Sarcopenia is a growing problem, especially in nursing care. It is therefore mandatory to integrate measures such as resistance training to maintain muscle strength into nursing care. The aim of this study was to investigate the acceptance and feasibility of a novel training algorithm in a nursing home environment. Furthermore, the reliability of measurements for the diagnosis of sarcopenia was tested in the nursing home setting. Twenty-eight nursing home residents took part in the study, which encompassed two pre- and two post-examinations and a four-week training intervention. The training sessions were documented with regard to acceptance and feasibility as well as training motivation and intensity. A combined acceptance and feasibility of at least 54

Half of all people aged 65 years and over who fall cannot free themselves from the fall situation, have to wait for help and suffer a long lie. Those affected have an increased risk of restricting the daily activities, becoming increasingly dependent and moving into a nursing home within 1 year. There is currently little evidence on the consequences, diagnostics and treatment of fall-related long lies. This paper aims to provide an overview of the current state of research. The results indicate that long lies are associated with physical, psychological, social and spiritual consequences, whereby the severity is not only influenced by the duration of immobility. It is recommended that individuals affected by this condition be diagnosed and treated on an interdisciplinary basis to comprehensively assess all aspects. The aim should be to reflect on the experience with those affected, strengthen their self-confidence and prevent further falls and prepare them for possible further long lie falls.

Abstract Objectives To investigate associations of the bioelectrical impedance analysis (BIA)-derived phase angle (PhA), an indicator of body cell mass, hydration status, and cell membrane integrity, with type 2 diabetes (T2D), prediabetes, and glycemic and insulin-related traits. Methods Using data from the Cooperative Health Research in the Region of Augsburg (KORA) S3/S4 studies, we analyzed 7728 participants aged 25–74 years for prevalent T2D and 7006 participants who did not have diabetes at baseline for incident T2D. A subsample aged 55–74 years at S4 was followed to assess incident oral glucose tolerance test (OGTT)-defined prediabetes or T2D (prediabetes/T2D), and glycemic and insulin-related traits (S4/F4/FF4). The PhA was calculated from BIA 2000-S at 50 kHz. Logistic and Cox regressions were applied for binary outcomes, and two-level growth models for continuous traits. Results In S3/S4, 324 participants had prevalent T2D at baseline, and 707 developed T2D during a median 15.7-year follow-up. In S4/F4/FF4, during up to 14 years of follow-up, 251 out of 626 normoglycemic participants at S4 developed incident prediabetes/T2D, and 792–804 participants without diabetes at S4 had three repeated measurements of continuous traits. The PhA (per 1-degree) was positively associated with incident T2D (hazard ratio [HR] and 95% confidence interval [CI] in S3/S4: 1.37 [1.21–1.54]) and incident prediabetes/T2D (HR [95% CI] in S4/F4/FF4: 1.33 [1.07–1.67]) without sex differences. The PhA (per 1-degree) was also positively associated with fasting glucose (beta [95% CI]: 1.2% [0.1–2.2%]) and insulin resistance (beta [95% CI]: 7.0% [2.3–11.7%]) cross-sectionally, and with changes in 2-h glucose longitudinally (beta [95% CI]: 4.5% [2.3–6.7%]) (S4/F4/FF4). In contrast, the PhA (per 1-degree) was inversely associated with prevalent T2D (odds ratio [95% CI] in S3/S4: 0.72 [0.56–0.93]) in men only. Conclusions The PhA at 50 kHz had stage-dependent associations with glucose metabolism, with higher values observed during subclinical stages and lower values after diabetes manifestation.

