesting a potential anti-inflammatory role for vitamin D in older individuals. © 2014, American Aging Association.

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