key: cord-0077089-29w3tiwv
authors: nan
title: Posters
date: 2022-04-13
journal: J Frailty Aging
DOI: 10.14283/jfa.2022.23
sha: 255fbfe79bb663a120b4f52f88f7cce32c9e7f5c
doc_id: 77089
cord_uid: 29w3tiwv

nan

Background: Older Background: Frailty is common among preoperative elderly patients with gastric cancer. The different frailty subgroups before surgery may be capable of recognizing the patient's status more accurately and predicting the adverse outcomes more targeted. Purpose: To classify the frailty subgroups by employing the Tilburg Frailty Indicator (TFI), as well as exploring the differences in postoperative total complications, length of stay (LOS), disability, and quality of life (QOL) between each subgroup among preoperative elderly gastric cancer patients. Methods: Overall 290 patients were enrolled in this follow-up study. The TFI was used to collect the information of physical, psychological, and social frailty. The data of total complications and LOS were provided from the electronic medical records, while the data of disability and QOL were obtained from the telephone at 30 days after discharge. Results: The TFI divided the preoperative elderly gastric cancer patients into eight frailty subgroups: exclusive physical frailty (18.3%), exclusive psychological frailty (20%), exclusive social frailty (3.4%), physical and psychological frailty (14.5%), physical and social frailty (3.4%), psychological and social frailty (3.4%), multidimensional frailty (4.8%) and full robust subgroup (32%). The multidimensional frailty subgroup had worse outcomes in total complications (P=0.001) and LOS (P 0.001) while the subgroup of physical and social frailty had poorer QOL (P=0.015) at 30 days after discharge. Conclusion: The multidimensional frailty subgroup and the physical and social frailty subgroup should be of particularly concerned in the hospital and outside hospital according to our study. It also indicates that prehabilitation strategies can be developed precisely based on reported items to improve functional status of elderly gastric cancer patients. Further studies are needed to conduct in a longer-term period to capture significant change of other outcome indicators.

Background: Sarcopenia has assumed growing relevance as a morbimortality predictor after major abdominal surgery. The aim of this study is to access total psoas muscle area (TPA) and lean muscular area (LMA) impact in morbimortality after elective EVAR. Methods: Asymptomatic patients submitted to aortic endoprothesis implantation between January 1, 2014 and December 31, 2018 at our Vascular Surgery Department were retrospectively evaluated. After exclusion criteria were applied, 105 patients were included in the study; preoperative CT scans were evaluated using OSIRIX software (Bernex, Switzerland) . Two observers independently calculated TPA at the most caudal level of the L3 vertebra and respective density, therefore calculating LMA. Patients were separated by tertiles with the lowest being considered sarcopenic and with higher muscle steatosis and compared with the higher tertiles. Patient demographics and intra-and postoperative period variables were collected. Charlson Comorbidity Index was calculated and surgical complications classified according to Clavien-Dindo. Statistical analysis was performed using SPSS-25 software. Results: Considering TPA, univariate analyses revealed that patients in the lower tertile had inferior survival (p=0,03) while multivariate analyses showed tendency to significance (p=0,084, HR 3,107). For LMA, univariate analyses revealed that patients in the lower tertile had inferior survival (p=0,013) while multivariate analyses showed tendency to significance (p=0,075, HR 3,349). When analyzing patients in the lowest tertile of both TPA and LMA, both univariate (p=0,002) and multivariate (p=0, 018, HR 4, 166) analyses reveled inferior survival. Conclusions: Our study reveals reduced survival in patients with low TPA and low LMA submitted to elective EVAR; these factors should probably be taken into consideration in the future for pre-operative risk evaluation and surgical planning.

Fang-Ru Yueh 1 , Miaofen Yen 2 , Natashia Dhea 2 (1. Nursing Department, National Cheng Kung University Hospital, Tainan, ROC, Taiwan; 2. Nursing Department, National Cheng Kung University, Tainan, ROC, Taiwan) Background: Frailty is a syndrome of physiological decline, characterized by a marked vulnerability to adverse health outcomes and associated with the increased risk of mortality. Recent studies showed the prevalence of frailty gradually increases with age and deterioration of renal function. At present, there is no gold standard for frailty screening among chronic kidney disease (CKD) patients resulting in variation of frailty prevalence ranging from 7% to 73% which affects predictive value. In general, machine learning (ML) has been applied to fit in non-linear models, with the capability of recognizing and supporting the principles of accurately predicting. Therefore, developing the predictive models using ML may facilitate early intervention as an effort to improve detection, then reduce the impact of frailty among CKD populations. Objectives: The purpose of this study was to develop a feasible model for frailty in CKD patients using different ML methods. Methods: The supervised learning model was applied. An administrative database was collected from a cross-sectional design to analyze 144 patients with CKD of a medical center hospital from January 1, 2019, to December 31, 2019. The database collected risk factors of frailty, including clinical characteristics, physical, psychological, and social factors. A total of 25 input and 1 output variable were included in the data set. Different machine learning algorithms have been analyzed in model fitting to resolve the imbalanced nature of the data. We used the QOCA platform (the machine learning platform was developed from Taiwan) to achieve Logistic regression (LR), Random forest (RF), Decision tree (DT), Support vector machines (SVM), K nearest neighbor (KNN), Multi-layer perceptron (MLP), and Gradient Boosting (GB). Results: The accuracy of comparing seven ML models in this research was above 80%. The predicting frailty has shown top-performance with RF (accuracy=0.85, AUC=0.74) and SVM (accuracy=0.85, AUC=0.67) than other models. On average, LR has shown the lowest accuracy. Conclusion: The results show that the prediction performance of ML models varies in terms of different evaluation metrics, and RF model was the best model for predicting the performance of frailty. This predictive modeling is expected to provide a preference for medical decision-making of frailty among patients with CKD. Background: It is known well that sarcopenia may increase the risk of physical limitation and deterioration of quality of life. Early identification of the risk of sarcopenia is important because it will enable to implement the preventive and protective measures timely. The aim of the study was to determine the risk of sarcopenia (according to the SARC-F questionnaire) in Ukrainian women of different age groups. Methods: 460 women aged 50-84 years old (mean age 66.4 ± 8.8 years, mean height 161.5 ± 6.1 cm, mean body weight 71.8 ± 14.6 kg, mean BMI 27.5 ± 5.2 un), were included, being divided into groups by age (with five-year intervals) for the purpose of detection age-relative particularities in the frequency of sarcopenia. The risk of sarcopenia was determined by the SARC-F questionnaire, muscles strength was evaluated according to a handgrip strength using a spring hand dynamometer (kg) and physical performance -by the 5-time S51 chair stand test. Results: The study has shown a significant increase in sarcopenia frequency with age. It was detected 138 women (29.9%) with an increased risk of sarcopenia in the whole group according to the SARC-F questionnaire. The total score of the SARC-F questionnaire was significantly related to age (r = 0.49, p<0.0001). The incidence of women with the risk of sarcopenia also increased with age from 5.8% among 50-54 years' subjects to 72.5% in the age group 80-84. At the same time muscle strength significantly decreased with age (right: r = -0.38, p <0.05; left: r = -0.38, p <0.05). Handgrip strength was significantly lower in women 70 years and older (15.6±4.4 kg) compared to females aged 50-54 years (19.3±6.6 kg). The duration of the 5-time chair stand test increased with age (r=0.33, p<0.05) and was higher in women over 65 years old compared to females aged 50-54 years (p<0.05).In 67.4% of subjects with risk of sarcopenia, the skeletal muscle strength was lower than the cut-off point for the diagnosis of probable sarcopenia, in the women without risk of sarcopenia (according to SARC-F) the same parameter was equal to 26.6%. Conclusion: The risk of sarcopenia in Ukrainian women increases with age and becomes significantly higher in females over 70 years. Thus, women at 70 years and older are the candidates for active prevention of sarcopenia. strength and the Short Physical Performance Battery). Then, participants were classified as unfit for handgrip strength (≤ P25) according to published reference values (Dodds et al. 2014 ) as well as frail (≤ 9 points in the SPPB). Results: Better nutritional status (p<0.05) and performance within handgrip strength and the SPPB were significantly associated with lower CCI score among both males (p<0.005) and females (p<0.001). Patients with malnutrition or risk of malnutrition (OR: 2.165, 95% CI: 1.408-3.331, p<0.001) as well as frailty (OR: 3.918, 95% CI: 2.326-6.600, p<0.001) had significantly increased risk for being at severe risk of comorbidity. Patients at risk of malnutrition or malnourished had higher CCI score regardless of being fit or unfit according to handgrip strength (p for trend<0.05) and patients classified as frail had higher CCI despite their nutritional status (p for trend<0.001).

The current study reinforces the use of the MNA-SF and the SPPB in geriatric hospital patients as they might help to predict poor clinical outcomes, and indirectly postdischarge mortality risk.

Meei-Horng Yang 1,3 , Hung-Ru Lin 1 , Chieh-Yu Liu 1,2 , Liang-Kung Chen 4,5,6 , Tzu-Ying Lee 1 , Kee-Hsin Chen 7 (1. School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan; 2. Biostatistical Consultant Lab and Department of Speech Language Pathology and Audiology, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan; 3. External Affairs Department, Wei Gong Memorial Hospital, Miaoli, Taiwan; 4. Aging and Health Research Center, National Yang Ming Chiao Tung University Yangming Campus, Taipei, Taiwan; 5. Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan; Taipei, Taiwan; College of Nursing, Taipei Medical University, Taiwan) Background: The pace of population aging in Taiwan is faster than that of Western countries. Whether the choices of frailty instruments for community-dwelling older adults living alone differ from those of the elderly living with family has rarely been explored. Objectives: This study aimed to compare the consistency of frailty states (robust, pre-frail, and frail) and screening time among Kihon Checklist (KCL), Study of Osteoporotic Fractures (SOF) index, and Frieds' frailty phenotype (FP) index between the elderly living with family and older adults living alone. Methods: The study design was cross-sectional, encompassing 95 community-dwelling persons referred by one outpatient clinic, six public health centers, and one social welfare foundation, and aged 65 years or above in Miaoli County, Taiwan. FP was selected as the frailty screening golden standard instrument for comparison. Results: Among the study subjects, 53 participants (55.8%) were female, with an average age of 76.7 years old. For community-dwelling older adults living with family and those living alone, their frailty states by KCL and FP show a statistically significant difference. The Spearman correlation between FP and KCL indices was 0.44 (p<0.001), and FP and SOF indices was 0.61 (p<0.001). For community-dwelling older adults living with family and those living alone, there was a significant statistical difference in the screening time between KCL and SOF, and the time was 3.6 min versus 5.2 min, 0.7 min versus 1 min, respectively. Conclusion: The frail state of the older adults living alone measured by the three frailty instruments was two-four times higher than that of the older adults living with family, especially the frailty of the older adults living alone measured by KCL was 67.6%, much higher than that of SOF (16.2%) and FP (29.7%). The different domains measured by KCL of the older adults living alone were mainly lifestyle and depressive mood. The older adults living alone were higher than the older adults living with family in the screening time measured by all the three frailty instruments. The KCL index can be a sensitive screening tool to evaluate frailty for older adults living alone in need of social assistance.

Meei-Horng Yang 1,3 , Hung-Ru Lin 1 , Chieh-Yu Liu 1,2 , Liang-Kung Chen 4,5,6 , Tzu-Ying Lee 1 , Kee-Hsin Chen 7 (1. School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan; 2. Biostatistical Consultant Lab and Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan; 3. External Affairs Department, Wei Gong Memorial Hospital, Miaoli, Taiwan; 4. Aging and Health Research Center, National Yang Ming Chiao Tung University Yangming Campus, Taipei, Taiwan; 5. Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan; Taipei, Taiwan; College of Nursing, Taipei Medical University, Taiwan) Background: Little is known regarding the impact of transitions in frailty on community-dwelling older adults living with family and older adults living alone. Objectives: The purpose of this study is to understand the frailty transitions over time between the elderly living with family and living alone in six months. Methods: This study is a prospective cohort study. In March 2021, 110 community participants over the age of 65 were gathered for the first time, and 95 participants took re-measurements six months later. The frailty instruments include Kihon Checklist (KCL), Study of Osteoporotic Fractures (SOF) index, and frailty phenotype (FP), respectively consisting of 25 items, three items, and five items. Results: The average duration for the elderly to live alone was 6.8 years. 37 participants (38.9%) were older adults living alone. Using the KCL tool, 3.4% of the community-dwelling older adults living with family and 8.1% of those living alone were classified as being in improved frail status (from prefrail to robust or frail to pre-frail or frail to robust), 60.3% and 75.7% as being in unchanged frail status, and 36.2% and 16.2% as being in worsened frail status (from robust to pre-frail or robust to frail or pre-frail to frail).Using the SOF tool, 5.2% of the community-dwelling older adults living with family and 21.6% of those living alone were classified as being in improved frail status, 75.9% and 54.1% as being in unchanged frail status, and 19% and 24.3% as being in worsened frail status. With the FP tool, 8.6% of the community-dwelling older adults living with family and 18.9% of those living alone were classified as being in improved frail status, 72.4% and 56.8% as being in unchanged frail status, and 19% and 24.3% as being in worsened frail status. A statistical significance (χ2=7.10, p<0.05) was observed in SOF, while no statistical significance (χ2=5.13; χ2=2.99, p>0.05) was observed in KCL and FP. Conclusion: The dynamic changes showing frailty status in both improving and worsening directions of the participants living alone were higher than those living with family, indicating that changes in the natural frail status of the elderly living alone were more unstable than those living with family. Early interventions should be considered for frailty, especially for the elderly living alone.

Background: Sarcopenia as an index of protein-calorie malnutrition is common in liver cirrhosis but with variable frequencies. Its assessment method, normal cut-off points for its diagnosis and correlation with disease severity indices are also controversial. This study aimed to evaluate the prevalence of sarcopenia in Iranian cirrhotic patients as compared with age and gender matched controls by sarcopenic severity scores, and to assess its correlation with disease severity scores. Methods: During 2015-2016, anthropometric indices (BMI, Triceps skin fold) and their derived measures (mid upper arm muscle area and its ratio to height and squared height; CMUAMA, CMUAMA/Ht, CMUAMA/Ht2) of ambulatory cirrhotic patients were assessed regarding age, sex and nearly similar socioeconomic status of healthy volunteer living in the same area as the controls. The patients' sarcopenic severity scores were compared with their disease severity indices: Child Turcotte pugh, (CTP), traditional and new model of end stage liver disease formula MELD, and MELD-Na. Results: Anthropometric assessments of 131 patients (47 female, 84 male) and that of the same number of controls were in favor of sarcopenia in all patients irrespective of their disease severities based on all defined scoring systems. Conclusions: Sarcopenia as an indicator of protein-calorie malnutrition was common in Iranian cirrhotic patients, beginning in early stages of disease. The appropriate normal cut-off was helpful for its detection and scoring. CMUAMA.ss and CMUAMA/Ht2.ss scores may be more relevant indices for sarcopenia detection and proper deduction. There was no statistically significant correlation between sarcopenic severity indices and disease severity scoring systems. Thus, sarcopenic severity indices are recommended as an independent factor for the prognosis.

