To present the local evidence and final recommendations of the Clinical Practice Guidelines workgroup convened by the Chapter of Geriatricians and the Society for Geriatric Medicine Singapore. The aim is to develop contextualized evidence-based recommendations that facilitate adoption of the Asian Working Group for Sarcopenia (AWGS) 2019 consensus into current practice in Singapore. The workgroup drew upon the AWGS’2019 consensus, updated literature review of Singapore studies till 31 Dec 2020, and evidence from recent systematic reviews. From 40 local studies included for data extraction, we constructed evidence tables organized as: definition and epidemiology; diagnosis and evaluation; and treatment and intervention. Twenty recommendations - case-finding, diagnosis, treatment, prevention, research - were developed, and graded for strength and quality using the GRADE approach. Consensus from an expert panel(N=23) was achieved after two rounds of the modified Delphi process. The local prevalence of sarcopenia among community-dwelling older adults ranged from 13.6% to 25%. Most studies adopted the AWGS’2019 and AWGS’2014 criteria. Reported case finding tools include SARC-F, calf circumference (CC) and SARC-CalF. Gender-specific AWGS cut-offs for appendicular skeletal mass were used to define low muscle mass. Different protocols and dynamometers were used to assess handgrip strength, whilst gait speed and 5-times chair stand were commonly used to assess physical performance. We conditionally recommend a case-finding approach in at-risk older adults using validated case-finding tools. Screen-positive individuals should be assessed for ‘possible sarcopenia’ and underlying causes. For diagnosis, we conditionally recommend using the AWGS’2019 algorithm, and dual-energy X-ray absorptiometry when necessary to determine low lean mass for a confirmatory diagnosis of sarcopenia. For treatment, we strongly recommend resistance-based exercises and conditionally recommend a quality protein-rich diet/protein supplementation, with Vitamin D supplementation for insufficiency (<30 micrograms/L). For prevention, we recommend regular resistance-based physical activity and adequate protein intake (≥1.0g/kg bodyweight). We encourage more research to address local evidence gaps.

Singapore Clinical Practice Guidelines For Sarcopenia: Screening, Diagnosis, Management and Prevention

Objectives: Sarcopenia is a skeletal muscle loss disease with adverse outcomes, including falls, mortality, and cardiovascular disease (CVD) in older patients. Distal radius fractures (DRF), common in older people, are strongly related to falls. We aimed to investigate the correlation between DRF and low skeletal muscle mass, which strongly correlated to sarcopenia. Methods: We performed a retrospective review of data from patients diagnosed with or without DRF in our institute between 2015 and 2020. Finally, after propensity score matching, data from 115 patients with and 115 patients without DRF were used for analyses. Multivariate logistic regression analysis was performed for sex, body mass index (BMI), the presence of low skeletal muscle mass, bone quality measured by dual-energy X-ray absorptiometry (DXA), and comorbidities (diabetes mellitus, CVD). Results: We found that female sex (odds ratio = 3.435, p = 0.015), CVD (odds ratio = 5.431, p < 0.001) and low skeletal muscle mass (odds ratio = 8.062, p = 0.001) were significant predictors for DRF. BMI and osteoporosis were not statistically significantly related to DRF. Conclusions: Women with low skeletal muscle mass and CVD may be more responsible for DRF than osteoporosis.

https://www.mdpi.com/2077-0383/11/19/5581/pdf?version=1664155783

The Association of Low Skeletal Muscle Mass with Complex Distal Radius Fracture

Embodied conversational agents (ECAs) have the potential to facilitate empathic relationships between older adults and eHealth coaches, but little research has been conducted on how to effectively include appearance and personality in the design of ECAs such that older adults can empathize with the agent. In this study, we aimed first to develop design requirements for ECAs that induce empathy in older adults. Second, we developed and reflected upon a remote (online), iterative co-design methodology which can be used as an alternative when traditional physical methods cannot take place (e.g. during COVID-19). Over the course of three months, five older adults (mean age 68 years) 1) received a paper booklet, 2) were invited to an Q&A session, 3) after which they were asked develop their own ECAs at home using the booklet, 4) and came back to discuss their designs online in a group setting to determine design requirements, 5) which were used to develop an interactive ECA, 6) that was individually evaluated in an online meeting. The final ECA, called Robin, was positively perceived in terms of appearance, but the participants expected the conversation with Robin to be more flexible and deeper. Overall, the current study demonstrated the feasibility of remote co-design activities for this population and presents recommendations for researchers and practitioners interested in or in need for a remote approach. Moreover, the current findings are translated in lessons learnt to inform design and development of future ECAs for older adults. 

