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.

This commentary discusses how health economic techniques can usefully be applied to inform clinical and policy decision making in the aged care sector from two perspectives: firstly, in relation to the measurement and valuation of the costs and benefits of new and existing health care technologies and modes of aged care service delivery and secondly, in relation to the facilitation of autonomy and patient choice.

Drug-related problems in older people during care transitions have become a major public health problem since they threaten patient safety. The objective of our paper is to investigate the extent and frequency of drug-related problems (discontinuity, adherence, errors, interactions and adverse events) after hospital discharge and the efficacy of interventions intended to reduce them. We included 20 studies in the review. All of them underlined the high frequency and complexity of drug-related problems in older people after hospital discharge. Interventions proposed to improve care transitions led to diverse and sometimes contradictory results, but the findings suggested that combining hospital discharge measures with home follow-up strategies is of value. We conclude that it is not possible to estimate the frequency of drug-related problem through a review of selected articles or to evaluate the efficacy of the proposed interventions. More research is needed in this field to reduce uncertainty and generate evidence-based recommendations for physicians.

We present a case report of an 86-year-old lady with pubic ramus and sacral insufficiency fractures who developed extra-vesical bladder rupture following displacement of the pubic ramus fracture, a very unusual complication.

Background: depression is common in elderly people and may be associated with increased cardiovascular risk and incident dementia.

Method: participants in the Hypertension in the Very Elderly Trial (HYVET) completed a depression screening instrument, the Geriatric Depression Score (GDS), at baseline and annually. We examined the association of GDS score with incident stroke, mortality and dementia using Cox proportional hazards models (hazard ratios, HR and 95% confidence intervals, CI) adjusted for treatment group and other potential confounders.

Results: 2,656 HYVET participants completed the GDS. The mean follow-up was 2.1 years. A GDS score ≥6 was associated with increased risks of all-cause (HR 1.8, 95% CI 1.4–2.3) and cardiovascular mortality (HR 2.10, 95% CI 1.5–3.0), all stroke (HR 1.8, 95% CI 1.2–2.8) and all cardiovascular events (HR 1.6, 95% CI 1.2–2.1). Risk of incident dementia also tended to be increased (HR 1.28, 95% CI 0.95–1.73). Each additional GDS point at baseline also gave rise to a significantly increased risk of fatal and non-fatal cardiovascular events, all-cause mortality and dementia.

Conclusion: there was a strong association between baseline depression scores and later fatal and non-fatal cardiovascular endpoints over a mean follow-up of 2 years in a hypertensive very elderly group. The mechanism of this association warrants further study.

Background: self-reported body mass index (BMI) based on self-reported height and weight is a widely used measure of adiposity in epidemiological research. Knowledge about the accuracy of these measures in late life is scarce.

Objective: the study aimed to evaluate the accuracy and changes in accuracy of self-reported height, weight and BMI calculated from self-reported height and weight in late life.

Design: a longitudinal population-based study with five times of follow-up was conducted.

Participants: seven hundred seventy-four community-living men and women, aged 40–88 at baseline (mean age 63.9), included in The Swedish Adoption/Twin Study of Aging.

Methods: participants self-reported their height and weight in a questionnaire, and height and weight were measured by experienced research nurses at an in-person testing five times during a 20-year period. BMI was calculated as weight (kilogramme)/height (metre)².

Results: latent growth curve modelling showed an increase in the mean difference between self-reported and measured values over time for height (0.038 cm/year) and BMI (0.016 kg/m²/year), but not for weight.

Conclusions: there is a very small increase in the mean difference between self-reported and measured BMI with ageing, which probably would not affect the results when self-reported BMI is used as a continuous variable in longitudinal studies.

Objective: this analysis was to investigate the effects of dehydroepiandrosterone (DHEA) on cardiovascular risk factors in older women with frailty characteristics.

Design, setting and participants: the study was a double-blind, randomised, placebo-controlled trial of 99 women (mean 76.6 ± 6.0 year) with the low DHEA-S level and frailty.

Intervention: participants received 50 mg/day DHEA or placebo for 6 months; all received calcium (1,000–1,200 mg/day diet) and supplement (combined) and cholecalciferol (1,000 IU/day). Women participated in 90-min twice weekly exercise regimens, either chair aerobics or yoga.