Cédric Villain 1,2 , Soazig Lebaube 1 , Corinne Kremer 1 , Chantal Chavoix 2 , François Fournel 3 , Anaïs Briant 4 , Bérengère Beauplet 1, 5,6 (1. Department of Geriatric Medicine, Centre Hospitalier Universitaire de Caen Normandie, France; 2. Normandy Univ, UniCaen, INSERM U1075, COMETE, Caen, France; 3. Clinical Research Department, Centre Hospitalier Universitaire de Caen Normandie, France; 4. Biostatistical Unit of Research Department, Centre Hospitalier Universitaire de Caen Normandie, France; 5. Normandy Univ, UniCaen, INSERM U1086, ANTICIPE, Caen, France; 6. Normandy Interregional Oncogeriatric Coordination Unit, 28 rue Bailey, Caen, France) Background: Introduction: The diagnosis of sarcopenia is based on the measurement of HandGrip Strength (HGS), for which the gold standard dynamometer is the Jamar®. The electronic Gripwise® is smaller and lighter and its measurements have been found correlated with the Jamar® in laboratory tests, to confirm in real life, handled by aged patients. Methods: This monocenter cross-sectional study included inpatients aged 65 years and older. Considering the Intraclass Correlation Coefficient (ICC) of HGS measurements should be greater than or equal to 0.90± 0.02 with an alpha risk of 5%, the sample size was calculated at 348 patients. Results: From 2021 September the 1st to November the 18th, 348 out of 649 eligible inpatients were included, of whom 174 patients were allocated to start the measurements set with the Jamar®, and the others 174 patients to start with the Gripwise®. The patients mean age was 79 years± 9 and 48% were male. The ICC was 0.93 (95%CI 0.92;0.94, p<.001) for the maximum value and of 0.94 (95%CI 0.93;0.95, p<.001) for the mean values, whatever the dominant hand side and the seated/bedridden position of the patient. However, there was a significant difference in detecting low values (<16kg in women, <27kg in men): 48% with the Jamar®, and 71% with the Gripwise® (p<.001). Conclusion: The measurements correlation between the Gripwise® and the Jamar® was confirmed in real life. However, lower values obtained with the Gripwise® could lead to over-diagnose sarcopenia and applying a correction coefficient could be necessary. Key words: aged, inpatients, Hand Strength, Sarcopenia, neoplasms S54

John Tshon Yit Soong 1,2 , Rachel Choe 1 , Selva Rajoo Anandraj 1 , Erna Santoso 3 , Shikha Kumari 3 , Diarmuid Murphy 1,2,3 , Reshma A Merchant 1, 2 (1. National University Hospital, Singapore; 2. National University Singapore, Singapore; 3. National University Health System, Singapore) Background: There is increasing interest in using routinely collected data to identify frailty at scale. The Hospital Frailty Risk Score (HFRS) is a score based on standardized diagnostic codes. However, agreement for this score to bedside clinical frailty scales have not been optimal. Additionally, the score has not been validated on a local Singapore population. Objectives: The aim of this study was to test the degree of agreement of HFRS to bedside frailty scores (Clinical Frailty Score (CFS) and FRAIL scale) in a hospitalized Singapore population, and to see if this agreement may be improved. Methods: This retrospective observational study utilized routinely collected administrative and electronic health record data from a single tertiary hospital in Singapore. The HFRS score was calculated using within-spell diagnostic codes, with scores of ≥ 5 taken to denote frailty. Between June to September 2021, 202 patients admitted to General Medical and Geriatric Medicine wards had CFS and FRAIL scale calculated. Area under the Receiver Operating Characteristic Curve (AUC) for frailty as defined by CFS>4 and FRAIL>2 was calculated as primary outcome measure. Additionally, sensitivity and specificity were calculated. To improve the predictive power of HFRS, diagnostic codes 2 years prior to index admission were added and the cut-point for HFRS was calculated at the Youden index. Results: The HFRS agreement to CFS>4 and FRAIL>2 was AUC 0.59 and 0.62 respectively. Sensitivity and specificity of HFRS to CFS>4 was 37.3% and 73.1%. Sensitivity and specificity of HFRS to FRAIL>2 was 37.9% and 72.6%. Adding 2 years of historical diagnosis codes prior to index admission improved agreement of HFRS to CFS>4 and FRAIL>2 to AUC 0.74 and 0.75 respectively. Sensitivity and specificity for HFRS to CFS>4 improved to 70.7% and 67.3%. Sensitivity and specificity for HFRS to FRAIL>2 improved to 72.9% and 66.1%. At the Youden index, the optimal cut-point for CFS>4 and FRAIL>3 was a HFRS of 3.7. Conclusion: The HFRS score has poor agreement to CFS and FRAIL scores in a Singapore hospitalized population. The agreement can be improved by enriching the score with 2 years of historical data and adjusting the HFRS cut-point.

Fang-Wen Hu 1 , Chien-Yao Sun 2 , Chia-Ming Chang 2 (1. Nursing Department, National Cheng Kung University Hospital, Tainan, ROC, Taiwan; 2. Geriatric Department, National Cheng Kung University Hospital, Tainan, ROC, Taiwan) Background: Advanced age, cancer, and surgery are the key factors leading to decline in function. The incidence of functional decline in older patients is 30-60%. If cancer and surgery are combined, functional decline is aggravated, and recovery is slow. Previous studies have pointed out that, one year after surgery, as many as 24% of older cancer patients are still unable to recover to their baseline function, resulting in many complications and adverse outcomes, such as cognitive impairment, falls, delirium, disability, admission to nursing home, and increased risk of death. Objectives: To investigate preoperative frailty and intrinsic capacity associated with postoperative functional recovery and quality of life in older patients surgically treated for cancer. Methods: This longitudinal study was conducted at a 1,343-bed tertiarycare medical center in Taiwan. Patients were eligible for inclusion if they were age 75 and over, if they were able to communicate independently without sensory deficits, and if they were admitted for elective surgery for curative treatment of a confirmed lung, colorectal or urologic malignancies. Patients had a terminal malignancy with distant metastasis were excluded. Demographic variables (age, gender, marital status, and educational level), health conditions (tumor type, cancer metastasis, and Cumulative Illness Rating Scale for Geriatrics [CIRS-G]), Clinical Frailty Scale [CFS] , and intrinsic capacity were collected at admission. The Minimum Data Set Activities of Daily Living [MDS-ADL] and EuroQoL 5-dimension 3-level questionnaire [EQ5D] were assessed at admission, postoperative, one-month, three-month, six-month and one-year postoperative cancer treatment. Results: The mean age of the 74 participants was 80.3±4.6 years, and 56.8% were female. Generalized estimating equation showed that older patients with increased preoperative CFS score was significantly associated with worsened MDS-ADL (Adjusted β = 1.25, 95% CI 0.39~2.11, p=0.004) and decreased EQ5D postoperative cancer treatment (Adjusted β =-0.04, 95% CI -0.07~ -0.01, p=0.004). However, preoperative intrinsic capacity did not show any significant association with MDS-ADL and EQ5D postoperative cancer treatment. Conclusion: This study provides evidence that frailty is a better predictor than intrinsic capacity of postoperative functional recovery and quality of life in older patients surgically treated for cancer.

ADULTS. Laura Tay 1,2 , Ee Ling Tay 3 , Shi Min Mah 3 , Aisyah Latib 4 , Charissa Koh 4 , Yee Sien Ng 2, 5 (1. Geriatric Medicine, Department of General Medicine, Sengkang General Hospital, Singapore; 2. Geriatric Education and Research Institute, Singapore; 3. Department of Physiotherapy, Sengkang General Hospital, Singapore; 4. Health Services Research and Evaluation, SingHealth, Singapore; 5. Department of Rehabilitation Medicine, Singapore General Hospital, Singapore) Background: Decline in intrinsic capacity (IC) may underlie the diminished homeostatic reserves in frailty and contribute to adverse health outcomes in older adults. Objectives: We examine (i) associations between IC and baseline frailty and physical fitness, (ii) impact of IC on risk for frailty progression and adverse outcomes at one year among community-dwelling older adults. Methods: Ongoing prospective cohort study of older adults aged >55 years. The 5 domains of IC were assessed at baseline through a structured questionnaire and physical fitness battery: locomotion (Short Physical Performance Battery, 6-minute walk test), vitality (nutritional status, muscle mass), sensory (self-reported hearing and vision), cognition (Chinese Mini-Mental State Examination, self-reported memory problem), psychological (Geriatric Depression Scale-15, self-reported anxiety/ depression). Composite IC score (0-10) was calculated, with higher scores representing greater IC. Frailty status was based on modified Fried criteria, with frailty progression defined as incremental Fried score at 1 year. Multiple logistic regression was performed to examine risk for frailty progression with individual IC domains and composite IC, adjusted for age and gender. Results: 815 participants (mean age 67.7+6.9 years, 72.8% females) completed all baseline assessments. Decline across all 5 IC domains was observed across robust, pre-frail and frail participants (p<0.05), with decremental composite IC score [9 (8-9), 8 (6-9), 5.5 (4-7.5), p<0.001]. Higher IC correlated significantly with all physical fitness measures, self-rated health, physical activity level and life-space mobility (p<0.001). Frailty progression was observed in 10.9% of 238 participants who completed 1-year follow-up. All 5 IC domains were significantly associated with risk for frailty progression (p<0.05), and reduced risk for frailty progression was observed with higher baseline composite IC score (OR=0.65, 95% CI 0.52-0.82, p<0.001). Among participants who were robust at baseline, higher composite IC score reduced risk for progression to pre-frailty/ frailty at 1-year (OR=0.55, 95% CI 0.39-0.78, p<0.001). Higher IC reduced risk for hospitalization (OR=0.84, 95% CI 0.71-0.99, p=0.040) and falls (OR=0.766, 95% 0.66-0.88, p<0.001) during followup. Conclusion: Decline in IC may present before frailty becomes clinically manifest, and increases an older person's risk for progressive frailty. Monitoring of IC domains may facilitate early personalized intervention to avoid adverse health outcomes. Background: Older adults have multiple comorbidities and take many medications. Then, they are particularly exposed to potentially inappropriate medication prescribing (PIP). Among them, institutionalized residents represent a more vulnerable population due to higher level of comorbidity and frailty. These PIP are associated with iatrogenic events (hospitalizations, falls, and confusion). These PIP could induce additional healthcare costs (in addition to medication costs alone) due to a more frequent use of the healthcare system (hospitalizations, outpatient visits,...). Objectives: The aim of this study was to explore the association between healthcare costs and PIP exposure among institutionalized older residents. We conducted a secondary analysis on the data from the FINE (Factors associated with INappropriate transfer to the Emergency department among nursing home residents) study, an observational, multicenter, case-control study. Seventeen emergency department in the Midi-Pyrénées region in France participated in the study. All nursing home residents admitted to the selected emergency department were included. Methods: The detection of PIP was performed using a computer algorithm combining 5 explicit criteria-based tools (STOPP/START criteria, European list of potentially inappropriate medications (EU(7)-PIM), French Alert and Mastering of drug Iatrogenicity (AMI) indicators, contraindications). The algorithm generated a number of medication-related non-compliances (NC) for each drug prescription. The economic analysis was carried out from the point of view of the French National Health Insurance with a time horizon of 6 months after transfer to the emergency department. Direct medical costs (hospitalization, visits and medical acts, paramedical acts, medications and medical equipment) and non-medical costs (transport) were taken into account. Results: Our study included a total of 616 residents, with a mean age of 86.5 ± 7.3 years, 69% women (n=425). They took 8.8 ± 3.6 medications. The computer algorithm estimated, on average, 4.8 ± 2.8 NC per resident. Our results do not show significant higher healthcare costs in residents exposed to PIP (total healthcare costs and nonmedication healthcare costs). Conclusion: These results represent preliminary work in an underdeveloped economic literature. The cost of the residents' last year of life or palliative management could mask the impact of PIP on healthcare costs. Future work needs to be considered.

Pan Liu, Yiming Pan, Yaxin Zhang, Yun Li, Lina Ma (Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric Disease, China) Background: Frailty can increase the prevalence and influence the prognosis of hypertension in older adults. Frailty and hypertension may share common pathophysiological features, while the underlying mechanism was still unclear. We aimed to explore the potential markers of frailty in older hypertensive patients. Method: A cross-sectional study was performed including frail and non-frail hypertensive older adults. The frail group and non-frail group were matched for age and sex in a 1:1 ratio, and each group had 43 participants. Frailty was assessed by Fried phenotype, and quality of life was evaluated by SF-36 item. ELISA method was used to detect the levels of serum biomarkers. Results: Compared with nonfrail older adults, the frail patients had lower self-rated general health score (p<0.001) and lower SF-36 score (p=0.002). There was no difference in chronic diseases such as coronary heart disease, cerebrovascular disease, diabetes, chronic kidney disease and fundus arteriosclerosis between the two groups. Frail older hypertensive adults had higher interleukin-6 (IL-6, p=0.045) and C-Terminal Agrin Fragment (CAF, p=0.005) levels, and lower adiponectin (p=0.031) level than non-frail patients. Circulating CAF was negatively associated with grip strength, even after adjusted age (r=-0.394, p=0.013). The regression analysis shows that after adjustment for age, sex and SF-36 score, CAF and adiponectin remained independently associated with frailty. Conclusion: Frail older hypertensive adults had worse physical function. Low adiponectin and high CAF might contribute to frailty in older hypertensive adults. More clinical and basic studies are needed to explore the underlying mechanisms and further intervention strategies. Background: Vasculitis refers to a group of heterogeneous chronic autoimmune conditions associated to significant morbidity and mortality. Chronic inflammation and prolonged exposure to glucocorticoids may accelerate the process of frailty in patients with vasculitis. The prevalence of frailty in patients with vasculitis remains unexplored. Objectives: To describe the prevalence of self-reported frailty in patients with vasculitis. Methods: VascStrong is a longitudinal study utilizing the Vasculitis Patient-Powered Research Network (VPPRN), an internet-based prospective longitudinal cohort. Data elements collected included type of vasculitis, demographic, and use of medications. Frailty was measured by the FRAIL scale, a self-report measure which queries on 5 domains: 1. Fatigue, 2. Resistance (inability to climb 10 stairs), 3. Ambulation (inability to walk several blocks), 4. Illnesses (>=5/11 comorbidities), and 5. Loss of Weight (>=5% weight loss in the last year). Patients were classified as robust, pre-frail, and frail based on 0, 1-2, or >= 3 criteria, respectively. Results: The survey collected information from October 8, 2021-January 15, 2022. For this preliminary analysis, 228 responses were included. The most common diagnosis was granulomatosis with polyangiitis (39.0%), followed by eosinophilic granulomatosis with polyangiitis (11.4%), microscopic polyangiitis (10.1%), and giant cell arteritis (7.5%). Patients were predominantly female (71.5%), non-Hispanic white with a mean age 57.6 years. Prevalence of robustness, pre-frailty, and frailty was 28.5%, 47.8%, and 23.7%, respectively. The majority of patients with each form of vasculitis were rated as frail or prefrail. Among the individual FRAIL domains, fatigue and loss of weight were the most frequent (48.7% and 42.5%, respectively) while illnesses, was the least common (3.5%). When compared to robust patients, frail and pre-frail patients were younger, more frequently female, more likely to be obese, and reported more frequent use of glucocorticoids. Patients with urticarial vasculitis and Takayasu's arteritis were more commonly prefrail or frail, compared to patients with other types of vasculitis. Conclusion: Self-reported frailty or pre-frailty is prevalent in the majority of patients with multiple forms of vasculitis. Future analysis will focus on identifying factors associated with frailty in patients with vasculitis, to allow earlier identification and prevention in this population at high-risk for frailty. Background: Frailty -vulnerability to stressors, caused by multisystem dysfunction-and cognitive impairment are common, often coexist and may have a bidirectional association in older adults. Recent evidence suggest that dementia can be prevented by addressing several modifiable risk factors. It is unclear whether factors associated with dementia risk would vary according to patients' frailty status. Objectives: The study aim was to determine differences in risk factors between frail and non-frail in Veterans enrolled in a VA Dementia Prevention Clinic. Methods: This is a descriptive case series of Veterans in a Dementia Prevention Clinic identified through a search of the VHA electronic health records. Veterans were classified as having mild cognitive impairment (MCI), at risk of developing MCI, or reported subjective cognitive complaints. We compared Veterans with and without MCI in terms of frailty status, lifestyle habits, sociodemographic characteristics, perceived stress, and polypharmacy. Frailty was defined using a 31-item VA Frailty Index (VA-FI) generated as a proportion based on the number of items present: frail (VA-FI>0.21) and non-frail (VA-FI<0.21). We compared frail and non-frail groups using t test for continuous variables, and Pearson chi-square for categorical variables. Results: 58 Veterans identified as frail or non-frail; mean age 76.21 (SD=6.57), 96.6% male, 60.3% Caucasian, 34.5% Black, 20.7% Hispanic, 48 (82.8%) frail, 56 (96.6%) had MCI, and 2 (3.4%) had subjective cognitive complaints. Those with MCI were divided into frail=46 (82.1%) vs. non-frail=10 (17.2%). Compared with non-frail, Veterans with frailty displayed a low adherence to a Mediterranean diet (frail: n=39, 88.6%, p<0.043), and polypharmacy (frail: n=43, 95.6%, p<0.011). There were no differences in marital status, race, physical activity, perceived stress score, substance use, activities of daily living (ADL), instrumental activities of daily living (IADL), PHQ-2, loneliness scale, or social networking scale. Conclusions: Veterans enrolled in a VA Dementia Prevention Clinic were mostly frail. Compared with non-frail, veterans with frailty had lower adherence to the Mediterranean diet, and polypharmacy. Older patients with frailty and at risk for dementia may benefit from interventions aimed at improving adherence to the Mediterranean diet and the deprescribing of inappropriate medications.