BackgroundLarge language models (LLMs) are increasingly used to generate patient-oriented medical information. In geriatrics, such information must balance accuracy, relevance, and safety, as older adults may be particularly susceptible to misleading or harmful advice. However, systematic evaluations of expert perceptions across multiple geriatric conditions remain limited. ObjectiveThis study aimed to explore geriatricians’ perceptions of the accuracy, relevance, and potential harm of LLM-generated patient information across common geriatric conditions and to examine variability and interrater agreement in expert ratings. MethodsIn this cross-sectional expert rating study, 10 geriatricians evaluated 50 LLM-generated statements covering 5 geriatric conditions (sarcopenia, osteoporosis, urinary incontinence, depression, and dementia). Statements addressed diagnostic, etiological, prognostic, risk-related, and therapeutic aspects. Experts rated perceived accuracy, relevance, and potential harm using 5-point Likert scales. Rating distributions were summarized using medians and IQRs. The Kendall coefficient of concordance (W) was used exploratorily to assess agreement in the relative ordering of statements within predefined strata. Readability was assessed using Flesch-Kincaid Grade Level and Flesch Reading Ease. ResultsExpert ratings indicated high perceived accuracy (median 4.32, IQR 4.01-4.59 and perceived relevance (median 4.51, IQR 4.06-4.66), while perceived potential harm remained low (median 1.59, IQR 1.17-1.92). IQR values ranged from 0.00 to 1.38 with most values clustering below 0.5, indicating limited dispersion in expert ratings. Agreement in the relative ordering of statements varied across domains, with W values ranging from 0.27 to 0.62 (median 0.53, IQR 0.46-0.58), indicating moderate concordance. No statements combined low perceived accuracy with high perceived potential harm. Readability analysis indicated generally accessible language, with a median Flesch-Kincaid Grade Level of 8.3 (IQR 7.4-9.6) and a median Flesch Reading Ease score of 60.8 (IQR 50.1-66.9). ConclusionsLLM-generated patient information for common geriatric conditions was rated as largely accurate and relevant, with low potential harm in typical scenarios. Variability in expert emphasis and the exploratory nature of agreement analyses highlight the limitations of perception-based evaluation. Future studies should incorporate guideline-based validation, readability optimization, and patient-centered outcomes to more comprehensively evaluate the safety and suitability of LLM-generated information for geriatric patient education.

Background & aims Bioelectrical impedance analysis (BIA) has been widely applied for assessing body composition. The phase angle (PhA), a raw parameter derived from BIA, reflects body cell mass, cellular hydration, and cell membrane integrity. Although the PhA has been proposed as a potential marker for various aspects of diseases, its role in dysglycemia remains uncertain. We therefore aimed to investigate its associations with early and advanced stages of dysglycemia in a large population-based sample. Methods This cross-sectional study used data from participants (19-74 years) enrolled at the baseline assessment (2014-2019) from a large population-based cohort. The whole-body PhA at 50 kHz was obtained from multi-frequency BIA. Two samples were analyzed. In the main sample (N = 178,097), the types of known diabetes (type 1, type 2, and a history of gestational diabetes vs. no diabetes) were ascertained. Among individuals with known type 2 diabetes, data on disease duration, current treatment, glycemic control (hemoglobin A1c levels), and diabetes-related microvascular complications were further analyzed. Additionally, in a random subsample without known diabetes (N = 16,153), oral glucose tolerance tests (OGTT) were performed to ascertain early stages of glucose dysregulation (prediabetes and newly detected diabetes vs. normoglycemia). Logistic regression was applied to assess sex-specific associations of the PhA with glucose dysregulation at different stages. Results In the main sample (mean age: 49.5 years; 50.1% men), 309 individuals (0.2%) reported having known type 1 diabetes, 8,234 (4.6%) type 2 diabetes, and 1,044 (1.2% of women) a history of gestational diabetes. In the OGTT subsample, 2,662 participants (16.5%) had prediabetes and 534 (3.3%) had newly detected diabetes. A higher PhA (per 1°) was associated with a lower odds of known type 1 diabetes (relative risk ratio [RRR] and 95% confidence intervals [CIs], men: 0.33 [0.27, 0.40]; women: 0.39 [0.29, 0.52]) and known type 2 diabetes (RRR [95% CIs], men: 0.72 [0.69, 0.76]; women: 0.88 [0.81, 0.96]) after adjustment for age, lifestyle factors, obesity, and disease markers. Stronger inverse associations of the PhA with known type 2 diabetes were observed for those with longer disease duration (i.e., > 10 years), advanced-stage treatment (i.e., insulin only), poorer glycemic control (i.e., hemoglobin A1c ≥ 64 mmol/mol), or microvascular complications. Men showed stronger inverse associations with advanced dysglycemia than women (p sex-interaction < 0.001). In contrast to the inverse associations observed for known type 1 and type 2 diabetes, the PhA showed positive associations with early dysglycemia. Specifically, a higher PhA (per 1°) was associated with a higher odds of a history of gestational diabetes (RRR [95% CIs]: women: 1.69 [1.51, 1.88]), prevalent prediabetes (RRR [95% CIs]: men: 1.45 [1.32, 1.59]; women: 1.34 [1.13, 1.58]) and newly detected diabetes (RRR [95% CIs]: men: 1.33 [1.11, 1.60]; women: 1.37 [1.05, 1.79]). Conclusions The bioimpedance-derived PhA showed positive cross-sectional associations with early dysglycemia and inverse cross-sectional associations with advanced dysglycemia. The observed associations may partly reflect reverse causation and disease-related changes in body composition accompanying advanced dysglycemia. Longitudinal studies are warranted to assess temporal relationships between the PhA and dysglycemia.