Main outcome measures: assessment of outcome variables included hormone levels (DHEA-S, oestradiol, oestrone, testosterone and sex hormone-binding globulin (SHBG)), lipid profiles (total cholesterol, high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol and triglycerides), body composition measured by dual energy absorptiometry, glucose levels and blood pressure (BP).

Results: eighty-seven women (88%) completed 6 months of study; 88% were pre-frail demonstrating 1–2 frailty characteristics and 12% were frail with ≥3 characteristics. There were significant changes in all hormone levels including DHEA-S, oestradiol, oestrone and testosterone and a decline in SHBG levels in those taking DHEA supplements. In spite of changes in hormone levels, there were no significant changes in cardiovascular risk factors including lipid profiles, body or abdominal fat, fasting glucose or BP.

Conclusion: research to date has not shown consistent effects of DHEA on cardiovascular risk, and this study adds to the literature that short-term therapy with DHEA is safe for older women in relation to cardiovascular risk factors. This study is novel in that we recruited women with evidence of physical frailty.

Objective: the aim of this study is to estimate the cross-sectional and longitudinal impact of hearing loss on use of community support services and reliance on non-spouse family/friends among older people.

Methods: Blue Mountains Hearing Study participants (n = 2,956) were assessed for hearing impairment by audiologists in sound-treated booths. Participants were classified as hearing impaired if PTA_{0.5–4 kHz} >25 dB HL. Use of services and non-spouse family/friend support was assessed cross-sectionally. Incident use was assessed among survivors at the 5-year follow-up (n = 1,457).

Results: a significant cross-sectional association between hearing loss (>25 dB HL) and use of community support services was observed after adjusting for age, sex, living status, self-rated poor health, self-reported hospital admissions, disability in walking and best-corrected visual impairment [odds ratio (OR) 2.12, 95% confidence interval (CI) 1.15–3.90]. Participants with hearing loss who never used a hearing aid were twice as likely to use formal supports as participants without hearing loss (multivariate-adjusted OR 2.25, 95% CI 1.19–4.24). Hearing loss increased the incident need for non-spouse family/friend support or community services (multivariate-adjusted OR 1.49, 95% CI 1.02–2.18).

Conclusions: after adjusting for confounding factors, hearing impairment negatively impacted on the independence of older persons by increasing reliance on community or family support.

Background: vasovagal syncope (VVS) has been diagnosed with increasing frequency in older people since the description of the head-up tilt table test (HUTT). There is, however, a paucity of research describing the clinical features of VVS in this group. To address this issue, we investigated the age distribution and differences in clinical characteristics associated with age in patients diagnosed with VVS by HUTT at our tertiary referral centre.

Methods: 1,060 consecutive patients with tilt-positive VVS were identified from a prospective database containing the demographic and clinical information of individuals assessed in our unit over a 10-year period. VVS was diagnosed with appropriate haemodynamic changes during HUTT and accompanying symptom reproduction.

Results: we found a bimodal age distribution with a small peak at 20–29 years and a larger peak at 70–79 years. Patients aged ≥60 years were less likely to report total loss of consciousness [odds ratio (OR) 0.50, 95% confidence interval (CI) = 0.38–0.64], near loss of consciousness (OR 0.53, 95% CI = 0.40–0.70) or palpitations (OR 0.45, 95% CI = 0.28–0.72) and more likely to present with unexplained falls (OR 2.33, 95% CI = 1.36–4.32). The typical provoking factors of prolonged standing (OR 0.55, 95% CI = 0.40–0.72), posture change (OR 0.61, 95% CI = 0.46–0.82) and hot environments (OR 0.57, 95% CI = 0.42–0.78) were also less common in older patients.

Conclusion: in our large study population, VVS was more common in older patients. The clinical presentation differed significantly between the two groups. Older patients were less likely to give a typical history and therefore clinicians need to have a high index of suspicion when evaluating the older patient presenting with collapse or unexplained falls.

Objective: To investigate the hypotheses that delirium affects the most vulnerable older adults and is associated with long term adverse health outcome.

Design: Prospective, cohort study.

Setting and Participants: 278 medical patients aged 75 years and over admitted acutely to a district general hospital in South Wales.

Measurements: Patients were screened for delirium at presentation and on alternate days throughout their hospital stay. Assessments also included illness severity, preadmission cognition, co-morbidity and functional status. Patients were followed for 5 years to determine rates of institutionalization and mortality. Number of days in hospital in the 4 years prior to and 5 years after index admission were recorded.