Olena Tomarevska 1 , Oleksandr Poliakov 1,2 , Nataliia Ponomarenko 3 (1. D.F. Chebotarev Institute of Gerontology of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine; 2. Kyiv Medical University, Kyiv, Ukraine; 3. Chernihiv Polytechnic National University, Chernihiv, Ukraine) Background: The age-related decline in sensory functions affects the intrinsic capacity and residual working performance of a person aged 60+ years. Progressive decline in sensory functions in old age and beyond contributes to decreased abilities to continue lifelong learning, upskilling and reskilling opportunities, as well as completion of daily household tasks. Objective: The purpose of the study is focuses on identifying cohort differences the hearing and vision capabilities in persons aged 60+ years in the periods (2009) (2010) (2011) (2012) (2013) (2014) and the ongoing pandemic crisis (2020-2021) for estimate contribute on the decreasing healthy ageing in Ukraine. Methods: In studies were analyzed the results of functional abilities as vision and hearing, also characteristics blood pressure conducted by a medical specialist in 120 persons with compensated agerelated processes aged 60-89 years from (2009-2014) period and 112 persons aged 61-95 years from an online digital tool "Human Health Passport" of self-assessment and studies by a medical specialist from (2020 -2021) period. The significance of differences was assessed by the criterion chi-square, t-test. Results: In this study has been found the disorders hearing in 34% person from (2009) (2010) (2011) (2012) (2013) (2014) period and 25% person in the pandemic crisis (p>0.05). The vision functional ability of the elderly persons to read book or newspapers are disorder in 73% in cohort study from (2009) (2010) (2011) (2012) (2013) (2014) , and 63% in cohort study 2020-2021 years (p>0.05). Meanwhile, the functional ability of vision to see on the distance we get significant results between disorders 17% in cohort from (2009) (2010) (2011) (2012) (2013) (2014) , and 46% elderly persons in pandemic period crisis (p<0.001). Cohorts' differences mean systolic blood pressure of the elderly persons in groups with disorders functional ability to see on the distance without glasses are (141.2±3.4) under and (123.1±1.4) in pandemic crisis (p<0.001). Conclusions: The phenomenon of an increase in the frequency of reduced vision at a distance without glasses in the elderly during a pandemic crisis requires further research, as it makes a significant contribution to health decline, frailty and decreasing healthy ageing in Ukraine. However, the state of hearing and the ability to read without glasses in people aged 60+ in different periods of research, we did not reveal significant differences in Ukraine. Background: Frailty is a common condition in nursing home (NH) residents but its prevalence in German institutions is unknown. Valid and easy-to-use screening tools are needed to identify frail residents. Objectives: We used the FRAIL-NH scale and the Clinical Frailty Scale (CFS) to (a) obtain the prevalence of frailty in German NH residents, (b) investigate the agreement between both instruments, and (c) evaluate their predictive validity for adverse health events. Methods: In this prospective cohort study, 246 German NH residents (mean age 84±8 years, 67% female) were categorized according to their frailty status by FRAIL-NH (not frail (0-1p), frail (2-5p), most frail (≥6p)) and CFS (not frail (1-4p), mild to moderately frail (5-6p), frail (≥7p)). Agreement between both instruments was examined by Spearman correlation, area under the receiveroperating curve (AUC, with 95% confidence interval (CI)), sensitivity and specificity using the "most frail" category of FRAIL-NH as reference standard. Adverse health events (death, hospital admissions, falls) were recorded for 12-months. Multivariate cox and logistic regression models were built, calculating hazard ratios (HR) and odds ratios (OR) with 95% CIs. Results: According to FRAIL-NH 71% were most frail, 26% frail and 3% not frail. According to CFS, 66% were frail, 27% mild-to-moderately frail and 7% non-frail. Both scales correlated significantly (rs=0.78; R²=60%). The AUC was 0.92 (0.88-0.96). Using a CFS cut-off of 7 points, sensitivity was 0.90 and specificity 0.92. The frailest groups according to both instruments had an increased risk of death (FRAIL-NH HR=2.19 (1.21-3.99); CFS HR=2.56 (1.43-4.58)) and hospital admission (FRAIL-NH OR=1.95 (1.06-3.58)); CFS OR=1.79 (1.01-3.20)) compared to less frail residents. Both instruments were unable to predict falls. Conclusion: Frailty is highly prevalent in German NH residents. Both instruments show very good agreement despite different approaches. Risk of mortality and risk of hospitalization are increased in the frailest groups according to both tools, but not the risk of falls. Based on our findings and due to its simple and quick administration, CFS may be an alternative to FRAIL-NH for assessing frailty in nursing homes. Background: Australia's population is increasingly ageing and given that ageing is closely linked with frailty, the increasing frail ageing population is a challenge for health services. Frailty is also a predictor of negative clinical outcomes, patient outcomes and increases the risk of postoperative complications, length of stay, functional dependency post discharge, readmission to hospital and death during hospitalisation. A nurse-led volunteer support program aiming to minimise the development/progression of frailty was implemented (as part of a multi-strategy approach) for older adults in two wards of an acute metropolitan hospital in Perth, Western Australia. Volunteer support (cognitive, nutritional, mobility, sensory and orientation support) was provided to patients by trained volunteers according to an individualised Volunteer Support Care Plan, that was developed by a nurse based on the patient admission assessment. Additional to a randomised control trial to evaluate the effectiveness of nurse led volunteer support interventions and another strategy, a stakeholder evaluation including clinical staff, families and patients was undertaken. This presentation reports on the clinical staff perspectives. Objectives: To evaluate clinical staff experiences of a nurse led volunteer support program for older adults in hospital. Methods: A pre-and-post implementation design, incorporating both qualitative and quantitative data, was utilised. Clinical ward staff (nurses, allied health) views of the volunteer support program were evaluated by a survey pre-implementation and by a survey and focus groups postimplementation. Descriptive statistics were used to explore sample characteristics. Independent samples, non-parametric tests were used to compare survey responses pre-and postimplementation. Thematic analysis was conducted on the qualitative data. Results: Clinical staff perceptions pre-and post-implementation of the nurse led volunteer support program were mostly positive, with no significant difference between the groups. Approximately 88% of staff supported continuation of the volunteer program. Analysis of the open-ended survey responses and thematic analysis of the focus group interviews identified anticipated challenges and benefits of the program for patients and staff. Conclusion: These results may inform further development of nurse-led models of volunteer support to support older adults in hospital and positively impact on outcomes including frailty and health care costs. Background: The prevalence of frail and prefrail among older adults around the world is high, particularly in middle income country. Effective intervention to improve physical function for frail older adults in community has been limited, particularly delivering via online platform. Objective: To investigate the impact of a multicomponent exercise program and health education sessions deliver via telemedicine on health outcomes of pre-frail older persons living in an urban area. Methods: One hundred and twenty-seven pre-frail participants were enrolled, with an average age of 69.29 (± 6.02) years. Participants were randomly assigned to the intervention and control group using computer generated list. The intervention group received a regular ongoing multicomponent group exercise program in conjunction with health education sessions through telemedicine while control group received only educational sessions. Primary outcome was physical performances at 12 weeks of intervention. Secondary outcomes included frailty status, physical fitness, physical activity level, and health-related quality of life. Result: At 12 weeks, the intervention group had a significantly higher SPPB score than the control group (11.8±0.57 vs 11.4±1.16; p=0.029). The frailty score, sit and reach test, Timed Up and Go Test, 2-minute walk test, and handgrip strength are all significantly improved in the intervention group after 12 weeks. Conclusion: A 12-week multicomponent exercise and health education sessions delivered through telemedicine is an effective tool for improving physical fitness and reduce frailty in pre-frail older participants in an urban area in Thailand. Further study to reaffirm the effectiveness this program in multiple sites would be of interested. Background: Frailty, multimorbidity and disability are different conditions, often overlaped. The accumulation of them may contribute to quality of life decrease among older adults, challenging healthy aging promotion and primary health care delivery, reason why such relationships demand thorough investigation. Objective: To examine the magnitude of multimorbidity and disability contributions in the relationship between frailty and quality of life. Methods: A crosssectional analysis of Longitudinal Investigation of Functioning Epidemiology (LIFE) was performed with 201 older adults interviewed in three health care units randomly selected in a Southeastern Brazilian city. Quality of life was assessed by the question "How satisfied are you with your quality of life?". Answers were grouped in satisfied and unsatisfied. Five well-known frailty criteria were investigated by self-report, and those who referred three or more criteria were classified as frail. Multimorbidity was defined by the self-report of two or more diseases or health conditions. WHODAS 2.0 with 12 items evaluated disability, classifying with disability those who pointed difficulty to perform at least two activities. Five multivariate logistic regression models were tested, each one unadjusted and adjusted by sex, age and education: frailty, multimorbidity, disability, accumulated conditions ranging from 0 to 3, and all variables. The Research Project was approved by University Ethic Comission and was funded by a Research Foundation of State of Minas Gerais, grant number APQ 03367-18. Results: Mean age was 68.13±6.88 years; 77.1% were women; mean education was 5.62±4.12 years. Frailty increases the odds of having worse quality of life in 3.55 and 3.68, unadjusted and adjusted, respectively; disability increases 3.54 and 3.85; and multimorbidity was not related to quality of life. Each condition accumulated increases the odds in 2.25, after controlling for sex, age and education. When all conditions were inserted in the model, only frailty remained significant. Frail older adults were 3 times more likely to have worse quality of life, independently of multimorbidity, disability, sex, age and education. Conclusion: Frailty is the most important condition contributing to decrease in quality of life among older adults, suggesting it should be focused by primary health care in face of aging population. Keywords: Public Health, Aging, Frailty, Health Care.

Background: Aging is a natural result of life activity of the human organism and is accompanied by a variety of disorders in physiological processes. The detection of relationships between changes the functional state of the organism in aging and cognitive processes are an actual problem. Objectives:

The aim of the study is to identify the relationship between cognitive disturbances, physical capabilities and the state of the cardiovascular system in long-livers. Methods: 75 longlivers aged 93.7 ± 2.8 years were examined. In long-livers, hemodynamic parameters, vital capacity of the lungs (VCL), height, body weight were measured, cardiovascular activity index (ICA), body mass index (BMI) were calculated. Physical capabilities were determined by tests the muscular strength in forearms and of the hands, chair stand test. Cognitive disturbances were determined by the MMSE test. Results: Cognitive function without changes were observed in 22% of long-livers, the age-dependent decrease of memory -24%, mild cognitive decline -22%, the initial stage of dementia -25%, more expressing stages of dementia were observed in 7% of long-livers. MMSE indices were positively correlated with BMI (r = 0.69, p <0.001), VCL (r = 0.50, p <0.01). Between ICA values and MMSE test data there is a non-linear dependence of the form y=a+bx+cx2. MMSE indices positively correlated with ability of the long-livers to wash without anyone's help (r = 0.42, p <0.001), go up and down the stairs (r = 0.31, p <0.01), and do light housework (r = 0.50, p <0.001), with muscle strength in the forearms and hands (r = 0.33, p <0.01), with the ability to perform a chair stand test (r = 0.46, p <0.001). The ability to perform a chair stand test negatively correlated with number of falls (r = -0.27, p <0.05). Conclusions: The revealed non-linear relationship between ICA and the level of cognitive impairment indicates the fact that diseases of the cardiovascular system, in particular arterial hypertension, are a prognostic adverse factor in cognitive disturbances. In turn, cognitive disturbances adversely affect physical capabilities.

Background: As for longevity increases, so do ageingrelated diseases, comorbidities and geriatric syndromes. Frailty is an emerging public health problem with implications at all levels, whose signs and symptoms are predictors of health complications. Frailty early detection is essential to prevent, delay the onset and decrease the burden of frailty. The transition to a sustainable health system involves the integration of digital technologies for health, promoting patient empowerment. FRAILSURVEY is a mobile application that allows an easy assessment of frailty. Objectives: This study aims to evaluate the prevalence of frailty, in Portuguese participants aged 65 or more years old, who used FRAILSURVEY as a frailty screening tool. Moreover, the association with potential explanatory variables was also assessed. Methods: In this cross-sectional analysis, we used data from 848 individuals. Gender and age-standardized prevalence and the association between frailty (based on the Groningen Frailty Index) and sociodemographic, economic, physical and, hobbies and activities variables were evaluated. Results: The mean age of the participants was 74.8 7.6 years old, and 57.1% were female. The overall prevalence of frailty was 64.5%, being higher among women (72.9% vs. 53.3% in men) and increasing along with age groups (from 54.4% to 71.5%, to 90.4% for those aged 65-74, 75-84, and 85+ years old, respectively). Females were 2.3 times and widows were 3.1 times to be frail, compared with being male and married. Lower selfperceived health and economic levels were also associated with being more prone to be frail. Participants who reported lower contactnlevels with family, neighbours or friends, and who reported not engaging in physical activity frequently, such as walking, yoga or cycling, were also more likely to develop frailty (2.3 and 3.7 times, respectively). Conclusion: This is the first work that reports the prevalence of frailty in the Portuguese population with data collected through a mHealth platform. Frailty prevalence is similar to other studies in Portugal, showing that FRAILSURVEY is a more effective, faster and cheaper way to collect data. Considering the associated variables, the development of tailored interventions is easier, so that the burden caused by this condition can be reduced.

Andres Duarte-Rojo 1 , Rachel K. Grubbs 1 , Randi Wong 2 , Pamela M. Bloomer 1 , Robert Rahimi 3 , Alexandra Steinberg 4 , Jennifer C. (StE) is a neuropsychological test assessing psychometric speed and cognitive processing and has been validated to diagnose minimal hepatic encephalopathy (HE). Frailty, as measured by the Liver Frailty Index (LFI), is highly prevalent in endstage liver disease (ESLD), particularly among patients with HE. While the LFI comprises tests of physical function, it might conceivably also capture the contributions of cognitive impairment to physical frailty in ESLD. This study assessed the relationship between cognitive function (StE) and physical function (LFI) in ESLD. Method: Patients with ESLD underwent LFI, StE and overt HE testing using modified orientation log (MO-log) and Clinical Hepatic Encephalopathy Staging Scale (CHESS) at 3 centers. Expected StE values were obtained from www.encephalapp.com. Pearson correlation and multivariable linear regression models were used to investigate StE variability. Stroop On, Stroop Off, and their combinations were analyzed separately to characterize StE contribution in terms of cognitive processing (On-Off) versus psychomotor speed (Off). Results: Of 172 subjects (58 ± 10 years; 59% male; 93% white; 37% alcohol, 25% NASH), 68% had Child-Pugh B/C cirrhosis, and 69% had prior overt HE. On testing, 97% had normal mentation (MO-log ≥23), none had overt HE (CHESS ≥3) and 81% had minimal HE. Cognitive function in terms of StE On+Off increased across frailty categories and showed a fair linear relationship with LFI ( Fig.) , of similar magnitude to that observed for age (rho = 0.29, p<0.001) and education (rho = -0.24, p<0.002). However, StE and LFI correlation weakened from Off (rho = 0.37, p<0.001) to On (rho = 0.20, p=0.008) and On-Off (rho=-0.05, p=0.5) modalities, suggesting that psychomotor speed was the main factor driving the association between cognitive and physical function. On multivariable analysis, adjusted for age, education and sex, only StE On+Off (β=15.38, p<0.02) and StE Off (β=8.95, p<0.001) remained associated with LFI. Conclusion: Using StE and LFI, an association between cognitive and physical function in ESLD was found, likely attributable to psychomotor speed over cognitive processing. Our findings suggest that the comprehensive assessment of minimal HE should include frailty metrics, and vice versa. Also, such brainmuscle relationship further supports investigating interventions targeting both physical and cognitive function in ESLD. Background: In hospital settings, malnutrition affects 30-50% of aged inpatients and is related to a higher risk of hospital complications and death. Objectives: This study aims to assess the efficacy of a multidisciplinary team decisionmaking model on multiple interventions for aged malnourished inpatients. Methods: This trial will be a multicenter, openlabel, randomized control trial conducted in the geriatric wards of at least five hospitals in five different regions. We aim to include 500 inpatients over the age of 60 with or at risk of malnutrition based on a Mini Nutritional Assessment Short-Form (MNA-SF) score of ≤11 points and the Global Leadership Initiative on Malnutrition with an expected length of stay of ≥7 days. Eligible inpatients will be randomized into a 1:1 ratio, with one receiving a multidisciplinary team intervention and the other receiving standard medical treatment or care alone. A structured comprehensive assessment of anthropometry, nutritional status, cognition, mood, functional performance, and quality of life will be conducted twice. These assessments will take place on the day of group allocation and 1 year after discharge, and a structured screening assessment for elderly malnutrition will be conducted at 3 months and 6 months after discharge using the MNA-SF. The primary outcome will be nutritional status based on changes in MNA-SF scores at 3 months, 6 months, and 1 year. The secondary outcome will be changes in cognition, mood, functional status, length of hospital stay, and all-cause mortality 1 year after discharge. Results: To date, 10 participants have been recruited for this study. The study is expected to be completed by December, 2023. Conclusion: This study will establish a multidisciplinary nutrition support team that will develop an innovative intervention strategy that integrates nutritional screenings, evaluations, education, consultation, support, and monitoring. Moreover, nutritional intervention and dietary fortification will be provided to hospitalized elderly patients with or at risk of malnutrition. The nutrition support team will formulate a clinical map for malnutrition in elderly patients with standardized diagnosis and treatment for malnutrition in this population.

