The "Sarcopenia, Frailty and Dependence Study Group" is an emerging research group in the Maresme Health Consortium (CSdM) accredited by the Catalan Government in 2014 (AGAUR; 2014, SGR 499). It is a multidisciplinary group that includes epidemiologists, public health specialists, geriatricians, family physicians, internists, endocrinologists, rehabilitation specialists, clinical pharmacists, nurses, dietitians/nutritionists and social workers. The group performs mainly clinical research with the aim to provide scientific evidence with a clear application and/or translation in clinical practice. The group has experience both in hospital-based and population-based studies carried out in primary care centers. Group members decided to share their experience from 2014 on in order to enhance their research and look for synergies that allow them to realize most ambitious projects in the field of aging and dependency. The group's mission is to generate useful scientific knowledge to improve care for the elderly (especially those pre-frail and frail), to prevent functional decline and disability and keep them functionally autonomous and independent as long as possible. The group is seeking to obtain recognition by the AGAUR as a consolidated research group in 2017.
Fragility is a clinical syndrome with multiple causes, which are neither well known or understood, characterized by a loss of muscular power and physiological reserves that lead to a situation of vulnerability and increased risk of suffering disability, Health complications, dependence, institutionalization and death from external aggressions.
It has an occurrence of about 10% in the population over 65, greater prevalence in women and increases sharply over 89 years. Fragile individuals consume more health and social resources. Experts agree that fragility is a dynamic condition that is potentially reversible if it is detected and treated early with exercise, correct nutrition and protein supplement and control of underlying illnesses along with a reduction in polypharmacy. Studies of the causes, prevention and or treatment of the fragile syndrome must necessarily be multidisciplinary and including professionals from many specialisations.
Endocrinology of Aging
This line explores the endocrine changes that occur in aging and their impact on fragility and functional decline. The study of the decline of various hormonal pathways with aging and their impact on muscle power and functional ability of the individual are of special interest to our group; these include those with an anabolic effect, such as gonadotrophins (testosterone, oestrogen), somatotrophins (GH and GH-1) and ghrelin. Knowing the role of each of these hormones would allow us to plan future strategies of hormone replacement in elderly people at high risk of fragility. We are particularly interested in:
- Determining the role of ghrelin in the appearance of sarcopenia and fragility
- Knowing the effect of declining anabolic hormones (testosterone, oestrogen, GH, IGF-1 etc) on sarcopenia and fragility
- Knowing the effect of some inflammation markers (TNF-alpha, IL-6, PCR, etc) on sarcopenia and fragility
- Evaluating the possible interactions between hormonal factors, nutritional inflammatories and physical exercise on the appearance of sarcopenia and fragility
- Evaluating the sex differences for the effects of the above hormonal and inflammatory factors
- Defining the role of ghrelin in the apparition of sarcopenia and fragility
Polypharmacy in the elderly
Polypharmacy is frequent in the elderly and raises the risk of adverse effects of medication. Polypharmacy is recognized as a factor that contributes to the pathology of fragility. The reduction of polypharmacy and the safe and adequate use of medication in the elderly, who frequently require dose adjustments for renal or hepatic insufficiency, the control of possible duplications, interactions and an adequate evaluation of the benefits and risks of each medication have to be a priority to improve safety, quality of life and efficiency in the clinical management of this population.
We are interested in:
- Evaluating safety of medication in the aged population and determining the risk factors for secondary effects of medication in this group
- Evaluating the effectiveness of interventions aimed at a safer and more rational use of medication in poly-medicated elderly people
Rehabilitation, physical exercise and analysis of movement
The loss of muscle power is a fundamental element of the fragility syndrome. Sarcopenia determines the capacity of the individual to walk, their risk of falling and their functional capacity. It is of interest to study the changes in balance and speed in fragile and pre-fragile individuals, the impact on their functional capacity and risk of falling as well as evaluating interventions promoting rehabilitation in exercise programmes.
The group aims to:
- Characterize balance and speed in the elderly (with static and dynamic baropodometry and posture) and evaluate the impact of alterations on the apparition of accidental falls
- Evaluate the effect of sarcopenia and fragility on balance and speed
- Evaluate the effectiveness of interventions based on exercise programmes on fragility and the functional capacity in the elderly and pre-fragile or fragile
Anorexia and nutrition in the elderly
On one hand appetite and nutritional status is one of the potential determinants or triggers for fragility and functional decline in the elderly. We are interested in studying nutritional status and eating habits as risk factors for fragility as well as the effectiveness and safety of nutritional interventions (protein supplements, vitamin D etc) aimed at improving the nutritional status and functional capacity of the individual.
We aim to:
- Evaluate nutritional factors and dietary habits associated with sarcopenia and fragility in the elderly
- Evaluate the effectiveness of interventions aimed at improving nutritional status in the elderly and their effect on fragility and sarcopenia
- Evaluate the effectiveness of interventions aimed at normalizing weight in the elderly obese in the prevention of fragility
Mateu Serra Prat, Unitat de Recerca Hospital de Mataró Carretera de Cirera s/n 08304 Mataró (Barcelona)
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