Results: Delirium was detected in 103 patients and excluded in 175. Median time to death was 162 days [Interquartile range (IQR) 21-556] for those with delirium compared to 1444 days (25% mortality 435 days, 75% mortality >5 years) for those without (P<0.001). After adjustment for multiple confounders, delirium was associated with an increased risk of death [hazard ratio range 2.0-3.5; P ≤0.002]. Institutionalisation was higher in the first year following delirium (P=0.03). While those with delirium tended to be older with more preadmission cognitive impairment, greater functional dependency and more co-morbidity, they did not spend more days in hospital in the 4 years prior to index admission.

Conclusions: Delirium is associated with high rates of institutionalization and an increased risk of death up to five years after index event. Prior to delirium, individuals seem to compensate for their vulnerability. The impact of delirium itself, directly or indirectly, may convert vulnerability into adverse outcome.

Background: dementia and visual impairment are common in older adults, and both conditions create a high risk of disability. Care professionals lack evidence on how best to support older adults with both conditions.

Objective: the study investigated attitudes towards working with older adults with concurrent sight loss and dementia, the challenges involved and suggestions for service development.

Methods: a qualitative study was conducted comprising 18 in-depth interviews and two focus groups with care professionals within mental health and low vision services.

Results: care professionals were alert to the high levels of risk among patients with joint sight loss and dementia. In-depth interviews revealed that insufficient time and expertise can lead to an overcautious approach that prioritises the reduction of risk rather than the promotion of independence. Focus groups highlighted the role that joint working can play in supporting older adults’ valued roles and activities. Barriers to joint working were identified alongside strategies to assist the process.

Conclusion: it is essential that care professionals and service providers acknowledge and respond to the complex needs of this population. Joint working was considered key to assessing risks and targeting interventions. The research workshop presented here provides a useful format for improving practice across inter-professional boundaries.

Purpose: health-related quality of life (HRQOL) is an important psycho-social characteristic which may impact an individual’s ability to manage their chronic disease. We examined the association between HRQOL and antihypertensive medication adherence in older adults.

Methods: participants were part of a cohort study of older adults enrolled in a managed care organisation and treated for hypertension (n = 2,180). Physical and Mental Component Summary Scores (PCS and MCS) of HRQOL were assessed using the RAND Medical Outcomes Study 36-item tool. Adherence to antihypertensive medication was assessed with the eight-item Morisky Medication Adherence Scale.

Results: the mean age of participants was 75.0 ± 5.6 years, 69.3% were white, 58.5% were women and 14.1% had low antihypertensive medication adherence. Low HRQOL scores were associated with lower levels of antihypertensive medication adherence in older adults. After adjustment for covariates, those with low PCS and MCS scores were 1.33 (95% CI 1.01, 1.74) and 2.26 (95% CI 1.74, 2.97) times more likely, respectively, to have low antihypertensive medication adherence than those with PCS and MCS scores in the top 2 tertiles.

Conclusions: low HRQOL may be an important barrier to achieving high medication adherence.

Objectives: the study aimed to examine the prevalence of comorbidity, the prescribing of potentially inappropriate medications and treatment conflicts in a large sample of older people who have been dispensed an antidepressant medicine.

Methods: a cross-sectional study of administrative claims data from the Department of Veterans’ Affairs, Australia, 1 April–31 July 2007, of veterans aged ≥65 years was conducted. Comorbidities determined using the pharmaceutical-based comorbidity index, Rx-Risk-V. Concomitant medicines that may be potentially inappropriate for patients with depression and areas of treatment conflicts were determined from Australian clinical guidelines or reference compendia.

Results: a total of 39,695 subjects were included, with a median of 5 comorbid conditions (inter-quartile range 3–6). Ninety percent of medicine use was attributed to the treatment of comorbid conditions. Eighty-seven percent of the study cohort was identified as having at least one comorbid condition that may cause a potential treatment conflict when an antidepressant is used. Those conditions of most concern included cardiovascular diseases, anxiety disorders, arthritis or pain management and osteoporosis.

Conclusion: we observed a high level of potentially inappropriate prescribing and treatment conflicts that may arise when caring for older patients dispensed an antidepressant with comorbidity. These have the potential to place a large number of older people with depression at increased risk for adverse events.

A case of yellow nail syndrome in an 88-year-old man in association with renal cell carcinoma was reported.