Background: More than one-third of hospitalized elderly patients have experienced functional declines of activities. Early intervention of exercise has shown preventive effects. However, poor health, lack of health literacy and motivation of ambulation in the elderly patients, unavailable training equipment, no control of duration and intensity of training, and no immediate feedbacks to training keep older patients from getting out of bed during hospitalization and home, resulting in insufficient activity and functional decline. Objectives: The interventional equipment to train limbs muscles, AIFASE, is able to simultaneously monitor physical indicators and to record exercise parameters during exercise. Our study was to investigate the effects of AIFASE use for improvement of muscle strength among hospitalized older adults. Methods: A prospective cohort study was conducted at acute geriatric ward in a tertiary care medical center of southern Taiwan. After acute condition stabilized, those geriatric inpatients that were not chair to bed bound before hospitalization were included. AIFASE was arranged to use for training at least once daily until discharge. In addition to the baseline muscle strength of limbs, the adjustment of training level was determined according to the AI feedback of previous level of exercise (resistance and training time), and the degree of self-perceived fatigue after last exercise. The muscle strengths of upper and lower limbs were measured before AIFASE use and before discharge. Results: A total of 70 subjects were enrolled. Their mean age was 85.0 (69-100) years and the average length of hospitalization was 12.9 days. During hospitalization, subjects used AIFASE for exercise 4.8 times (median of 3), and had significantly increased muscle power of limbs after training, especially lower limbs (p <0.001). Further analysis by total time of AIFASE use showed that muscle power of four limbs significantly increased (upper limbs, p= 0.002~0.023; lower limbs, p <0.001) among those used AIFASE for > 30 minutes (57.1% of cases). Among those used AIFASE for < 30 minutes, muscle power increased only in the lower limbs (p= 0.015~0.027). Conclusion: This study shows that elderly inpatients using AIFASE during hospitalization can improve muscle strength, especially in the lower limbs. Further casecontrolled studies are needed to confirm the benefits of this intervention. Key words: smart healthcare, assistive technology, artificial intelligence, frailty, functional decline, reablement Background: The concurrent presence of high adiposity, low bone density (osteopenia/osteoporosis) and low muscle mass (sarcopenia) in older adults has led to the recognition of "osteosarcopenic obesity" (OSO) as a singular entity. Vitamin D may play important role in the manifestation of OSO, in terms of intake, absorption, and bioavailability. Evidence suggests that bioavailable 25(OH)D may be a better indicator of Vitamin D compared to total 25(OH)D due to its weak bind to albumin, increasing its 'availability'. Objective: The aim of this study was to study the interrelationship between fat, bone and muscle indices and to determine their associations to total and bioavailable 25(OH)D levels in postmenopausal women. Method: We assessed body composition, bone density, and 25(OH)D indices of multiethnic, postmenopausal Malaysian women (n=141, aged 45 to 88 years). Body composition was assessed using bio-electrical impedance analysis (BIA) and bone density was assessed using quantitative ultrasound (QUS). Serum total 25(OH)D was measured using chemiluminescent microparticle immunoassay (CMIA). Serum vitamin D binding protein (VDBP) was measured using a monoclonal enzymelinked immunosorbent assay (ELISA) and bioavailable 25(OH) D was calculated using modified Vermuelen formula. Results: Hierarchical linear regression of model comparisons found muscle mass (appSMMI and overallSMMI) to be significant predictors for bone density (6-7% of the variance, p<0.05), even after controlling for adiposity indices. No direct correlations, however, was found between adiposity and bone density indices. Both total and bioavailable 25(OH)D were negatively correlated with body fat percent (p<0.001) and positively correlated with muscle mass (p<0.05). Although both forms of 25(OH)D were positively correlated with bone density (BUA), the correlation of bioavailable 25(OH)D was marginally stronger compared to total 25(OH)D (r=0.234, p=0.012 and r=0.199, p=0.030, respectively). While no significant correlation was found between OSO and any index of 25(OH) S63 D, participants with severe obesity [BFP ≥ 44%] and concurrent presence of low bone density (Osteopenic Obesity) were likely to be Vitamin D deficient (total 25(OH)D <30nmol/L) compared to participants without any musculoskeletal health disorders, obese or otherwise. Conclusion: The findings suggest that muscle mass is the stronger predictor of bone density compared to adiposity. Moreover, severely obese people are prone to hypovitaminosis D, which could lead to the manifestation of musculoskeletal health disorders, such as osteosarcopenic obesity.

Background: Osteoporosis is associated with significant morbidity and mortality, particularly in elderly population groups. Osteoporotic patients have an increased risk of falls and disability, with poor long term outcomes due to increased hospital length of stay and prolonged rehabilitation. One suggested method to opportunistically screen for osteoporosis is measurement of the hounsfield unit (HU) of the lumbar vertebrae on computed tomography (CT) scans of the abdomen. This information is valuable, however is rarely assessed by radiologists. Objectives: The primary objective is to assess the correlation between osteoporosis, determined by lumbar vertebrae HU and length of stay (LOS) at a tertiary hospital elderly patients presenting with a fall. Methods: Patients over the age of 65 who presented to our hospital emergency department (between January 2020 to July 2020) with a fall who received abdominal CT imaging were identified. Opportunistic measurement of the lumbar vertebrae (L3) HU was obtained. The measurement was derived by placing a region of interest (ROI) at a single 3mm slice over the trabecular bone at L3 excluding the cortex and basivertebreal vein to measure the HU. A cut off for osteoporosis was determined at 135 HU (as described by Pickhardt et al.) Exclusion criteria included patients with lumbar spine compression fractures, osseous lesions and spinal metallic hardware. Results: 314 were included in the study, 176 male and 138 female patients. Average age was 78 (range 65-91). 180 patients met the predefined cut off for osteoporosis via HU measurement. Females accounted for 69% (124 patients). The average length of stay for patients without osteoporosis was 3.7 days (range 1 -22) and for patients with osteoporosis based on opportunistic HU measurements was 5.5 days (range 1 -29). Using a cut off of 3 days as a significant difference of LOS, there was a significant difference in LOS of the two patient groups (p<0.05). Conclusion: Osteoporitc patients identified via opportunistic screening with CT had greater length of stays when admitted to hospital due to a fall. Further research is required to establish guidelines in this field, and the reporting of relevant findings by the radiologist could be of benefit to clinicians.

Y u l i y a S a f a r o v a 1 , Assem Nessipbekova 2 , Aizhan Syzdykova 2 , Farkhad Olzhayev 1 , Aida Baibulatova 1 , Andrey Tsoy 1 , Aislu Yermekova 1 , Malika Shertai 1 , Bauyrzhan Umbayev 1 (1. National Laboratory Astana, Nazarbayev University, Kazakhstan; 2. School of Sciences and Humanities, Nazarbayev University, Kazakhstan) Background: Mesenchymal stem cells (MSCs) can regulate the osteoclast's resorptive activity in a paracrine manner. However, with aging MSCs reduce the secretion of antiosteoclastic factors such as osteoprotegerin (OPG). This impairs bone regeneration during the transplantation of the autologous cells. Our previous studies have shown that inhibition of the Cdc42 activity can rejuvenate MSCs. Moreover, the interactions between the OPG gene and the Cdc42 gene were detected. In the current research, we investigated the effect of the Cdc42 inhibition on the secretion of OPG and its effect on the resorptive activity of osteoclasts. Objectives: Rat osteoclasts, adipose-derived mesenchymal stem cells (ADMSC), Cdc42. Methods: Osteoclast progenitor cells were derived from the rat bone marrow. Upon osteoclast differentiation, the medium was changed to contain conditioned media from the ADMSC young rats, ADMSC aged rats, ADMSC aged rats treated with CASIN, and ADMSC aged rats modified with siRNA of Cdc42. Osteoclast resorption assay was performed using a 24-well plate precoated with an inorganic bone-mimicking surface. The level of OPG in the MSC-conditioned media (MCM) was measured by ELISA. Results: The secretion of OPG decreases in aged ADMSC. Moreover, MCM from the aged cells demonstrated increased bone resorption activity compared to the young cells. Exposure of cells to the small molecule CASIN and silencing of Cdc42 led to a three-fold increase in the secretion of OPG compared to the young cells and an almost seven-fold increase compared to the aged cells. MCM from the young and aged cells after the Cdc42 inhibition demonstrated decreased bone resorption activity of osteoclasts compared to the aged cells.

The results of ELISA analysis of the OPG levels are consistent with the presence of a pronounced anti-osteoclast effect in the conditioned media, which is expressed through the decrease in the bone-resorbing activity of osteoclasts. The results obtained indicate that inhibition of the Cdc42 significantly activates the anti-osteoclastic activity of MSCs. This work was funded by the CRP grant of Nazarbayev University № 091019CRP2113.

Chen-Cheng Yang (Department of Occupational and Environmental Medicine, Department of Family Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan) Background: Frailty is a clinical syndrome characterized by physical activity, cognition, and emotional impairment. It is a state of increased vulnerability to stressors, especially in older adults, which leads to adverse health outcomes such as falls, disability, hospitalization, and mortality. Polypharmacy refers to the use of multiple medications or unnecessary drug use. Polypharmacy is common in older adults, especially those with multi-morbidities, as one or more medications may be used for each condition. Patients may have increased risks of adverse effects and harm. Potential adverse outcomes include decline in cognition and mobility as well as drug-drug interactions and drug-disease interactions. Objective: However, data on the association between frailty and polypharmacy are scarce. Therefore, we aimed to investigate the association between frailty and polypharmacy. Materials and Methods: This was a cross-sectional study of people aged ≥65 years. A total of 205 participants were included and interviewed using questionnaires. Polypharmacy was defined as the daily use of eight or more pills. Frailty was assessed using a screening tool, including (1) the Fatigue, Resistance, Ambulation, Illness and Loss of Weight Index (5-item FRAIL scale), (2) Future research is required to further enhance our understanding of the risk of frailty among older adults. Geriatrics and Gerontology, Obu, Aichi, Japan; 3. Faculty of Health Sciences, Department of Human Care Engineering, Nihon Fukushi University, Mihama, Aichi, Japan) Background: Sarcopenia is one of the most important health issues in today's ageing society. The thigh is often used in studies of ageing and muscle because of its significant age-related muscle loss. As an evaluation method, computed tomography (CT) is an effective means of assessing not only the quantity but also the quality of skeletal muscle. However, there are few reports on the changes in muscle and fat areas according to the severity of sarcopenia in the elderly population using CT. Therefore, we aimed to examine the relationship between sarcopenia severity and muscle, and fat area.Objectives: 321 patients (116 men and 205 women, mean age 77.2±7.1 years, age range 53-96 years) who visited the Integrated Healthy Aging Clinic in National Center for Geriatrics and Gerontology, Japan, from 2016-2017 were included in this study. Methods: Based on the Asia Working Group for Sarcopenia2019 criteria, patients were divided into four groups: normal group, low-functional group (with normal skeletal muscle mass, but reduced muscle strength or physical function), sarcopenia group, and severe sarcopenia group. We measured skeletal muscle (SM), intermuscular adipose tissue (IMAT), subcutaneous adipose tissue (SAT) and CT attenuation values (CTV) using cross sections of the mid-thigh CT. Then, we compared each result between the four groups. Results: We found a significant decrease in the SM area in sarcopenia in both sexes. In women, a decrease in SAT was observed in the sarcopenia group, and an increase in IMAT was observed in the low-functional group. CTV decreased in men with sarcopenia and severe sarcopenia; similarly, women in the low-functional and severe sarcopenia groups had decreased CTV. Conclusion: By combining not only muscle mass but also fat mass and CTV, we were able to better examine the pathogenesis of sarcopenia and differences between men and women. Background: Type 2 diabetes mellitus has been associated with dysfunctional mitochondrial dynamics (biogenesis, fission, and fusion) and decreased muscle cross sectional areas (CSA). We previously reported that ginger root extract supplementation enhanced the mRNA expression of mitochondrial biogenesis-associated genes in diabetic rats. However, the effect of ginger root extract on the protein expression of basal mitochondrial dynamics (fission and fusion) and CSA in diabetic rats has not been elucidated. Objectives: We investigated the effects of gingerol-enriched ginger (GEG) supplementation on mitochondrial dynamic and CSA in diabetic rats. Methods: Thirty-three male rats were assigned to three groups: low-fat diet (CON group), high-fat-diet+streptozotocin (single dose 35mg/kg BW) (T2DM group), and high-fat-diet+streptozotocin+0.75%GEG in diet (GEG group) for 42 days. Soleus tissues were collected and analyzed for cross sectional area (CSA) using H&E stain and the protein expression of fission (DRP1, PDRP1), fusion (OPA1, MFN2), and mitophagy (Pink1, Parkin, LC3A/B) using western blot. The data of CSA and protein expression of groups was presented as the fold-change relative to CON group. Results: Compared to the CON group, T2DM had greater MFN2 protein expression in soleus (p=0.002). Supplementation of GEG into diet suppressed MFN2 protein expression in soleus than those in T2DM group (p=0.05). There was no difference in soleus MFN2 protein expression between GEG group and CON group. Unlike MFN2 protein expression, there was no difference in OPA1 protein expression between the CON group and the T2DM group. Intriguingly, GEG supplementation resulted in decreased protein expression of OPA1 in diabetic rats (p=0.006). No differences in protein expression levels of DRP1, PDRP1, Pink1, Parkin, and LC3A/B were observed among the groups. In terms of CSA, the T2DM rats had decreased CSA than those in the CON rats (p<0.001). Supplementation of GEG into diet significantly increased CSA in diabetic rats (p<0.001). No significant difference in CSA was observed between the CON group and the GEG group. Conclusion: In T2DM, GEG supplementation attenuated both mitochondrial outer membrane fusion (MFN2) and mitochondrial inner membrane fusion (OPA1) in diabetic rats, without modulating the mitochondrial fission (DRP1, pDRP1) and mitophagy (Pink1, Parkin, LC3A/B). Background: Low dietary protein intakes increases susceptibility to muscle loss and functional decline associated with ageing (sarcopenia). Understanding factors that influence an individual's daily protein intake could provide a useful insight into developing practices to help increase protein consumption. One such factor could be a person's knowledge about protein and its importance for health. We hypothesised that greater knowledge about protein, would lead to higher daily protein intakes. Objectives: To assess if there is a relationship between an individual's protein knowledge and their habitual dietary protein consumption. Moreover, to explore whether age has any influence on this relationship. Methods: Adult participants were invited to an online survey. One part of the survey consisted of a 24-hour recall (Intake24) to derive information about the respondent's protein consumption. Protein intake was adjusted for body mass, to obtain protein intakes as grams/kg body mass/day (g/ kgBM/day). The final part of the survey consisted of a protein knowledge questionnaire which yielded a numeric score. Data were checked for normality and Spearman's Rho statistical analysis was conducted using SPSS 26. Results: The number of respondents to the survey was n=141, age range 18-92 years. The data was divided into two age categories: younger-middle aged adults; 18-49 years (n=85) and middle-older aged adults; 50+ years (n=56). Spearman's correlation analysis between protein intake and protein knowledge were r= -0.21 (p=0.46) in the younger age category and r=0.307 (p=0.022) in the older age category. Mean (SD) protein intakes (g/kgBM/d) were 1.06 (0.58) and 1.00 (0.45) for the younger and older age categories, respectively. Thirty-three percent of young-middle aged adults were not achieving protein recommendations (0.8g/kgBM/d) compared to thirty-eight percent of middle-older aged adults. Analysis of the data as a whole led to no apparent association between protein knowledge and intake. Conclusions: There was a significant correlation between protein knowledge and intake in middle-older age that was not seen in the younger age category. This suggests that increasing knowledge around dietary protein may benefit middle-older age people at risk of sarcopenia. This observation would benefit from a large sample size and further research to understand the factors that determine protein intake throughout the life-course.