Abstract The Simpler Modified Fried Frailty Scale (SFS) was developed for the rapid evaluation of physical frailty in older adults. The aim of this study was to translate, culturally adapt and validate the German version of the SFS using the Fried Frailty Phenotype (FFP) as a reference. The methodological implementation was carried out in two phases: First, the German version was translated from the original English version according to established standards, culturally adapted and tested for comprehensibility in a small sample. Interrater reliability and test-retest reliability were assessed in 20 older patients. This was followed by clinical validation in a sample of 100 geriatric participants (mean age 82 ± 6.5 years; 66% women). The German SFS proved to be understandable and reliable. Internal consistency was moderate with a Cronbach’s alpha of 0.692. Agreement with the FFP was substantial (Cohen’s kappa = 0.80; p < 0.001). All five individual items showed significant positive correlations with the total score and with the corresponding FFP domains. In regression analyses, the total SFS score was significantly associated with frailty status (OR = 2.954; 95% CI: 1.877–4.649; p < 0.001), with unintentional weight loss, fatigue and physical inactivity showing particularly high discriminatory power. A cut-off value of ≥ 3 points showed a sensitivity of 91.67%, a specificity of 88.46%, a positive predictive value of 88.00% and a negative predictive value of 92.00%. The likelihood ratios (LR) were LR⁺ = 7.97 and LR⁻ = 0.09. The ROC analysis yielded an area under the curve (AUC) of 0.817 (95% CI: 0.734–0.899), confirming the good diagnostic accuracy of the scale. Overall, the German SFS proved to be a practical, reliable and valid instrument for identifying frailty in older people and is suitable for use in research and everyday clinical practice.

