Département des Sciences de l'activité physique, Université du Québec à Montréal (UQÀM), Montréal, Québec, Canada; Groupe de recherche en activité physique adaptée, Université du Québec à Montréal (UQÀM), Montréal, Québec, Canada; Centre de recherche de l'institut universitaire de gériatrie de Montréal, Montréal, Québec, Canada.
Département des Sciences de l'activité physique, Université du Québec à Montréal (UQÀM), Montréal, Québec, Canada; Groupe de recherche en activité physique adaptée, Université du Québec à Montréal (UQÀM), Montréal, Québec, Canada; Centre de recherche de l'institut universitaire de gériatrie de Montréal, Montréal, Québec, Canada.
Exp Gerontol. 2019 Oct 1;125:110678. doi: 10.1016/j.exger.2019.110678. Epub 2019 Jul 31.
Muscle mass and strength decline are known to be key factors in the development of physical incapacities in later life. These structural and functional declines are even more significant in older people during hospitalizations, increasing risk of falls, fractures, and loss of quality of life. In clinical daily practice, functional and muscular decline are assessed using the validated Short Physical Performance Battery (SPPB). Nevertheless, psychological conditions (pain, demotivation, depression) and temporary physical incapacities (e.g: hip fracture) during hospitalization can be significant barriers to evaluate these patients. Skeletal muscle ultrasound assessment could be an alternative in clinical daily practice since muscle architecture (MA) is related to poor muscle function. However, this potential objective and clinical tool is not yet implemented in geriatric setting during hospitalization. Our study aimed at: 1) comparing MA, muscle mass and strength measurements in hospitalized older adults with different functional levels, 2) evaluating the association between these measurements.
Forty-four hospitalized older adults were divided in 2 groups: 21 Pre-Disabled (PDis (SPPB: 6-9): 81 ± 7 years old, SPPB:7.6 ± 1.1) and 23 Disabled (Dis (SPPB:<6): 83 ± 7 years old, SPPB:3.6 ± 1.6). SPPB, body mass (BM) and composition (bio-impedance), handgrip strength (HS, dynamometer) and MA (Pennation angle (PA), muscle thickness (MT); ultrasound) were evaluated.
Relative muscle strength (HS/BM: 0.28 ± 0.08 vs 0.34 ± 0.09 kg/kg), PA (10.6 ± 1.8 vs 12.3 ± 1.9°), and MT (16.4 ± 0.4 vs 19.2 0.4 mm) but not lean body mass were significantly different between Dis and PDis, respectively. Significant associations between PA and the SPPB (r = 0.37) or walking speed (r = 0.38); between SCF and walking speed (r = -0.36); as well as between MT and SPPB (r = 0.29), walking speed (r = 0.30), LBM (r = 0.382) or MMI (r = 0.361) were observed.
Muscle architecture (proxy of muscle quality) and functional capacities/status of hospitalized older adults are related. Thus, ultrasound seems to be a potential useful and objective screening tool for clinicians to assess/prevent physical decline during hospitalization. Larger and/or longitudinal studies are needed to confirm our findings from a pilot pragmatic study.
肌肉质量和力量的下降是导致老年人身体机能下降的关键因素。在老年人住院期间，这些结构和功能的下降更为明显，增加了跌倒、骨折和生活质量下降的风险。在临床日常实践中，使用经过验证的简短身体表现电池（SPPB）评估功能和肌肉下降。然而，住院期间的心理状况（疼痛、动力不足、抑郁）和暂时的身体机能障碍（例如：髋部骨折）可能是评估这些患者的重大障碍。肌肉骨骼超声评估可能是临床日常实践中的另一种选择，因为肌肉结构（MA）与肌肉功能不良有关。然而，这种潜在的客观和临床工具尚未在老年住院患者中实施。我们的研究旨在：1）比较不同功能水平的住院老年人的 MA、肌肉质量和力量测量值，2）评估这些测量值之间的相关性。
44 名住院老年人分为 2 组：21 名预失能（PDis（SPPB：6-9）：81±7 岁，SPPB：7.6±1.1）和 23 名失能（Dis（SPPB：<6）：83±7 岁，SPPB：3.6±1.6）。评估 SPPB、体重（BM）和组成（生物阻抗）、握力（HS，测力计）和 MA（Pennation 角（PA）、肌肉厚度（MT）；超声）。
相对肌肉力量（HS/BM：0.28±0.08 与 0.34±0.09 kg/kg）、PA（10.6±1.8 与 12.3±1.9°）和 MT（16.4±0.4 与 19.2 0.4mm）在 Dis 和 PDis 之间差异有统计学意义。PA 与 SPPB（r=0.37）或步行速度（r=0.38）之间存在显著相关性；SCF 与步行速度（r=-0.36）之间存在显著相关性；MT 与 SPPB（r=0.29）、步行速度（r=0.30）、LBM（r=0.382）或 MMI（r=0.361）之间也存在显著相关性。
住院老年人的肌肉结构（肌肉质量的代表）和功能能力/状态有关。因此，超声似乎是一种有潜力的有用的客观筛查工具，可供临床医生在住院期间评估/预防身体机能下降。需要更大规模和/或纵向研究来证实我们从一项实用的初步研究中得出的发现。