Background: A staggering 15% of older adults suffer from dysphagia (difficulty swallowing) which can have devastating consequences on an individual's health (malnutrition, dehydration, aspiration pneumonia) and quality of life (QOL). Sarcopenia, the natural loss of muscle strength and function with age, is a contributing factor to age-related swallowing difficulties. Most dysphagia research has focused on sarcopenia of the tongue, given the ease of capturing tongue strength with oral manometry devices. However, much less is known about the pharyngeal muscles which are difficult to quantify non-invasively but play a vital role in executing safe and efficient swallowing. Objectives: A seminal paper by Aminpour (2011) established that the pharyngeal muscles are prone to sarcopenia. They measured the thickness of the pharyngeal constrictor muscles on videofluoroscopic swallowing studies (VFS) using a simple one-way ANOVA in young and older subjects. Recently, our lab established that swallowing structures are influenced by overall body size (which typically differs between men and women). For the current study, our objective was to replicate the Aminpour study while controlling for subject sex and size. Method: Data came from two existing datasets of healthy adults: 20 young (<35) and 44 older (>65), balanced for sex and height. We measured the thickness of the posterior pharyngeal wall at the anterior inferior corner of the C3 vertebra perpendicular to the spine. Inter-and intra-rater reliability measures were performed. Results: A linear mixed effects model revealed that the thickness of the posterior pharyngeal wall was significantly reduced in the older dataset (mean = 3.71 mm, SE = 0.21) compared with the younger dataset (mean = 4.77 mm, SE = 0.35) [F=4.48, p=0.039] with a strong effect [d=0.93]. Sex and height were not significant factors. Conclusion: Consistent with our hypothesis and previous research, our data confirm that the pharyngeal swallowing muscles are prone to sarcopenia. We hypothesize there is a cyclic relationship between sarcopenia of the swallowing muscles and inefficient swallowing which can contribute to poor nutritional status and frailty. There is a need to establish interventions to reverse/prevent sarcopenia of the pharyngeal muscles to support optimal nutritional intake in our rapidly-aging population. Background: Frailty in older adults is related with the number of complex factors and leads to fatal outcomes such as disability and death. Although several related factors of frailty have been identified, especially in older adults living in community, the predictors in the older adults dwelling longterm care facilities are still unclear. Objectives: We aimed to confirm the prevalence of frailty and related factors among older adults residing long-term care facilities. Methods: We used the cross-sectional data of the fist-year of the ongoing prospective cohort study. A total of 405 residents aged 60 years old or more recruited from 13 long-term care facilities in Korea from 2021, August to 2022, January. Because of blocking access to the facilities due to pandemic COVID-19, data were collected by nurses working at their long-term care facilities after having education through video and/or manual provided by the researcher. Frailty was assessed with FRIAL-NH, which consists of seven items and the total score varies from 0 to 14. The participants were categorized as robust (0-5), pre-frail (6-7), and frail (≥8) according to the total score of FRAIL-NH. The health-related condition (comorbidities, number of medications, and oral health), nutritional status (mini nutritional assessment and body mass index), and sarcopenia (calf circumference and grip strength) were included in the measurement as frailty related factors. Multiple regression analyses were conducted to identify the predictors of frailty. Results: Mean age of participants was 83.79 8.09, and 78.0% were women. The prevalence rate of robust, pre-frail and frail were 18.5%, 25.2%, and 56.3%, respectively. The mean FRAIL-NH score was 5.00 2.50. In multivariate analysis, the strongest predictor was nutrition (β= -0.36, p=<.001), and then followed by calf circumference (β= -0.28 p=<.001), comorbidities (β=0.19, p=<.001), number of medications (β=0.17, p=<.001), and dry mouth (β=0.08 p=.046). Those variables explained 38.4% of the variance of frailty (Adj R2=.384, F=49.00, p<.001). Conclusion: Participants with multiple factors such as poor nutritional status, reduced muscle mass, and polypharmacy should be focused on close observation and needed regular health assessment to prevent the progress to disability and/or death.

Poor nutritional status is associated with worse prognosis and increased risk for adverse outcomes in patients hospitalized with heart failure (HF). Objectives: To assess the utility of adding the Prognostic Nutritional Index (PNI) to the Veterans Health Administration frailty index (VA-FI) in predicting time to death in patients hospitalized with HF. Methods: Retrospective cohort study of veterans hospitalized with HF as their primary diagnosis from October 2015 to October 2018. Veterans age ≥50 years with reported albumin and lymphocyte counts in the year prior to the hospitalization were included. Albumin and lymphocyte count were used to calculate the PNI. We defined malnutrition as PNI<43.6, based on the Youden index. The VA-FI was calculated from the year prior to the hospitalization and identified five groups: robust (≤0.1), prefrail (0.1-0.2), frail (0.2-0.3), moderately frail (0.3-0.4), and severely frail (>0.4). Malnutrition was added to the VA-FI (VA-FI-plus) using the same cutoffs. We then identified the changes in frailty status using the VA-FI versus VA-FI-plus by summarizing the count by each class and report the hazard ratio (HR) for all-cause mortality in each VA-FI category based on the new classification from VA-FI-plus groups. Results: We identified 29,025 patients in the cohort (mean age: 73.4 years, BMI: 31.3 kg/m2). VA-FI-plus identified more frail patients within each VA-FI class that belong to the next frailty strata. For instance, VA-FI categorized 1457 as robust, while VA-FI-plus classified 1162 patients as robust and reclassified 292 as prefrail (20.2%). The same reclassification was observed for VA-FI prefrail (18.3%), frail (16.7%) and moderately frail (16.7%) groups. We observed higher mortality rates among those whose frailty class changed based on VA-FI-plus compared to VA-FI: robust (HR, 1.65, 95%CI:1.38, 1.97), prefrail (HR, 1.52, 95%CI: 1.41, 1.65), frail (HR, 1.42, 95%CI: 1.33, 1.52), and moderately frail (HR, 1.33, 95%CI: 1.24, 1.43). Conclusion: Adding PNI to VA-FI provides a more accurate mortality assessment among Veterans hospitalized for HF. When data are available, the VA-FI-plus may be utilized in clinical settings to identify hospitalized HF patients at higher risk for adverse outcomes.

Doris Eglseer 1 , Mariella Traxler 1 , Silvia Bauer 1 (1. Medical University Graz, Institute of Nursing Science, Graz, Austria) Background: Sarcopenic obesity (SO) is an increasingly common phenomenon with a prevalence of up to 33.5% in older adults. SO increases the risk of disability, immobility, care dependency and negative health outcomes like dyslipidaemia, insulin resistance, osteoarthritis, falls or lower quality of life. It is well-known that protein is essential for muscle metabolism. Objectives: The aim of this analysis was to identify the association between the intake of different sources of protein and the presence of sarcopenic obesity in individuals around retirement age. Methods: This study is a secondary data analysis of the SHARE (Survey of Health, Ageing and Retirement in Europe) data, a large pan-European panel study. Data collection was conducted in 2020. We defined SO in this study as a BMI ≥ 30kg/m2 and a handgrip strength below the 25th percentile in our sample (men: <38 kg, women: <24 kg). For data analysis, descriptive statistics, statistical tests and multiple logistic regression analyses were used. Results: In total, 5362 participants aged between 50 and 70 years (mean age 62) were included, with 3054 (57%) being female. The prevalence of SO was 7.2%. Nearly half of the participants (44.1%) were retired. 64.3% stated performing moderate physical activity more than once a week. Overall, 2325 (43.4%) consumed dairy products daily, 1529 (28.5%) consumed meat or fish daily, and 649 (12.1%) consumed eggs or legumes daily. Logistic regression analysis revealed that a non-daily consumption of meat and fish (OR 1.8, CI 1.4-2.4), physical activity less than 1x/week (OR 2.1, CI 1.7-2.6) and being in retirement (OR 1.7, CI 1.3-2.0) was significantly associated with the presence of SO. Conclusion: Our analysis suggests that protein consumption, namely the intake of meat and fish, moderate physical activity as well as being in retirement are influencing factors in the development of SO. The transition phase to retirement may be a great opportunity to adopt new healthy nutrition and exercise habits. Therefore, intervention programs in clinical practice should also focus on this patient group. However, intervention studies are needed to formulate specific recommendations on the intake of different protein sources for the prevention and treatment of SO. Background: It is being proposed that nutritional quality is a key factor for sarcopenia prevention, especially among older adults over 80 years old. Previous studies demonstrated a significant association between low protein intake and low muscle mass and muscle strength. However it was also shown that nutrition patterns and nutritional quality may be as important or even more relevant for sarcopenia prevention than protein intake as an single nutritional variable.Additionally, prevalence of sarcopenia was assessed through the EWGSOP 2010 and 2018 revised criteria and subsequantially compared. Objectives: Therefore, this study aims to investigate the prevalence of sarcopenia and its associations with diet quality and nutritional status in older adults aged 80 years and over. Methods: A cross-sectional study enrolled individuals 80 years of age or older who were in outpatient follow-up at a tertiary hospital in southern Brazil between March and October 2018. To obtain energy and macronutrient intake data a 24-hour dietary recall (24HR) was conducted to allow the Healthy Eating Index (HEI) calculatation. Nutritional status was categorized based on the Mini Nutritional Assessment (MNA). Sarcopenia was diagnosed using the 2010 and 2018 EWGSOP criteria. To measure muscle mass, an electrical bioimpedance test was performed and the muscle mass index was calculated. Muscle strength was measured by handgrip dynamometry and gait speed was measured in a 4-m test. In order to test the association among studies variables and sarcopenia a Multivariate Poisson Regression Analysis was conducted and results were expressed in Prevalence Ratios (PR). Results: 119 included participants (>=80 years old), predominantly female (n=67; 56.3%), mean age 83.4±3.0 years, and 43.7% had a low education level (n=52). The prevalence of sarcopenia was 46.7% (EWGSOP 2010) and 17.6% according to the revised consensus definition. Nutritional quality measured by the HEI was not associated with muscle mass or the diagnosis of sarcopenia in this study. However, for each 100 kcal increase in Total Energy Intake it was identified a significant risk reduction for sarcopenia (PR 0.83 CI95% 0.77 -0.91; p<0.001) and for severe sarcopenia as well (PR 0.79 CI95% 0.71 -0.89; p<0.001). Differently than anticipated, high protein intake [>= 1.2g/kg] was independently associated with a greater risk for sarcopenia (PR 3.19 CI95% 1.36 -7.54; p=0.008) and for severe sarcopenia (PR 5.43 (1, 6) . Conclusion: In this study, the Healthy Eating Index was not significantly associated with Sarcopenia. However it was demonstrated that the higher the Total Energy Intake the lower was the risk for sarcopenia; Differently than expected, higher protein intake was independently associated with sarcopenia. Further analysis is required to confirm the aforementioned results, so a nested longitudinal study was planned to investigate the association between different nutrition patterns and sarcopenia. Background: In view of the aging of the Brazilian population, the study of multimorbidity and its different patterns, based on combinations of diseases, is necessary, as well as the relationship to antecedent factors and outcomes. Objectives: To evaluate the influence of multimorbidity patterns on functional capacity, in two assessments 9 years apart, in a cohort of community-dwelling older adults. Methods: Longitudinal study with data from the baseline (2008-2009) and follow-up (2016-2017) from the FIBRA Study. Basic Activities of Daily Living (BADL) -the Katz Index -was the outcome variable and the independent variables were the presence of two or more diseases, divided according to the following multimorbidity patterns: (1) cardiopulmonary (heart and lung diseases); (2) vascular-metabolic (systemic arterial hypertension, diabetes mellitus, stroke, cancer); and (3) mental-musculoskeletal (arthritis, depression and osteoporosis). The chi-square test was performed (significance level of 5%) to verify the association between the outcome variable and the independent variables, and crude and adjusted logistic regressions were used to estimate the odds ratios and respective confidence intervals (CI 95%). Results: Functional disability in BADL was more frequently observed among women (p=0.008), in those with multimorbidity (p=0.020) and with cardiopulmonary, vascular-metabolic and mental musculoskeletal multimorbidity patterns (p<0.05). After adjusting for sociodemographic variables and lifestyle habits, older adults with multimorbidity classified in the vascularmetabolic pattern were 2.07 (95% CI: 1.21-3.54) times more likely to have functional disability in BADL. Conclusion: The result showed that older adults with multimorbidity classified in the vascular-metabolic pattern were more likely to have functional disability. These findings highlight the complexity of the multimorbidity phenomena, and they may contribute to the clinical management and formulation of strategies to prevent disability. (Florida Internal University, Miami, FL, USA) Background: Advanced liver disease is a well-known cause of severe frailty, disability, and mortality. Methodological advances and growing clinical experience with non-invasive transient elastography (TE) offer now a major opportunity to improve understanding about the impact of less advanced liver dysfunction on clinical vulnerability. Objectives: To assess the relationship of liver stiffness measurement (LSM) and the controlled attenuation parameter (CAP) obtained by TE, surrogate markers for liver fibrosis and steatosis, respectively, with self-rated health status, a general health index strongly associated with frailty and its distal outcomes. Methods: Crosssectional study using recently released National Health and Nutrition Examination Survey (NHANES) 2017-2020 data, which included a large sample with TE (Fibroscan®)-measured LSM and CAP. Hierarchical, weighted logistic regression models were used to assess the odds of self-rated general health status (excellent/very good vs. good/fair/poor) as a function of LSM and/or CAP, with adjustment for demographics, chronic diseases, metabolic syndrome parameters, and liver-related biomarkers (aminotransferases, gamma-glutamyl transferases, and albumin). Sarcopenia and frailty phenotype status were not available. Results: Incrementally higher LSM (stiffer) was associated with increasingly lower probability of better health status. As compared to those with LSM in the bottom quintile (<4 kilopascals [kPa]), those with LSM in the intermediate quintiles and top quintile (>7 kPa) had substantially lower odds of self-rating their general health as excellent or very good: odds ratio (OR) .64 (95% confidence interval [CI] .44-.95; p=.030), and OR .56 (95%CI: .32-.96; p=.036), respectively. CAP was not independently associated with self-rated health status in the fully adjusted model. Conclusion: higher LSM, as a surrogate marker of liver fibrosis, was independently and meaningfully associated with self-rated health status, a strong indicator of vulnerability of adverse health outcomes in older adults. Whether the observe associations involve a causal effect through sarcopenia pathways is yet to be elucidated. In line with the literature, our results raise the question as to whether noninvasive TE screening could be useful to identify older adults with liver steatosis and/or fibrosis in a not too advanced stage who could benefit from preventive interventions; e.g., diet and exercise in patients with non-alcoholic fatty liver disease.

Li Zhang 1,2 , Fei Sun 2 , Zhe Tang 1,2 Yun Li 1,2 , Lina Ma 1,2 (1. Department of Geriatrics, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, China; 2. Beijing Geriatric Healthcare Center, Xuanwu Hospital Capital Medical University, Beijing, China) Background: : Geriatric depression is a major world public health problem worldwide. Depression leads to various functional somatic disorders and seriously affects treatment attitudes in patients with diseases, thus reducing the quality of life, and depressive symptoms also significantly increases health care spending. Objectives: This study aimed to investigate the prevalence of depressive symptoms and the association between medical conditions among communitydwelling older adults in China. Method: Data for the analyses were obtained from the China Comprehensive Geriatric Assessment Study. We conducted 5984 community-dwelling older adults aged 60 years and above from seven provinces throughout China. A comprehensive geriatric assessment was performed by formally trained interviewers using a unified questionnaire during the person-to-person interviews. Depressive symptoms were evaluated using the Geriatric Depression Scale-30. Medical conditions were assessed by several questions (such as "Frequency of medical visits in the last year" and "Payment method of medical expenses"). The prevalence of depressive symptoms and the association between medical conditions and depressive symptoms were analyzed. Results: The prevalence of depressive symptoms in older adults was 12.9%, which was higher in women (15.2%) than in men (10.2%), higher in the southern region (15.2%) than in the northern region (10.2%), and higher in rural areas (19.2%) than in urban areas (9.0%). Older adults with a higher disease burden have a higher prevalence of depressive symptoms. Beijing (14.1%) had the highest depressive symptom rate, and Shanghai and Harbin had the lowest rate (8.6%), which was statistically significant. A higher prevalence of depressive symptoms was associated with a higher disease burden (p<0.001) and a higher frequency of hospital visits during the last year (p<0.001). There was also a significant difference between older adults with no basic health insurance (p<0.001) and those who needed caregivers for illness (p<0.001). Conclusion: In China, depressive symptoms are common among older adults. The prevalence is significantly higher in women, rural areas, and northern China. Reducing disease burden, increasing acceptable care, and ensuring better basic health insurance can reduce the incidence of depressive symptoms.