Abstract Background Sarcopenia is associated with anabolic resistance, a blunted muscle protein synthesis response to protein ingestion. Here, we hypothesized that anabolic resistance may be associated with a delayed postprandial decline in circulating plasma amino acids following protein ingestion. We therefore wanted to investigate whether an oral protein tolerance test (OPTT) combined with untargeted plasma metabolomics can detect age-related or sarcopenia-related differences in amino acid time courses consistent with altered postprandial amino acid handling, which could potentially reflect reduced anabolic sensitivity. Moreover, we investigated whether metabolites other than amino acids reacted to the OPTT. Methods Twelve young healthy adults (controls: 22-28 years) and 12 older adults with clinically diagnosed probable or confirmed sarcopenia (70-91 years) ingested 20 g of whey protein after an overnight fast. We collected venous blood at baseline, 1 h, and 2 h post-ingestion and analyzed the samples by untargeted LC-HRMS plasma metabolomics. Linear mixed-effects models were fitted for 2,968 metabolic features with Benjamini–Hochberg FDR correction. For each category (branched-chain amino acid, essential amino acid [EAA], total amino acid) we summed the within-subject log ₂ fold changes (FC) of the constituent amino acids. This composite is reported as the summed log ₂ FC Results 201 metabolites were structurally annotated including 58 amino acid-related metabolites and 97 lipids. Fourteen of 17 proteinogenic amino acids increased significantly after protein ingestion (FDR<0.05). In young controls, essential amino acids rose more steeply at 1 h than in sarcopenic individuals (+10.06 ± 1.05 vs. +7.84 ± 1.58 summed log ₂ FC) and declined more between 1 and 2 h (−4.93 ± 1.29 vs. −0.20 ± 2.27 summed log ₂ FC). Leucine exemplified this pattern best, rising 1.74 log ₂ FC in controls and declining to 0.96 at 2 h, while remaining elevated at 1.61 log ₂ FC in the sarcopenic group at 2 h (p=0.009). Beyond amino acids, whey protein lowered circulating free fatty acids in both groups (FA 18:2, FA 18:1, FA 16:0; all FDR<0.05). Medium- and long-chain acylcarnitines (Car 8:0, Car14:2) declined postprandially in controls but remained elevated in sarcopenic individuals (p<0.05), suggesting altered postprandial lipid metabolism. Conclusion In this proof-of-concept study, an OPTT showed that plasma EAAs declined more slowly from their postprandial peak in older adults with sarcopenia than in young adults, consistent with altered postprandial amino acid handling that may reflect anabolic resistance. Whey protein ingestion additionally modulates lipid and acylcarnitine metabolism in an age-dependent manner, suggesting broader alterations in postprandial metabolic regulation in older adults with sarcopenia.

BACKGROUND:In order to improve the quality and comparability of intervention studies, common endpoints have gained significance. The European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) consensus paper identified suitable endpoints for trials investigating the treatment of sarcopenia. With the help of a systematic review, we analyzed which endpoints have been used in randomized controlled intervention trials investigating the treatment of sarcopenia to date, to what extent these correspond to the recommended endpoints of the ESCEO consensus and whether minimal clinically important differences (MCID) were defined. Based on these identified endpoints we also aimed to identify which type of intervention may be most effective in enhancing the investigated endpoint. METHODS:A systematic search (PROSPERO ID: CRD42023468128) was carried out in various databases (PubMed, Embase, PsychInfo, Web of Science, Trial Registers) to find studies meeting the following criteria for further analysis: randomized controlled trials (RCTs), geriatric study population, sarcopenia (including probable sarcopenia and sarcopenic obesity), intervention study, published until October 2023 and written in English. The meta-analysis was conducted for the most common outcomes. RESULTS:Ninety publications met the criteria and were analyzed as full texts. The 90 intervention studies used a variety of different diagnostic criteria, intervention types and study settings. Measures of physical performance/strength (85 trials) and body composition (77 trials) were the most commonly used outcomes; in 74 studies, both outcome categories were used. Quality of Life was used in only 13 studies. In all categories, a very high heterogeneity between the measures was found and MCIDs were only rarely defined. Meta-analysis showed significant moderate intervention effects for the Timed-Up and Go-Test (TUG) and appendicular skeletal muscle index (ASMI), Handgrip strength and Chair Rise Test (CRT). The Short Physical Performance Battery (SPPB) showed no significant effects. CONCLUSION:Our results highlight the heterogeneity among sarcopenia intervention studies, which impairs the comparability regarding the efficiency of different interventions. However, our findings support the need for core outcomes or pre-defined common endpoints, for which the updated ESCEO recommendations can serve as a solid basis. Nevertheless, more consistent data are needed to enable a proper meta-analysis.

