This study evaluated a modified, timed version of the "Get-Up and Go" Test (Mathias et al, 1986) in 60 patients referred to a Geriatric Day Hospital (mean age 79.5 years). The patient is observed and timed while he rises from an arm chair, walks 3 meters, turns, walks back, and sits down again. The results indicate that the time score is (1) reliable (inter-rater and intra-rater); (2) correlates well with log-transformed scores on the Berg Balance Scale (r = -0.81), gait speed (r = -0.61) and Barthel Index of ADL (r = -0.78); and (3) appears to predict the patient's ability to go outside alone safely. These data suggest that the timed "Up & Go" test is a reliable and valid test for quantifying functional mobility that may also be useful in following clinical change over time. The test is quick, requires no special equipment or training, and is easily included as part of the routine medical examination.

The Timed “Up & Go”: A Test of Basic Functional Mobility for Frail Elderly Persons

http://www.klinikaikozpont.u-szeged.hu/pedia/images/pdf/CME_TEL/Full-Text/25.pdf

The Hallmarks of Aging

The European Working Group on Sarcopenia in Older People (EWGSOP) developed a practical clinical definition and consensus diagnostic criteria for age-related sarcopenia. EWGSOP included representatives from four participant organisations, i.e. the European Geriatric Medicine Society, the European Society for Clinical Nutrition and Metabolism, the International Association of Gerontology and Geriatrics-European Region and the International Association of Nutrition and Aging. These organisations endorsed the findings in the final document. The group met and addressed the following questions, using the medical literature to build evidence-based answers: (i) What is sarcopenia? (ii) What parameters define sarcopenia? (iii) What variables reflect these parameters, and what measurement tools and cut-off points can be used? (iv) How does sarcopenia relate to cachexia, frailty and sarcopenic obesity? For the diagnosis of sarcopenia, EWGSOP recommends using the presence of both low muscle mass + low muscle function (strength or performance). EWGSOP variously applies these characteristics to further define conceptual stages as 'presarcopenia', 'sarcopenia' and 'severe sarcopenia'. EWGSOP reviewed a wide range of tools that can be used to measure the specific variables of muscle mass, muscle strength and physical performance. Our paper summarises currently available data defining sarcopenia cut-off points by age and gender; suggests an algorithm for sarcopenia case finding in older individuals based on measurements of gait speed, grip strength and muscle mass; and presents a list of suggested primary and secondary outcome domains for research. Once an operational definition of sarcopenia is adopted and included in the mainstream of comprehensive geriatric assessment, the next steps are to define the natural course of sarcopenia and to develop and define effective treatment.

/pdf/sarcopenia-european-consensus-on-definition-and-diagnosis-2axty2moc3.pdf

Sarcopenia: European consensus on definition and diagnosis Report of the European Working Group on Sarcopenia in Older People

Genome-wide association studies have identified hundreds of genetic variants associated with complex human diseases and traits, and have provided valuable insights into their genetic architecture. Most variants identified so far confer relatively small increments in risk, and explain only a small proportion of familial clustering, leading many to question how the remaining, 'missing' heritability can be explained. Here we examine potential sources of missing heritability and propose research strategies, including and extending beyond current genome-wide association approaches, to illuminate the genetics of complex diseases and enhance its potential to enable effective disease prevention or treatment.

/pdf/finding-the-missing-heritability-of-complex-diseases-3b6mbqztnq.pdf

Finding the missing heritability of complex diseases

Recent scientific work has established both a theoretical basis and strong empirical evidence for a causal impact of social relationships on health. Prospective studies, which control for baseline health status, consistently show increased risk of death among persons with a low quantity, and sometimes low quality, of social relationships. Experimental and quasi-experimental studies of humans and animals also suggest that social isolation is a major risk factor for mortality from widely varying causes. The mechanisms through which social relationships affect health and the factors that promote or inhibit the development and maintenance of social relationships remain to be explored.

https://science.sciencemag.org/content/sci/241/4865/540.full.pdf

Social relationships and health.

enteral formulae is not uncommon. We report a case of an elderly woman whose serum phenytoin level was markedly depressedduring concomitant administration of Osmolite. An 80-year-old woman was hospitalized with a right hemispheric cerebral infarct. Examination demonstrated stupor and a left hemiparesis. An EEG revealed status epilepticus and she received intravenous loading of phenytoin followed by a maintenance dose of 400 mg daily through a nasogastric tube, resulting in a serum level of 18.7 mcg/mL (therapeutic:lO-20 mcg/mL). Her mental status improved. Due to poor oral intake, Osmolite feeding via nasogastric tube at 50 cc/hr was begun on the sixth hospital day. Over the next four days, this was increased to 100 cc/hr for 16 hours a day. On the tenth day, the serum phenytoin level was 9.3 mcg/mL. A new loading dose of 800 mg phenytoin was given via the tube in two portions and the daily dose was increased to 500 mg. On the 12th day, the phenytoin level was 5 mcg/mL. The patient received 1000 mg orally in two portions but only had a level of 9.8 mcg/mL the next morning. On the 13th and 14th hospital days, she received 500 mg of phenytoin daily. Simultaneously, her Osmolite was discontinued and a pureed diet begun. On the 25th day, the serum phenytoin level was 13.3 mcg/mL and remained in therapeutic range thereafter without further dosage alterations. The patient was receiving no medications known to depress phenytoin levels. Phenytoin has a narrow therapeutic index. One reason for the difficulty in maintaining therapeutic levels may be an interaction between orally administered phenytoin and enteral feeding preparations. This was 6rst noted by Baur' in young head trauma patients whose phenytoin dose requirement plummeted when enteral feedings were discontinued. A postulated mechanism for this interaction is binding of phenytoin to calcium caseinate or magnesium present in complete diet formulae, rendering the drug unavailable for absorbtion.2 Hypoalbuminemia, frequently seen in patients who receive enteral formulae, can lead to a decline in total serum phenytoin levels but does not explain this apparent drug-nutrient interaction, as a similar decline in serum phenytoin levels has been noted in patients with normal albumin.3 No data exist as to the incidence of this drug-nutrient interaction. A review of common reference sources failed to reveal mention of the interaction. There are a few case report^.^-^ The interaction is clearly important, since subtherapeutic levels may result during enteral feeding and toxic levels may appear after withdrawal. Monitoring of serum levels and alert adjustment in dosage are necessary.

Jack M. Guralnik

Papers

Direct Assessment of ADL in Alzheimer's Disease

Response to Dr. Paul Drinka