Nadine Simo-Tabue, Salvatore Metamo, Laure Nguegang, Marie-José Ntsama-Ebode, Callixte Kuate-Tegueu, Maturin Tabue Teguo (CHU de Guadeloupe, Guadeloupe, Les Abymes, France) Background: Aging has been clearly associated with visual and physical performance. Alteration of visual function is associated with negative health outcome such as cognitive decline, disability, loss of mobility. Objective: To determine the relationship between visual impairment (VI) and physical frailty (using the SOF index and SPPB). Method: Data from the Douala Study of Aging, an observational, cross-sectional study. Visual impairment was self-reported. Physical frailty was assessed using the SOF index and the SPPB test. Considering the SOF index, participants meeting one or more criteria (unintentional weight loss, inability to do five chair stands, low energy level) were classified as pre-frail/frail. The SPPB is consisting of three sub-tests : test of balance, chair stands test and gait speed test (range between 0 to 12). Participants with SPPB test score > 9 were classified as fit. Descriptive statistics and linear regression analyses were used to determine the relationship between VI and physical frailty. Result: The study sample consisted of 406 patients aged 55 years or older, among whom 49.80 % were female. The mean age of participants was 67.0 (+/-6.4) years. A total of 359 (88.4 %) have self-reported VI. Considering both test (SOF and SPPB), the prevalence of frailty/pre-frailty was 40 %. After adjustments, the VI was significantly associated with physical frailty (OR :2.88 IC95 % 1.23 -6.79, P<0.001) and OR : 2.69 IC 95 % 1.31 -5.55, P< 0.001) respectively for SOF index and SPPB test. Conclusion: Our study supports an association between VI and physical frailty defined according to the SOF index and the SPPB. This results suggest that VI could be consider as an indicator of physical frailty among elder persons in Subsaharan Africa. Background: Identification of sarcopenia creates an opportunity for interventions. Objective: To examine the prevalence and 14-year incidence of sarcopenia and identify factors associated with incident sarcopenia in older Chinese people. Methods: Longitudinal data on 915 communitydwelling older people aged 65 to 74 at baseline were used. This sample has been followed up for 14 years from 2001-2003 (baseline) to 2015-2017 (follow-up rate 33.8%). Sarcopenia was defined based on the Asian Working Group for Sarcopenia (AWGS) 2019 consensus criteria: low muscle mass was defined as height-adjusted appendicular lean mass <7.0 kg/m2 for men and <5.4 kg/m2 for women; low muscle strength was defined as handgrip strength <28 kg for men and <18 kg for women, and low physical performance was defined as gait speed <1.0 m/s. Multivariate logistic regression was used to examine the associations of sociodemographic, lifestyle, and medical conditions with incident sarcopenia. Results: Sarcopenia was present in 48.5% of older people at the 14-year follow-up. During an average of 14 years of follow-up, 190 (52.5%) men and 147 (34.4%) women developed sarcopenia, making the average annual incidence of sarcopenia 5.3%. The prevalence of sarcopenia was higher among older age groups (aged 70-74 years 53.6% vs. 65-69 years 45.2%) and among men (men 57.9% vs. women 39.5%). The incidence of sarcopenia was also higher among older age groups (aged 70-74 years 6.5% vs. 65-69 years 4.7%) and among men (men 7.9% vs. women 3.8%). After multivariate adjustment of age, sex, education, physical activity, energy and protein intake, and medical conditions, older age (OR 1.1, 95%CI 1.1-1.2) and diabetes (OR 1.8, 95%CI 1.1-3.0) were risk factors of incident sarcopenia, while female sex (OR 0.2, 95%CI 0.2-0.3) and higher BMI (OR 0.7, 95%CI 0.7-0.8) were protective factors. Conclusion: Despite a low follow-up rate, the high prevalence of sarcopenia among older people suggests that identification of sarcopenia with a view to intervention is particularly important for older men and those with diabetes, while weight loss/weight reduction without exercise should be avoided.

Hiro Kishimoto 1,2 , Xin Liu 2 , Harukaze Yatsugi 2 , Tianshu Chu 2 (1. Faculty of Arts and Science, Kyushu University, Japan;

Background: Aging population has become a severe problem faced by countries worldwide. With the increase of age, older adults' mental health and physical frailty have received particular attention. However, few studies have investigated the relationship between them. This crosssectional study aimed to clarify this association among communitydwelling older people in Japan. Methods: A total of 919 community-dwelling older men and women aged 65-75 years were included in the analysis. Data were drawn from the baseline survey of the Itoshima Frailty Study and a cohort study carried out in a west Japanese suburban community. Physical frailty was measured based on five criteria proposed by Fried and colleagues, and the individuals were classified into three groups: robust, physical pre-frailty, and physical frailty. Psychological distress was used to assess mental health, measured using the Kessler Screening Scale (K6), and divided into three groups: 0-1, 2-4, and 5 or more. Ordinal logistic regression was used to estimate the odds ratios (ORs) and 95% S71 confidence intervals (CIs) between the psychological distress and physical frailty status. Results: Of all, 190 participants (20.7%) presented psychological distress, 46 participants (5.0%) presented with physical frailty, 24 participants (2.6%) had both symptoms. With the increase in the K6 score group, the participants had more physical pre-frailty and physical frailty (p<0.001). Additionally, the subitem more shrinking and more exhaustion of physical frailty also had a significant tendency. The significant positive correlations were observed between psychological distress and physical pre-frailty (OR, 3.05; 95% CI, 2.06-4.50) or physical frailty (OR, 10.68; 95% CI, 4.98-22.93). One-point increment of K6 scores was also significantly higher the risks of physical pre-frailty or physical frailty. Simultaneously, shrinking and fatigue also have a significant relationship with psychological distress. Conclusion: Our findings show that older adults with higher psychological distress were associated with a higher risk of physical frailty. The more shrinking and exhaustion of physical frailty sub-items were also associated with higher psychological distress. Background: Previous studies have suggested that lower serum levels of dehydroepiandrosterone sulfate (DHEA-S) are associated with increased rates of physical frailty. However, the evidence is limited to cross-sectional studies at given times. Objective: To investigate the association between serum DHEA-S levels and physical frailty in older Japanese community-dwellers using panel data of several survey waves. Methods: The data used in the present study were collected as part of the National Institute for Longevity Sciences-Longitudinal Study of Aging (NILS-LSA) project. Repeated measurement data of serum DHEA-S levels (μg/ dL) and frailty status were collected from 1886 older Japanese community-dwellers (age, 60-91 years; from the 2nd, 3rd, 5th, and 7th waves; cumulative participation: 4112 times; mean participation: 2.2 times). Frailty status (weight loss, grip strength, walking speed, sense of exhaustion, and physical activity) was identified according to modified criteria of the Cardiovascular Health Study. Associations between serum DHEA-S levels (sex-specific tertile [T1−T3] groups, with the T1 group used as the reference group) and 1) frailty and 2) the combination of prefrailty and frailty were estimated by random-effects logistic regression models, adjusting for age, sex, education level, disease history (stroke, hypertension, heart disease, and diabetes), smoking status, depressive symptoms, and survey wave. Results: The cumulative prevalence of frailty was 6.1%. Mean (SD) sex-specific serum DHEA-S levels (μg/dL) of T1, T2, and T3 were 46.8 (20.8), 88.7 (28.4), and 158.0 (58.9), respectively. After full adjustment, compared with participants in the T1 group, the OR (95% CI) of frailty was 0.69 (0.44, 1.08) for participants in group T2 and 0.50 (0.30, 0.83) for participants in group T3 (P for trend = 0.007). However, when using prefrailty/frailty as the outcome, the results became marginally insignificant. Conclusion: Higher serum DHEA-S levels tended to be associated with a lower risk of frailty in older Japanese community-dwellers. Background: Reductions in muscle mass associated with age often occur in conjunction with changes in adipose tissue mass and/or function, suggesting these tissues are dependently regulated. While the mechanisms by which adipose tissue may regulate muscle are incompletely understood, there is mounting evidence for the existence of reciprocal endocrine cross-talk mechanisms between muscle and adipose tissue that can influence metabolism and health. Objective: Recent work demonstrates that microRNA (miRNA) produced in adipocytes are released into the circulation via exosomes, whereby they can travel to distal tissues including skeletal muscle. Adipocytes are believed to be the largest source of circulating miRNA, and miRNA regulation within adipose tissue is dramatically altered with age. However, it is unknown how changes in adipose tissue function with age impact exosomal miRNA expression and its subsequent effects on skeletal muscle function and metabolism. Our recently published work demonstrates that circulating levels of the miR-17~92 cluster (Mirc1) decline with age and are associated with an impaired anabolic response to acute exercise in muscle. Adipocytes are estimated to be the source of ~88% of circulating miRNA, suggesting that reductions in circulating Mirc1 with age result from decreased expression and/or secretion from adipose tissue. Method: We profiled the miRNome in the white (gonadal) adipose tissue, skeletal muscle and exosomes of 6 and 24 month (MO) C57BL/6J mice. Follow-up validation was performed with qPCR to determine the expression of specific Mirc1 members, its cluster host gene lncRNA MIR17HG and inflammatory markers. Results: We found significant decreases in 10 members of the miR-17~92 cluster (Mirc1) in 24 MO vs. 6 MO adipose tissue. Follow-up validation confirmed marked decreases in the expression of Mirc1 members in adipose tissue with age. Moreover, we demonstrate that exosomes S72 released from adipose tissue mirrored this expression pattern. Importantly, changes in exosomal content with age were corrected for total exosome release using U6/SNORD44 housekeeping miR expression; and total fat pad mass was similar in 6 MO and 24 MO. These results indicate that adipose-derived miRNA content is dramatically altered with age-even in the absence of changes in adiposity. Conclusion: Our results from mice recapitulate relationships we identified previously in humans: that reduced Mirc1 expression in circulation is predictive of age and anabolic resistance in skeletal muscle. Moreover, our results support the hypothesis that the decline in circulating Mirc1 with age may be attributed to age-associated changes in adipose tissue expression.

MRI. Bragi Sveinsson 1,2 , Matthew S Rosen 1,2,3 (1. Athinoula A. Martinos Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, USA; 2. Harvard Medical School, Boston, USA; 3. Department of Physics, Harvard University, Cambridge, USA) Background: Magnetic Resonance Imaging (MRI), with its excellent soft tissue contrast, can provide important information about skeletal muscle. This includes both muscle morphology and microstructure. For such measurements to serve as reliable biomarkers, they need to be consistent across measurements and provide high intra-rater agreement. Here, we examine muscle segmentation with high-resolution MRI at 7T and investigate intra-rater agreement in measurements of muscle crosssectional area and volume. Objectives: Our objective is to investigate the use of 3D high-resolution double-echo in steadystate (DESS) imaging at 7T to segment skeletal muscle. As the same method can be used to obtain quantitative estimates of tissue microstructure, the ability to also estimate muscle volume reliably would enable a holistic view of skeletal muscle condition by providing both morphological and microstructural information with one imaging method. Methods: The 3D DESS sequence was used to axially image the lower thigh of two healthy volunteers (referred to as volunteer 1 and 2) at 7T. An in-plane resolution of 0.1483x0.1483 mm2 was applied. Using the Horos imaging software, a region of interest (ROI) was drawn in the vastus medialis (VM) muscle in each volunteer. The scan volume did not cover the entire muscle, but the segmentation was performed over 50 2 mm slices, with the most distal slice containing the upper edge of the patella. The 2D ROIs were then combined to form a 3D volume. The ROI areas and the muscle volume were measured. To investigate reproducibility, this was performed twice in each of the two subjects and the agreement measured by comparing the ROI areas and the volume and by computing the DICE score for the two segmentations in each patient. Results: The VM volume in volunteer 1 was measured as 129 cm3 and 131 cm3 in the two segmentations. The mean absolute percentage difference in ROI areas was 1.53% and the mean DICE score was 0.98.

For volunteer 2, the volume measurements were 144 cm3 and 147 cm3, with ROI area mean percentage difference and DICE score of 1.88% and 0.98. Conclusion: Muscle volume and cross-sectional areas can be measured using high-resolution DESS at 7T with high reproducibility. Background: Immune function affects tissue homeostasis and may therefore contribute to physical function among older adults experiencing clinical stressors. Epidemiological studies show age-associated T-cell phenotypes correlate with adverse outcomes. Smaller studies show association between physical frailty and increased IL-6 production in human peripheral blood mononuclear cells (PBMC) stimulated ex vivo with lipopolysaccharide (LPS). How immune markers correlate with function during age-associated stressors such as osteoarthritis (OA) and chronic kidney disease (CKD) is not well understood. Objectives: This pilot study evaluated whether gait speed, grip strength, and short physical performance battery (SPPB) correlate with immune phenotypes in older adults with knee OA prior to planned knee replacement, and those with advanced CKD. Methods: CKD n=13 and OA n=20 underwent baseline evaluation including gait speed (4-meter walk), grip strength, and SPPB. Peripheral blood mononuclear cells (PBMCs) were froze, thawed, then stimulated ex vivo with a) lipopolysaccharide (LPS) (0, 0.1ug/mL) with IL-6 quantified by ELISA (2, 18, 24, and 48 hours) ; reported as area under curve b) Phorbol myristate acetate (PMA) (1.5ng/ml ) + Ionomycin (500ng/ml) with flow cytometry, staining for activated T cell cytokine production markers; reported as % positive. Pearson correlation coefficient and p-value were calculated. Results: For CKD, IL-6 AUC of LPS-stimulated PBMCs associated with gait speed (r=-0.698, p=0.008) and grip strength (r=-0.617, p=0.019), but not SPPB (r=-0.176, p=0.547). For OA, IL-6 AUC did not correlate with any measures (gait r=0.024, p=0.921; grip r=0.798, p=0.063; p=0.959) . PMA-Ionomycin-stimulated PBMCs associated with SPPB for CD4+C69+IL-17+ (r=-0.358, p=0.038) and p=0.016) . Similar results were obtained when age was included as a covariate. Conclusion: In this pilot analysis, innate immune response (LPS stimulation of PBMCs) correlated with some physical function measures for CKD and this was not found for OA. Though interesting, larger, prospective studies are needed to establish the significance of innate and adaptive immune phenotypes for physical function. For participants with OA, future studies should account for severity of knee pain during gait assessment. If confirmed, immune phenotypes could inform care planning and suggest therapeutic targets to preserve physical function in older adults with OA or CKD.

Kartik Nath 1 , Marie Lucey 2 , Sean Clark 2 , Eric Molho 3 , Dzintra Celmins 3 , David Hart 4 , Brianna Sheldon 3 , David A Merrill 5 , Stella Panos 5 , Melita Petrossian 5,6 , Robert Gillen 7 , Cay Anderson-Hanley 1, 7 (1. Neuroscience Program, Union College, Schenectady, NY, USA; 2. Center for Balance, Mobility, & Wellness, Gordon College, Wenham, MA, USA; 3. Parkinson's Disease and Movement Disorders Center, Albany Medical Center, Albany, NY, USA; 4. Division of Community Neurology, Albany Medical Center, Albany, NY, USA; 5. Pacific Brain Health Center, Santa Monica, CA, USA; 6. Pacific Movement Disorders Center, Santa Monica, CA, USA; 7. iPACES LLC, Clifton Park, NY, USA) Background: Parkinson's Disease (PD) with mild cognitive impairment (PD-MCI) presents with heterogeneity of motor and neuropsychological outcomes (Cammisuli et al., 2019) . The interactive Physical and Cognitive Exercise (iPACES) is a neuro-exergame that combines interactive cognitive gaming with physical exercise to target executive function for patients with MCI. Prior pilot studies with MCI found promising cognitive benefits from iPACES (Anderson-Hanley et al., 2018) . Objectives: The goal was to evaluate, for PD patients, the feasibility of using a tablet-based neuro-exergame (iPACES), which is currently in clinical trial for MCI, wherein PD has been an exclusionary criteria. However, patients with PD have requested participation and clinics are searching for interventions that might meet the needs of PD-MCI. Usability of iPACES components, including the reactivity to tremor of the touch-screen interface and accessibility of the pedaler have been concerns when considering enrolling patients with movement disorders. Methods: Patients with Parkinson's from clinics in the USA, were invited to briefly pedal-n-play the iPACES neuro-exergame, herein paired with a portable underdesk elliptical pedaler. Clinic staff invited patient feedback and documented challenges encountered. Results: Fifteen patients provided feedback after iPACES pedal-n-play (ave = 11 minutes; age = 74.3, SD = 9.8, range 51-90 yrs old). Ten of 15 patients had no problems using the equipment; four needed some assistance using the touch-screen, while a few patients had difficulty keeping their feet on the pedals. Reactions ranged from "marvelous idea" and "enjoyable," to "juvenile" or "not challenging enough." A number of practical ideas were generated for improving the usability of iPACES for PD. Conclusion: The iPACES neuro-exergame was largely experienced as usable by PD patients; only a few had difficulties with the touch-screen or pedaler, suggesting a PD pilot would be feasible. Adaptations might include adding foot straps, especially salient for those with dyskinesia. A pilot study would screen for cognitive status, but even with this sample of varied abilities, no patient found it too difficult. A future clinical trial would make use of iPACES automated adaptation of mental exercises to meet the ability of the participant, while also tailoring the cognitive tasks to address deficits of PD-MCI patients.

