Giuseppe Bellelli1, Antonella Zambon2, Stefano Volpato3, Pasquale Abete4, Lara Bianchi3, Mario Bo5, Antonio Cherubini6, Francesco Corica7, Mauro Di Bari8, Marcello Maggio9, Giovanna Maria Manca10, Maria Rosaria Rizzo11, Andrea Rossi12, Francesco Landi13. 1. School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy; Geriatric Unit, S. Gerardo Hospital, Monza, Italy. Electronic address: giuseppe.bellelli@unimib.it. 2. Department of Statistics and Quantitative Methods, Unit of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milano, Italy. 3. Department of Medical Science, University of Ferrara, Italy. 4. Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy. 5. Struttura Complessa Dipartimento Universitario Geriatria e Malattie Metaboliche dell'Osso, Città della Salute e della Scienza, Torino, Italy. 6. Geriatrics and Emergency Care, Italian National Research Centre on Aging, Ancona, Italy. 7. Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy. 8. Research Unit of Medicine of Aging, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Geriatric Intensive Care Unit, Department of Geriatrics and Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. 9. Department of Clinical and Experimental Medicine, Geriatric Rehabilitation Department, University of Parma, Parma, Italy. 10. UOC di Geriatria Ospedale SS, Trinità ASL 8, Cagliari, Italy. 11. Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Italy. 12. Department of Medicine, Geriatrics Division, University of Verona, Verona, Italy. 13. Department of Geriatrics, Neurosciences and Orthopaedics, Catholic University of the Sacred Heart, Rome, Italy.
Abstract
BACKGROUND & AIMS: To date, studies assessing the relationship between sarcopenia and delirium, two of the most common geriatric syndromes, are lacking. We sought to explore this association by investigating the co-occurrence of these two conditions and the independent association between them in a population of hospitalized older adults. METHODS: Cross-sectional multicenter analysis of older adults consecutively admitted to 12 acute geriatric units (AGUs). Sarcopenia was assessed upon admission by evaluating the presence of low skeletal mass index (kg/m2), and either low handgrip strength or low walking speed (European Working Group on Sarcopenia in Older People, EWGSOP criteria). Skeletal muscle mass was estimated using bioimpedance analysis. Participants underwent a comprehensive geriatric assessment upon admission; information concerning demographics, cognition (Short Portable Status Mental Questionnaire, SPMSQ) functional (Instrumental Activities of Daily Living, IADL and Basic-Activities of Daily Living, BADL), and health status (Charlson Index and specific diseases) was evaluated. The presence of delirium upon admission was ascertained as an explicit clinical diagnosis recorded by the researcher of each centre on the data form. All association estimates were reported as Prevalence Ratios (PRs) and 95% confidence intervals (CIs), using a Cox hazard proportional regression model with robust variance and constant time. RESULTS: Of the 588 analyzed patients (mean age = 80.9 ± 6.8, 53.2% females), 199 (33.8%) had sarcopenia upon admission to the AGU. According to a multivariable Cox regression, delirium upon admission (PR 1.66, 95% CI: 1.12-2.45), IADL total score (PR 0.93, 95% CI: 0.87-0.98), Body Mass Index values (BMI) ranging from 18.5 to 25.0 (PR 1.70, 95% CI: 1.33-2.18), BMI values >18.5 (PR 2.53, 95% CI: 1.81-3.53), previous stroke (PR 1.51, 95% CI: 1.10-2.07) and chronic heart failure (CHF) (PR 1.31, 95% CI: 1.02-1.68) were significantly and independently associated with sarcopenia upon admission to the AGU. CONCLUSION: The study, carried out in a population of hospitalized older patients, shows that a diagnosis of delirium upon admission to the AGU was more frequent in those with sarcopenia than in others. Furthermore, the study found that delirium was independently associated with the risk of being sarcopenic upon admission to the AGU. Future studies are needed to confirm this association.
BACKGROUND & AIMS: To date, studies assessing the relationship between sarcopenia and delirium, two of the most common geriatric syndromes, are lacking. We sought to explore this association by investigating the co-occurrence of these two conditions and the independent association between them in a population of hospitalized older adults. METHODS: Cross-sectional multicenter analysis of older adults consecutively admitted to 12 acute geriatric units (AGUs). Sarcopenia was assessed upon admission by evaluating the presence of low skeletal mass index (kg/m2), and either low handgrip strength or low walking speed (European Working Group on Sarcopenia in Older People, EWGSOP criteria). Skeletal muscle mass was estimated using bioimpedance analysis. Participants underwent a comprehensive geriatric assessment upon admission; information concerning demographics, cognition (Short Portable Status Mental Questionnaire, SPMSQ) functional (Instrumental Activities of Daily Living, IADL and Basic-Activities of Daily Living, BADL), and health status (Charlson Index and specific diseases) was evaluated. The presence of delirium upon admission was ascertained as an explicit clinical diagnosis recorded by the researcher of each centre on the data form. All association estimates were reported as Prevalence Ratios (PRs) and 95% confidence intervals (CIs), using a Cox hazard proportional regression model with robust variance and constant time. RESULTS: Of the 588 analyzed patients (mean age = 80.9 ± 6.8, 53.2% females), 199 (33.8%) had sarcopenia upon admission to the AGU. According to a multivariable Cox regression, delirium upon admission (PR 1.66, 95% CI: 1.12-2.45), IADL total score (PR 0.93, 95% CI: 0.87-0.98), Body Mass Index values (BMI) ranging from 18.5 to 25.0 (PR 1.70, 95% CI: 1.33-2.18), BMI values >18.5 (PR 2.53, 95% CI: 1.81-3.53), previous stroke (PR 1.51, 95% CI: 1.10-2.07) and chronic heart failure (CHF) (PR 1.31, 95% CI: 1.02-1.68) were significantly and independently associated with sarcopenia upon admission to the AGU. CONCLUSION: The study, carried out in a population of hospitalized older patients, shows that a diagnosis of delirium upon admission to the AGU was more frequent in those with sarcopenia than in others. Furthermore, the study found that delirium was independently associated with the risk of being sarcopenic upon admission to the AGU. Future studies are needed to confirm this association.
Authors: Alberto Zucchelli; F Manzoni; A Marengoni; G Bellelli; A Morandi; S Di Santo; E Rossi; M G Valsecchi; M Inzitari; A Cherubini; M Bo; E Mossello Journal: Aging Clin Exp Res Date: 2021-08-20 Impact factor: 3.636