This study characterises the oral and general health of community-dwelling older adults and examines the relationship between geriatric syndromes, oral health, and oral health-related quality of life (OHRQoL). The study included 138 patients (mean age 81 years, 73

Our study of 272,152 geriatric patients assessed osteoporosis treatment requirement and eligibility. Over 75

BACKGROUND:Various concepts are used to assess the health status of geriatric patients, including frailty, resilience, and intrinsic capacity. Frailty, as the oldest and best-known concept among these, focuses on identifying functional deficits, whereas resilience and intrinsic capacity primarily assess preserved abilities. The application of all these concepts supports risk stratification and therapy planning in older patients. OBJECTIVES:The aim of the present work is to systematically present intrinsic capacity and resilience as well as their relationship to and distinguishing characteristics from frailty. Additionally, intrinsic capacity and resilience are here considered within the framework of specific and overlapping features, as well as differences and practical relevance for geriatric care. MATERIAL AND METHODS:A narrative analysis of the concepts was conducted based on current literature. RESULTS:Content overlap between frailty, intrinsic capacity and resilience, particularly in the domains of mobility and mental abilities, is present. Since most concepts emphasize only one thematic focus, multidimensional models, such as intrinsic capacity, can be advantageous. Different versions of measurement tools, especially for frailty, exist for different clinical settings. To date, no standardized measurement tools of frailty, intrinsic capacity, and resilience have been universally recommended. CONCLUSION:All concepts play an important role in the clinically meaningful stratification of older adults. In clinical practice, it is recommended to select one concept based on the parameters to be evaluated and to apply it consistently across all assessment time points.

Background: Osteoporosis is a common disease that affects approximately 6 million people in Germany alone. Osteoporotic fractures impair the quality of life and may make independent living impossible. Recommendations on the diagnosis and treatment of osteoporosis are indispensable for the effective care of this large group of patients. Methods: For a thorough updating of the German clinical practice guideline (an evidence-based guideline with recommendations for clinical practice) on osteoporosis, a comprehensive, systematic search for relevant publications was carried out, including guidelines from other countries. The retrieved literature was assessed with standardized (Oxford) criteria, and clinically relevant key questions were answered according to the PICO scheme ("population, intervention, comparison, outcomes"). Results: The assessment of clinical risk factors for osteoporosis is the basis of osteoporosis diagnostics, which should be carried out quickly after a fracture. If risk factors are present in a postmenopausal woman or a man aged 50 or above, bone densitometry testing with dual-energy x-ray absorptiometry (DXA) is recommended. The further diagnostic evaluation should proceed in stepwise fashion depending on the clinical symptoms, the fracture status, and the degree of bone density reduction. Pharmacotherapy should be adapted to the fracture risk. Osteoanabolic treatment is recommended with high priority if the patient is judged to have a very high risk of fracture (10% or more in the next three years). The further course and duration of treatment should be determined individually, depending on the evolution of the patient's clinical state. Conclusion: Prerequisites for the optimal treatment of patients with osteoporosis include a correct diagnosis and interdisciplinary and interprofessional collaboration to determine and provide the proper treatment. 71% of persons with osteoporosis in Germany are still untreated, and this gap must be closed.

Severe respiratory infections pose a major challenge in clinical practice, especially in older adults. Body composition analysis could play a crucial role in risk assessment and therapeutic decision-making. This study investigates whether obesity or sarcopenia has a greater impact on mortality in patients with severe respiratory infections. The study focuses on the National Pandemic Cohort Network (NAPKON-SUEP) cohort, which includes patients over 60 years of age with confirmed severe COVID-19 pneumonia. An innovative approach was adopted, using pre-trained deep learning models for automated analysis of body composition based on routine thoracic CT scans. The study included 157 hospitalized patients (mean age 70 ± 8 years, 41