Yasuo Suzuki 1,2 , Yasumoto Matsui 2 , Yuji Hirano 2 , Izumi Kondo 2 , Tetsuya Nemoto 2 , Masanori Tanimoto 2 , Hidenori Arai 2 (1. Nihon Fukushi University, Japan; 2. National Center for Geriatrics and Gerontology, Japan) Background: Taking the time response into consideration, we have developed a new method to measure knee extension strength and have evaluated the motor function of older patients. In addition to maximum muscle strength, the time response of knee extension should influence the determination of frailty, yet it has not been adequately examined. Objective: This study aimed to clarify the relationship between the time response of knee extension strength and the frail criteria of the Fried and Kihon Checklist (KCL). Methods: A total of 327 patients (119 men; average age: 77.5 ± 9.0 years) who visited the Integrated Healthy Aging Clinic were included in the study. We measured the following indices of knee extension strength on the left leg, which is often the axle leg of Japanese people: muscle reaction time (RT), time constant to reach maximum force (TC), rate of force development (RFD), and maximum value of the force (MVF). Using ANCOVA, we then assessed the relationship between these four indices and frailty as determined by the Fried and KCL criteria within each sex, after adjusting for age. Results: We found that MVF was greater in robust compared to frail (p≤0.001, both males and females) and pre-fail (p=0.001, females; p=0.028, males) using the Fried criteria. MVF was also greater in robust (women: p<0.001, men: p=0.027) and pre-frail (women: p=0.005) compared to frail using the KCL criteria. In women, RT was shorter in robust (p=0.029) and pre-frail (p=0.004) compared to frail only when using the KCL criteria. However, RFD was greater in robust compared to frail with both the Fried (women and men: p<0.001) and KCL (women: p=0.040, men: p=0.010) criteria and RFD was also greater in pre-frail compared to frail with the Fried (women: p=0.026, men: p=0.001) and KCL (men: p=0.017) criteria. Conclusion: In older patients, knee extension strength, indicated by the maximum muscle strength and the time response, decreases as frailty increases. The RFD could differentiate between the pre-frail and frail groups of both sexes, using the Fried and KCL criteria. The RT between frailty groups was only different in women, using the KCL criteria. Christine Lafont, Caroline Berbon, Justine de Kerimel, Céline Mathieu, Maria Soto, Bruno Vellas (CHU Toulouse-Gérontopôle, Toulouse, France) Background: ICOPE is a dependence prevention program based on the assessment and the monitoring of 6 functions (Mobility, Cognition, Psychology, Nutrition, Vision, Hearing). The target population is independent subjects aged 60 and over. In this program, the WHO recommends performing a Step1 (screening) every 6 months in order to trigger an in-depth assessment and corrective interventions as soon as impairment occurs in one or more functions. The limits of the ICOPE program lie in the need to obtain a Step1 screening test from the participants every 6 months because the repetition of the measures determines the effectiveness of the prevention approach. The Gerontopole database (CHU-Toulouse-France) linked to digital tools (ICOPE Monitor and ICOPEBOT) enabled the automatic recording of Step1 performed over a period of 22 months. Objective: Describe the follow-up of ICOPE Step1. Compare subjects who had complete follow-up (at least one Step1 every 6 months) and those who had incomplete follow-up. Deduce strategies to promote the monitoring of the ICOPE program. Method: Based on the ICOPE database (January 2020-November 2021): -Descriptive analysis of the population followed (age, sex, impaired functions); -Flow chart of Step1 follow-up; -Descriptive analysis of the subjects who received full follow-up (at least one Step1 every 6 months) according to the duration of their follow-up and their comparison (based on initial Step1) with the population who did not have full follow-up. Results: 10,903 subjects benefited from an initial Step1 (74.0±10 years, 60.8% women). Impaired functions: vision (68.1%), cognition (59.5%), hearing (50.6%), psychology (38%), mobility (34.6%), nutrition (18.7%). 2,825 participants (25.9%) had a follow-up period of 6 months, 4,354 (39.9%) a follow-up period between 6 and 11 months and 3,724 (34.2%) a follow-up period between 11 and 22 months. Among the 8,078 participants who had a follow-up period of more than 6 months, 3,931 (48.7%) benefited from a complete follow-up (at least one Step1 every 6 months) versus 4,147 (51.3%) with an incomplete follow-up. The comparative results between these two populations will be presented during the congress. Conclusion: Analysis of the profile of participants with full follow-up helps to develop strategies to support ICOPE follow-up on a larger scale.

Background: Social isolation and loneliness before and during the pandemic contribute to many physical and mental health problems. isolation and loneliness increase the risk of early death by 26 percent, and has been equated to smoking 15 cigarettes a day. To address this problem an intergenerational program was created with healthcare focused University students, known as Legacy Builders, connecting with residents in the continuum of care settings. Student training focuses on mindfulness, SMART goal-setting, growth mindset, visualization goal-setting exercises, and legacy questions. The students are prepped with listening skills skill and reminiscence therapy. Through scripted virtual encounters, students create a legacy book for older adults engaged in the program. Objective: Tellegacy's objective is to decrease a sense of isolation and loneliness, while increasing a sense of selfefficacy, connection, and resiliency in older adults. Methods: The program utilizes UCLA Loneliness Scale to assess older adult loneliness and MoCA evaluates cognitive status before and after the intervention. Results: Residents in a memory care facility, ages 58 to 86, with multiple levels of dementia participated in the program of Summer 2021. In the UCLA Loneliness Scale, 13 of the 16 residents originally reported that they feel lonely or isolated prior to starting the program. After 5 weeks we had 7 out of the 16 residents report that they felt less lonely and less isolated after participating in the group. The MoCA results displayed that the group that participated in the program had: an overall score of 11.66% improvement on scores in executive functioning, memory, attention, abstract thinking, and naming, while the residents in the placebo group had an overall decrease in score of 0.45% over 5 weeks. Conclusion: Program impact was greater than anticipated. Although a small sample, both scales of loneliness and cognition improved. Intergenerational attitudes also improved as We noted positive changes of older adult perceptions of younger students and likewise from younger students towards older adults. Furthermore, we've noted students' newly desired interest in geriatrics. Currently we are exploring how photographs integrated into reminiscence therapy to enhance older adult focus, recall more details, articulate better, and take part in deeper conversations versus encounters without photos. Background: The use of bioelectrical impedance spectroscopy (BIS) parameters to predict health outcomes has received substantial attention in recent years. Phase angle (PhA), resistance ratio (R0/RI), characteristic frequency (fc), and membrane capacitance (Cm) are considered to be important BIS parameters. However, little is known about their relationship with muscle strength and function, sedentary time, and physical activity among older adults. Objectives: This study aimed to examine the association between the BIS parameters and muscle strength and function, sedentary time and physical activity in older adults. Methods: Data of 96 older adults (79 women and 17 men) living in continuing care retirement communities (CCRCs) were used. The BIS parameters were measured using a tetrapolar impedance spectroscopy (ImpediMed SFB7) device. Handgrip strength (GS) was assessed using the JAMAR Smart Digital Hand Dynamometer and muscle function using the short physical performance battery (SPPB) and timed-up-and-go (TUG) tests. Sedentary time, light physical activity (LPA) and moderatevigorous physical activity (MVPA) were assessed using the ActiGraph wGT3X-BT. GS, SPPB, TUG, sedentary time, LPA and MVPA were compared between the low PhA (<4.4° for women and <5.2° for men) and normal PhA groups. Pearson and Spearman s linear correlations, crude and adjusted linear regression analyses were also performed. Results: GS, SPPB and LPA scores were significantly higher in the normal PhA group, and TUG scores and sedentary time were significantly lower in the normal PhA group. Three BIS parameters (PhA, R0/RI, Cm) were significantly positively correlated with GS, SPPB, and LPA, and negatively correlated with TUG and Sedentary time. The fc parameter was significantly negatively correlated with GS and LPA and positively correlated with Sedentary time. Multiple regression analyses indicated that only PhA was a significant predictor of SPPB, TUG, Sedentary time, and LPA, independent of age, sex, height, and weight. Conclusion: Our results indicate that PhA is positively associated with muscle function, which suggests that PhA can be used as an indicator of functionality in older adults. PhA is also associated with sedentary time and LPA. Research is needed to investigate whether PhA can be improved by reducing sedentary time and increasing physical activity in older adults. Background: Sarcopenia measured through body composition analysis is emerging as an important prognosticator among various malignancies, including esophageal cancer. Skeletal muscle index (SMI) as determined by the third lumbar vertebrae on cross-sectional CT images has been demonstrated as a predictor of overall survival in esophageal cancer, using pre-defined cut off values for sarcopenia. However, this is largely within the setting of resectable disease. Objectives: The primary objective of this systematic review and meta-analysis was to determine the effect of sarcopenia defined by SMI on overall-survival in patients with unresectable esophageal cancer. Methods: On January 30th, 2021, a systematic search of the literature was conducted to identify the role of SMI among patients with unresectable esophageal cancer, with overall survival as the primary outcome. Databases included MEDLINE, EMBASE, Scopus, Web of Science, and Cochrane Library. Inclusion criteria included age >18, diagnosis of esophageal cancer, and non-operative management. A meta-analysis was conducted using RevMan 5.4.1 using an inverse variance, random effects model. Results: After the removal of duplicates, 2755 unique search results were obtained. Manual screening of titles and abstracts resulted in 287 studies full text articles that were reviewed. Of these, five studies met the inclusion criteria with data evaluating the effect of sarcopenia defined by SMI on overall survival. A total of 783 patients, the majority of which were male (n=638 81%), with a mean age of 68 years +/-2.3 were included. 641 (82%) of patients were diagnosed with squamous cell carcinoma. Sarcopenia, as determined by SMI using pre-defined cut-off values, was reported in 517 patients (66%). Meta-analysis demonstrated decreased overall survival in the sarcopenia group compared to the non-sarcopenia group (HR = 1.56; 95% CI 1.21-2.00; p = 0.0006; I2=13%; Figure 1 ). Conclusion: Sarcopenia as defined by SMI is predictive of overall survival amongst patients with non-operative esophageal cancer. Further analysis on the effect of sarcopenia on treatment related adverse effects and complications, particularly related to chemotherapy, radiotherapy, and esophageal stenting is needed to identify S78 (IDF, 2005 criteria) . The study groups were comparable in terms of age and duration of the postmenopausal period. Lean and fat masses, BMD of the lumbar spine (L1-L4), trabecular bone score (TBS) were determined on dualenergy X-ray absorptiometry, "Prodigy" (Lunar, USA, 2005) . ALBM was calculated by the formula (Baumgartner R., and others 1988). The figure was considered reduced at a value <5.5 kg/m2. Data were analyzed using Statistical Package 6.0. Results: We estimated that there are no significant BMD differences between groups A and B (p>0.05) and C and D (p>0.05), but they differ in patients with normal body weight and metabolic syndrome (p<0.005). TBS value of group A was higher compared to similar indices in groups B and C (p<0.005). The regression analysis showed a significant positive relationship between BMD of the lumbar spine and total fat in groups A and B. Comparison of indices between TBS and total lean mass showed a significant negative relationship in groups A and C. It was found that ALBM was <5.5 in 23.9% of patients with normal body weight. In groups B, C, and D this figure was 2.27%; 1.41%, and 2.63%, respectively. ALBM was significantly lower (p<0.005) in patients with normal body weight compared to other groups of patients. Conclusion: ALBM is significantly worse in postmenopausal women with low-energy fractures and normal body weight. This issue needs further study. Background: Resistance training (RT) is an effective non-pharmacological strategy to sustain and even to increase skeletal muscle mass (SMM) in older adults. However, the SMM responsiveness training is largely assorted and might be influenced by older adults' nutritional status (NS). Nonetheless, there is a gap concerning the influence of NS on SMM of older adults practitioners of RT. Objectives: To investigate the influence of NS on the SMM quantity of older adults enrolled in an RT program. Methods: The sample (n: 526; 68.3% women; 69+6.8 years old) were recruited from 23.034 older adults respondents of the project "Vigilancia de Fatores de Risco e Proteçao para Doenças Cronicas por Inquérito Telefonico" (VIGITEL, Brazil), in the 2019 survey. All participants should have more than 60 years old and must engage in RT programs at least once a week for more than three months. NS was determined according to body mass index and Lipschitz classification (underweight <22kg/m 2 ; eutrophic = 22.0 -27.0kg/m 2 ; overweight >27.0kg/m 2 ). SMM was predicted by an appropriate equation (Lee et al., 2000) . The influence of NS (independent variable) on SMM (dependent variable) was verified (multiple linear regression) adjusted by confounders factors in three blocks: crude, model 1 (age, sex, and scholarly), and model 2 (same of previous, protein intake, RT frequency, alcohol and/or cigarette consumption, and diabetes). Each independent variable's magnitude was verified by the standardized coefficients (β). Results: SMM mean for each NS was 16.6+4.2kg for underweight, 20.4+4.2kg for eutrophic, and 25.4+6.5kg for overweight. All models were statistically significant to explain SMM variability (R 2 crude =0.24; SEE crude =5.4 kg; R 2 model1 =0.85; SEE model1 =2.4 kg; R 2 model2 =0.85; SEE model2 =2.4 kg). The NS was significant for all models (β crude =0.491; β model1 =0.304; and β model2 =0.300). The addition of socio demographic variables (model 1) statistically impacted the coefficient of determination (↑0.61; p<0.001), but model 2 did not (↑0.001; p=0.460). Conclusion: The findings suggest that sex, age, scholarity and NS influences the amount of SMM of older adults engaged in RT's programs. In this sense, the higher the NS, the higher the SMM, regardless of socio demographic variables. Our findings show that the response of elderly practitioners of RT to the increase in SMM is influenced by NS.

Charlotte Cottignie 1,2 , Sophie Bastijns 1,2 , Femke Ariën 1,2 , Stany Perkisas 1,2 , Anne-Marie De Cock 1,2 (1. Department of Geriatrics, Antwerp University Hospital, Belgium; 2. Academic Department of Geriatrics, ZNA Middelheim, Antwerp, Belgium) Background: Body composition parameters are associated with worse outcome in oncological patients. Rapidly expanding evidence shows that cancer patients with myosteatosis or decreased skeletal muscle mass have higher rate of chemotoxicity, lower efficacy of chemotherapy and lower survival. Objectives: The goal of this study was to evaluate the effect of myosteatosis and muscle mass on chemotoxicity and overall survival in older cancer patients. Methods In a cohort of older oncologic patients receiving active treatment with chemotherapy, myosteatosis and muscle mass were measured via muscle density (MD) and cross-sectional area (CSA) of the psoas muscle at the level of mid-L3 prior to therapy. Chemotoxicity was measured according to Common Terminology Criteria for Adverse Events (CTCAE). Mortality rates were recorded. Correlations were calculated using Pearson or Spearsman correlations. Results: In total 60 patients were included (31 male, 29 female), with mean age of 78 years (SD 4.68, range 70-88 years). Obesity defined as BMI > 25 kg/m² was observed in 43.3%. In this cohort, the main tumor types observed were of gastro-intestinal or genito-urinary origin. 44.3% of patients had metastatic disease. Chemotoxicity was noted in 54% of the patients, with most of the chemotoxicity being hematologic (62.5%). 27.3% needed hospitalisation for chemotoxicity. After three and six months, 15% and 23.3% of the patients died respectively. Myosteatosis was found in 36.7% of all patients. The mean MD was 34 HU (SD 12.2, range 10.8-80.5), the mean psoas CSA was 5.8 cm² (SD 1.9, range 1.6-11.1). No significant correlations were found between radiographic muscle parameters and chemotoxicity. However, significant negative correlations were found between myosteatosis and three and six month mortality (R-0.333, P0.009 and R-0.263, P0.042 respectively). Furthermore, weak associations were found between psoas CSA and six month mortality (R-0.285, P0.028). No significant correlations were found between chemotoxicity and mortality. Conclusions: This study demonstrates the prognostic value of baseline skeletal muscle mass and myosteatosis in older oncology patients with active chemotherapy treatment. This finding indicates the importance of taking into account radiographic muscle parameters in decision-making for starting chemotherapy treatment in older patients with cancer.

L. Lapauw 1 , J. Dupont 1,2 , L. Vercauteren 1 , N. Amini 1 , J. Raes 3 , E. Gielen 1,2 (1. Department of Public Care and Primary Health, KU Leuven, Leuven, Belgium; 2. Department of Geriatric Medicine, UZ Leuven, Leuven, Belgium; 3. Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium) Background: Healthy gut microbiota (GM) possibly play a role in muscle metabolism and physiological processes through a hypothesized gut-muscle axis, influencing muscle mass and function and thus, sarcopenia. Objectives: The Trial in Elderly with Musculoskeletal Problems due to Underlying Sarcopenia -Faeces to Unravel the Gut and Inflammation Translationally (TEMPUS-FUGIT) aims to explore the gut-muscle axis by comparing GM-composition between older individuals with and without sarcopenia. Furthermore, TEMPUS-FUGIT aims to determine, in the group of sarcopenic older individuals, associations between GM, both systemic and intestinal inflammatory markers and the sarcopenia-defining parameters (muscle mass, muscle strength and physical performance). Additionally, the effect of optimized and individualized anabolic treatment interventions for sarcopenia on GM and intestinal inflammation will be explored. Methods: First, in a cross-sectional case-control study, 100 communitydwelling healthy controls will be matched according to age-, sex and BMI to 100 participants, aged ≥65 years, from the 'Exercise and Nutrition for Healthy Ageing' (ENHANce NCT03649698) trial. ENHANce is an ongoing randomized, placebo-controlled, triple-blind, trial (RCT) exploring the effects of single/combined interventions (exercise, protein and omega-3 supplementation) in five intervention arms in older adults with sarcopenia. Sarcopenia is defined according to the European Working Group on Sarcopenia in Older People 2 (EWGSOP2). In stool samples, the intestinal inflammatory markers faecal calprotectin, lactoferrin and S100A12 will be assessed and compared between sarcopenic and non-sarcopenic individuals. Systemic inflammatory markers, being hs-CRP, IL-4, IL-6, IL-13, TNF-α and IL-1β, will be determined in fasted blood samples. Linear regression will be used to determine associations between GM, inflammatory markers and sarcopenia-defining parameters. Second, ENHANce participants will deliver five intermittent stool samples to determine longitudinal GM changes during the 12-week intervention period. Linear mixed models will be used for analysis. Ethical approval was obtained (s65127) and the trial was registered at ClinicalTrials.gov(NCT05008770). Results:

The protocol of this study is close to submission. Results are expected by 2024. Conclusions: Aiming to clarify the relationship between the gut-muscle axis and sarcopenia, an impact is expected on clinical practice. Second, TEMPUS-FUGIT will contribute to discovery of new biomarkers for sarcopenia and will possibly open future perspectives for novel sarcopenia treatment strategies targeting GM.

in particular non-alcoholic fatty liver disease (NAFLD). The presence of sarcopenia in patients with CLD is associated with a number of negative outcomes, including an increase in mortality. Despite the recognised health impacts of sarcopenia the molecular pathways which underpin the development and progression of sarcopenia in CLD and NAFLD remain unclear. Objectives: The aim of this study was to characterise intracellular signalling pathways which may underpin sarcopenia across different stages of NAFLD severity. Methods: Muscle biopsy and serum samples were obtained from 9 non-cirrhotic NAFLD (aged 61.1+9.0 years), 4 cirrhotic NAFLD (aged 51.7±8.5 years) and 12 healthy age-matched controls (CON; aged 55.7+8.7 years). Body composition and physical function tests were also completed. The muscle transcriptome was determined by RNA-sequencing using QuantSeq 3' kit (Lexogen, Austria) and sequenced on Illumina's NextSeq 500. Transcripts were mapped to the human genome, and differentially expressed transcripts (P<0.05, Fold Change>1.5), identified using Qlucore Omics Explorer v3.6 (Qlucore AB, Lund, Sweden), were analysed using Ingenuity Pathway Analysis (IPA, Qiagen, UK). Results: Hepatocyte growth factor (HGF) was significantly greater in cirrhotic NAFLD patients in comparison to both non-cirrhotic NAFLD patients and CON (P<0.02). Pathway analysis revealed a significant enrichment in canonical pathways related to cell senescence, endoplasmic stress pathway and PI3K/AKT signalling in non-cirrhotic NAFLD vs. CON. A significant enrichment of genes related to protein ubiquitination, mitochondrial dysfunction, EIF2 and p70S6K signalling was identified in cirrhotic NAFLD vs. CON. Furthermore, FOXO and TGFB1 were identified amongst the top upstream regulators of non-cirrhotic NAFLD vs. CON, while ammonium and HGF were identified amongst the top upstream regulators of cirrhotic NAFLD vs. CON. Conclusion: Distinct differences in intracellular signalling pathways may underscore sarcopenia development at different stages of NAFLD progression. These changes may be driven by an increase in inflammation and ammonia within cirrhotic NAFLD patients and stress and biological ageing processes in non-cirrhotic NAFLD patients. These findings highlight a number of potentially novel targets for therapeutic intervention. Background: Type 2 diabetes portrays a considerable strain on the global health systems, in particular for the elderly population. In recent years sarcopenia has been shown to be a frequent comorbidity of diabetes. Objectives: This review will try to elucidate the interconnected pathophysiology of both sarcopenia and diabetes and will try to identify a common pathway to explain their development. Methods: A narrative review was performed by searching PubMed and Google Scholar databases for articles published about the underlying pathophysiology of both sarcopenia and type 2 diabetes. The medical subject heading (MeSH) terms "pathophysiology" AND "sarcopenia" AND "diabetes" OR "type 2 diabetes mellitus" were used. The search was limited to the English language. Titles and abstracts were screened to select potentially relevant articles. After screening 58 papers were used. Results: Sarcopenia and type 2 diabetes share multiple pathophysiological mechanisms. Common changes in muscle architecture consist of a shift in myocyte composition, myosteatosis and decreased capacity for muscle regeneration. Both diseases are further linked to an imbalance in myokine and sex hormone production. Chronic low-grade inflammation and increased levels of oxidative stress are also known contributors to the ageing process and play a part in the development of type 2 diabetes. Possible underlying mechanisms to explain this significant overlap in pathophysiology might be found in the post-receptor insulin signaling cascade or in a reduced expression of peroxisome proliferator-activated receptor gamma coactivator 1 α on the genetic level. Conclusion:

Research efforts in the future should be aimed at discovering possible common checkpoints in the development of type 2 diabetes and sarcopenia. These checkpoints could determine new and possibly shared therapeutic targets for both diseases. Furthermore attention should be given to early diagnosis of sarcopenia within the population of type 2 diabetics given the sizeable extra physical and medical burden it encompasses. A combination of simple diagnostic techniques could be used at their regular check-ups to diagnose sarcopenia at an early stage and to start lifestyle modifications and treatment as soon as possible.

on the modifiability of sarcopenia will help determine the utility of nutritional interventions

Western Chronic Disease Alliance

BGE-105) PREVENTS DISUSE-INDUCED MUSCLE ATROPHY IN AGED MICE

Department of Research

Research utilising computed tomography (CT) body composition quantification techniques suggests that patients with higher visceral adipose tissue or skeletal mass depletion have poorer functional capacity, greater chemotherapy toxicity, increased risk of cancer progression and higher mortality. The existing research is largely based on transverse slices at the third lumbar vertebra, there is no practical reason why body composition evaluation should be limited to this one level. There is a deficiency in the literature in comparisons of variation in sarcopenia in thoracic and lumbar levels for colorectal cancer patients. Objectives: To assess the variation in skeletal muscle at vertebral levels T4, T12 and L3 in pre-op rectal cancer patients and to validate the use of the measurements at T4 and T12 in rectal cancer patients. To determine the speed and reproducibility of obtaining these measurements at the three vertebral levels. Methods: This was a retrospective cohort study using the pre-existing ACCORD database. A total of 118 adult patients with stage I -III rectal cancer, undergoing curative resection from 2010 -2014, were assessed. CT based quantification of skeletal muscle was used to determine skeletal muscle cross sectional area (CSA) and was normalised for height to obtain the skeletal muscle index (SMI). Regression analyses were performed to assess the agreement between the current gold standard measurements at L3 with T4 and T12 vertebral levels. Results: In total, 80 of 118 patients were enrolled. The mean age was 63.0 + 13 years. The R-square correlation were 0.66 and 0.54 for T4 CSA and SMI respectively, and 0.79 and 0.73 for Th12. Conclusion: Our study demonstrated that differences exist between differing vertebrae level readings nevertheless quantifying sarcopenia at different levels is straightforward, reproducible, and reliable. Measures, especially at T12 are comparable to the measures achieved at L3. Key words: Skeletal muscle mass, T4, T12, Computed tomography, Sarcopenia.

Shuji Sawada 1,2 , Kei Suzuki 2 , Hisashi Naito 1 , Shuichi Machida 1 (1. Juntendo University, Chiba, Japan; 2. Suzuki Kei Yasuragi Clinic, Tokyo, Japan) Background: There is no common index for assessing frailty, sarcopenia, and locomotive syndrome (LS) severity. The phase angle (PhA) is a bioimpedance measurement that determines lean body mass and hydration status. Objectives: We aimed to determine whether the PhA can be a useful and common biomarker for assessing the severity of frailty, sarcopenia, and LS. Methods: A total of 247 Japanese participants (203 women aged 65-93 years and 44 men aged 67-86 years) volunteered to participate in this study. Each participant completed a physical performance test, which included a frailty, sarcopenia, and LS evaluation. To evaluate frailty, we assessed five variables, based on the 2020 revision of the Japanese version of the Cardiovascular Health Study, which included unintentional weight loss, selfreported exhaustion, low physical activity, weakness (low handgrip strength), and slowness (low walking speed). To evaluate sarcopenia, based on the recommendation of the Asian Working Group for Sarcopenia 2019 consensus, we measured handgrip strength, walking speed, and skeletal muscle mass. To evaluate LS, we used three tests proposed by the Japanese Orthopaedic Association; the two-step test, stand-up test, and 25-question geriatric locomotive function scale. Body composition was measured with bioimpedance analysis using the Body Composition Analyzer InBody 770 (InBody Co., Ltd., Seoul, Korea) and we calculated body mass index (BMI), skeletal muscle mass index (SMI), and PhA. We assessed the characteristics of these parameters at each stage of frailty [robust, pre-frailty, frailty], sarcopenia [non-sarcopenia, sarcopenia, severe sarcopenia], and LS [non-LS, LS-1, LS-2, LS-3]. The data were analyzed using Jonckheere-Terpstra trend test. Results: BMI and SMI showed significant decline based on sarcopenia severity (p < 0.001), but not on frailty and LS severity. In contrast, the PhA showed significant decline based on frailty, sarcopenia, and LS severity (p < 0.001). Additionally, to compare these disease states based on the PhA, the severities were listed as follows: non-LS > robust > LS-1 > non-sarcopenia > LS-2 > pre-frailty > frailty > sarcopenia > LS-3 > severe-sarcopenia (p < 0.001). Conclusion: The PhA can be a useful and common biomarker for assessing the severity of frailty, sarcopenia, and LS.Background: As we age our muscles atrophy due to a variety of factors including disuse. The term "use it or lose it" couldn't ring more true! Apelin is an exerkine produced and secreted from skeletal muscle during exercise and has been shown to activate key pathways that benefit skeletal muscle physiology. Apelin is an agonist of the APJ receptor, a G protein-coupled receptor (GPCR), that activates biological processes such as protein synthesis, mitochondrial biogenesis, and myogenesis which play pivotal roles in regulating muscle mass. Objective: Apelin exhibits poor drug-like properties since it must be administered intravenously and has a short half-life in blood. Hence, it was essential to discover and characterize an orally available small molecule apelin mimetic that acts as an APJ agonist. Preclinical validation of BGE-105 as an apelin mimetic capable of preventing muscle atrophy induced by disuse in aged animals. Methods: Aged mice were orally administered vehicle or BGE-105 at 50 mg/kg twice daily and one week into treatment, the right hindlimb was immobilized by casting and the muscles were allowed to atrophy over 3 weeks. When the cast was removed the muscles were weighted and the percentage atrophy was calculated by comparing the casted limb to the un-casted contralateral limb. The muscles were flash frozen and molecular analysis was performed to measure the relative expression levels of the APJ receptor via western blot. Results: -BGE-105 was able to significantly rescue muscle atrophy in the tibialis anterior (TA) and the extensor digitorum longus (EDL) after 3 weeks of immobilization; -Data is trending in the right direction for soleus with a 5% effect; -No effect was observed in the gastrocnemius; APJ expression is significantly lower in the gastrocnemius compare to the other muscle types, potentially explaining the lack of effect observed when treated with BGE-105. Conclusions: BGE-105 is able to significantly rescue muscle atrophy during disuse in aged animals and is a promising candidate for the treatment of frailty and sarcopenia.

The association between dementia and sarcopenia is unclear. Objectives: To clarify the relationship between dementia and the mass and quality of the quadriceps muscle, measured using mid-thigh computed tomography (CT). Methods: The subjects were 335 women (mean age 76.1±7.3 years) visiting the Integrated Healthy Aging Clinic. From the CT, the cross-sectional area (CSA) and CT values of the rectus femoris (R), vastus medialis (M), vastus lateralis (L), vastus intermedius (I) and the sum of four muscles (Sum) were measured using image analyzing software. The patients were classified into three groups: normal, mild cognitive impairment (MCI), and dementia using the Mini-Mental State Exam. Average values were compared among the groups using the analysis of variance. Results: The average CSAs (cm2) for R in the normal, MCI, and dementia groups were 4.65, 4.37, 3.98; for M, 6.89, 6.44, and 5.97; for L, 11.9, 11.2, and 10.3; for I, 11.8, 11.5, and 10.0; and for Sum, 35.2, 33.5, and 30.3, respectively. Between the normal and dementia groups, there were significant differences in all 4 muscles and the Sum(all:p<0.01, except for M:p=0.01). Between the MCI and dementia groups, the I, and the Sum showed significant differences (both p<0.05). Between the normal and MCI groups, nearly significant difference (p=0.081) was observed in M. The average CT values (Hounsfield unit) were 49. 1, 47.8, and 45.7 for R; 45.9, 44.1, and 45.4 for M; 42.7, 41.6, and 40.7 for L; 46.2, 45.1, and 43.3 for I; and 45.4, 44.2, and 43.2 for the Sum, respectively. Between the normal and dementia groups, significant and nearly significant differences occurred in R and I, (p<0.01, p=0.07, respectively). Conclusion: In the dementia group, compared to the normal group, the quadriceps CSA was lower in all muscles; compared to the MCI group, it was lower in I. Muscle quality was also lower in R and I. Quantitative and qualitative decline of the quadriceps muscle was observed in the dementia group; the degree of decline differed among the muscles. Zurich and University Hospital Zurich, Zurich, Switzerland; 3. Cantonal Hospital Graubünden, Chur, Switzerland) Background: From the multitude of routine medical laboratory assays, a potentially meaningful set of assays needs to be assembled aimed to best reflect sarcopenia in older adults or to define risk factors for amyotrophia in paralyzed younger individuals. Ill-known to good medical care such myocyte-related analytes as calpain, C-terminal agrin, 3-methylhistidine or cathepsin L genotype on FoxO3, blood plasma titin, urinary titin n-terminal fragment concentration (UTF), extent of DNA methylation and mitochondrial health may qualify; save titin and its fragments, these compounds are far from allowing quantitative estimation of sarcopenia and they have not been included on the test list of neither DO HEALTH nor SENIORLABOR studies performed with healthy elderly individuals: whereas DO HEALTH recruited 2157 adults age 70 years and older from 5 European countries (1006 from Switzerland), the observational SENIORLABOR study included 1,467 healthy senior adults >60 years of age from the Swiss midlands. Current efforts on diagnosing agerelated sarcopenia are largely limited to routine medical clinical parameters such as dual Energy X-ray Absorptiometry (DEXA) or bioimpedance, and functional tests such as gait speed and grip strength. However, in order to motivate drug development in the treatment of the now ICD-classified sarcopenia, novel diagnostic tools that quantitate remaining muscular functional capacity, muscle mass including its metabolic rate at rest, are needed. In a model adjusted for sex, age, treatment, and complications, surrogate-marker myoglobin above 60 µg/L may represent a hazard ratio (HR) of 2 for bed ridden status; an even lower myoglobin serum concentration 50 µg/L may become associated with an increase in mortality odds. Titin, also known as connectin, an abundant muscle protein along with myosin and actin, and found in circulating blood currently sees convenient quantitative lab techniques being developed, some of them using MALDI TOF and ELISA combined to measure plasma concentrations in the µg/L range. Warmblooded marmot, turtles, bears, squirrels, lemurs, chipmunks, mice, groundhogs and lizards, knowing how to preserve their muscles while hibernating, wake up in spring with most of their muscles as they went sleep. Biomarkers of sarcopenia hence need to include basic metabolic measures, e.g. glycemia, hemoglobin, myoglobin, leucine, 25-hydroxyvitamin-D, ACEinhibitors (perindopril) Background: Muscle ultrasound is on its way to become an important measurement tool for sarcopenia, but the absence of standardized measurement techniques still limits its use in clinical practice. Objectives: The goal of this study was to perform a proposed measurement protocol for ultrasound of the biceps brachii (BB) on healthy subjects of all ages. Ultrasound parameters were correlated to bio-electrical impedance analysis (BIA) and hand grip strength (HGS), both validated instruments to examine sarcopenia. Methods: Using ultrasound, the BB of the dominant arm was examined for muscle thickness (MT) and cross-sectional area (CSA), at 75% (distally) of the distance between the acromioclavicular joint and elbow crease. Subjects lay supine, with their arm in a neutral position. Afterwards, muscle mass (MM) and phase angle (PhA) were measured using BIA, and HGS was measured using a Jamar dynamometer. Correlations were calculated using Pearson correlation tests (PCC). Results: In total, one-hundredtwenty-three subjects (51 males, 72 females), aged 18 to 69, were included. MT and CSA measured by ultrasound showed significant positive correlations with MM (PCC respectively 0.787 and 0.841), PhA (PCC respectively 0.688 and 0.714) and HGS (PCC respectively 0,709 and 0,808). Conclusion: Ultrasonographic measurements of MT and CSA correlate strongly with MM, PhA and HGS, which helps to validate the proposed measurement protocol for ultrasound of the BB. The findings also support muscle ultrasound as a promising technique in the light of implementing an available and inexpensive diagnostic tool for sarcopenia.