INTRODUCTION:With the rise of aging societies and complex multimorbidity, age related endocrine alterations such as insulin-like growth factor I (IGFI) deficiency gain clinical importance. Beyond reduced growth hormone (GH) secretion, GH resistance represents an additional mechanism contributing to IGF-I deficiency, potentially aggravating age-related diseases. PURPOSE:This study investigates whether multimorbid, high-aged patients with IGF-I deficiency exhibit a form of acquired peripheral GH resistance, as indicated by altered GH-binding protein (GHBP) concentrations. MATERIALS AND METHODS:In a cross-sectional design we conducted a retrospective analysis of serum samples of 759 patients from the geriatric day clinic and acute geriatric ward of the Ludwig-Maximilians-University Hospital, Munich. RESULTS:The mean age was 81 years, with a mean baseline IGF-I of 85 ng/ml (corresponding to -0.07/-0.1 SDS in males/females), a mean GHBP concentration of 751 pM and a mean GH concentration of 1.68 ng/ml. Patients with IGF-I concentrations below 2 standard deviation score (SDS) exhibited significantly elevated GH alongside reduced GHBP, suggestive of a peripheral GH resistance (n = 48). In contrast, the subgroup (n = 26) with the highest IGF-I concentrations (up to 2 SDS), demonstrated elevated GH and high GHBP concentrations. CONCLUSION:Our findings suggest that low GHBP may indicate acquired peripheral GH resistance in a subset of multimorbid, high-aged patients. Further functional endocrine testing, including IGF-I generation test is necessary. Analysis of the subgroup with above-average IGF-I concentrations could provide insights into longevity and on the safety of GH and IGF-I treatment.

The consensus definition of sarcopenia enables a clear diagnostic algorithm. The syndrome can now also be coded in Germany (International Classification of Diseases 10, ICD-10 GM 62.50). Compared to the estimated prevalence it is still significantly underdiagnosed. Current treatment options include resistance training and a protein-rich diet, while pharmacological options are still missing. The Munich Sarcopenia Registry (MUSAR) aims to raise awareness of the syndrome and affected individuals. Additionally, it seeks to gain insights into risk factors, causes and treatment approaches. This publication conducts an initial analysis of 90 patient datasets with varying degrees of sarcopenia and examines the cohort for key geriatric parameters. Since 2018 patients from the geriatric clinic of the Ludwig Maximilians University Munich have been able to contribute their data to the registry. Sociodemographic, anthropometric, functional, and laboratory data are collected in a web-based registry. Compared to patients without sarcopenia, patients with sarcopenia are significantly older, have more comorbidities and show poorer functional performance as well as reduced quality of life. The results highlight the urgent need for further research and the development of new forms of treatment to improve the quality of life and independence of these patients. Challenges such as difficult recruitment complicate this endeavor. The MUSAR aims to minimize these issues and provides a valuable basis for generating extensive data through the systematic collection of patient data during hospital stays.

BACKGROUND:Loss of physical function is a growing health concern in aging populations. Resistance training, including strength training (ST) and power training (PT), is the main therapeutic approach, yet evidence regarding the most effective modality remains inconsistent. Soluble alpha klotho (sαKL) is a protein increasingly recognized for its role in muscle function and may serve as a biomarker of training responsiveness due to its association with aging, muscle integrity, and exercise-induced adaptions. Therefore, we aimed to investigate whether ST and PT differentially influence sαKL levels in older adults. METHODS:69 prefrail, community-dwelling older adults (65-94 years) were randomly assigned to 12 weeks of ST, PT, or a control group (ClinicalTrials.gov: NCT00783159). In a post hoc analysis serum sαKL levels and physical performance measures before and after the intervention were analyzed. RESULTS:23 participants were allocated to ST, 24 to PT and 22 to the control group. The participants had a mean age of 77 years, 70 % were female. There were no baseline differences between groups. Both ST and PT led to significant improvements in the Short Physical Performance Battery (SPPB) but only ST increased sαKL levels. CONCLUSION:Twelve weeks of ST, but not PT, significantly increased circulating sαKL levels in pre-frail older adults. Given the beneficial health effects of increased sαKL, these findings suggest that ST may offer additional biological advantages relevant to healthy aging. sαKL may serve as a promising biomarker for training-induced adaptions, but prospective trials are needed to confirm long-term effects and further clarify underlying mechanisms.