"Hi, My Name is Robin" - Remotely Co-designing an Embodied Conversational Agent for Empathy with Older Adults

Abstract Background Although the health benefits of physical activity are well documented, certain priority populations are often disproportionately insufficiently active and at higher risk of poor health. Recreation centres have the potential to provide accessible and supportive environments for physical activity for all. However, little is known about priority populations’ experiences of these venues and their views of how accessibility and inclusion can be optimised. This study aimed to gain in-depth insights of recreation centre experiences and potential strategies for improving inclusion and accessibility amongst priority populations (women, older adults, ethnic minorities, persons living with disabilities/additional needs, individuals identifying as LGBTQIA+, low socio-economic position). Methods This qualitative study (2021–2022) involved 18 semi-structured individual interviews with adult priority population users of recreation centres (50% 65 + years, 61.2% female) in one Melbourne municipality. Participants were asked to discuss their positive and negative experiences at the centres and to identify strategies for enhancing accessibility and inclusion. Interviews were audio-recorded and transcribed verbatim. Content analysis was performed for data analysis. Results While many participants had positive views of the facilities and programs at the centres, as they met their needs, they also had suggestions for improving accessibility and inclusion. Similarly, most participants were happy with the communications, felt included, and perceived the culture positively. Those who did not feel included at the centres offered many potential strategies for changing the culture, modifying communications (e.g., signage), and establishing partnerships for better access and inclusion. Conclusions The present study adds to essential knowledge concerning priority populations’ experiences of recreation centres. For recreation facilities that were generally perceived as having positive inclusion and accessibility, the findings nonetheless highlighted suggestions for further enhancement. These strategies may be useful more broadly for improving accessibility and inclusion, thereby promoting physical activity and ultimately health for all. 

Priority populations’ experiences of the accessibility and inclusion of recreation centres: a qualitative study


 The academic world is rapidly changing due to multiple influences, including COVID-19, technological advancement, tertiary competition, shifting government policies, and emerging research practices and priorities. Given this rapidly changing tertiary-education landscape, added importance is placed on the need for emerging research leaders to understand contemporary research practices which likely exceeds the skills displayed by their supervisors and mentors. Consequently, reflecting on 80+ years of collective post-PhD research experience, we identify and discuss six common characteristics of contemporary health research practice, with the aim of guiding and empowering higher degree by research students and emerging early career researchers as they develop their research identities and shape their approaches and values on the path to becoming research leaders in health. Indicative of today’s dynamic and exacting research environment, we propose that best practice contemporary health research should be: Diverse; Creative; Collaborative; Authentic; Respectful; and, Trusting. By understanding a diverse range of research approaches, and through working in collaborative and creative teams, diversity of thought, approach, and methods can become a cornerstone of practice. By blending this understanding with questions and research approaches that facilitate the pathway of translation uptake for the next-user, emerging research leaders can deliver authentic research with the requisite ingredients for impact.

Characteristics of contemporary health research practice: A shift from ivory tower to collaborative power

Promoting physical activity (PA) participation in older adults is important for preserving quality of life and functional independence. Co-design has been shown to increase engagement of end-users in health-related policies and interventions. This scoping review aimed to examine how co-design has been used to develop PA interventions for older adults.We searched MEDLINE, EMBASE, AMED, and CINAHL. Peer-reviewed primary research studies that met the following criteria were included: had at least one participant aged ≥60 years involved in the co-design process and the intervention was delivered to individuals whose mean age was ≥60, used co-design methodologies, and any form of PA. After duplicate removal, two or more independent reviewers completed title and abstract and full text screening. Data were extracted from the included studies according to study aims.Of the 29 included studies, 12 different terms were used to describe co-design with variable operational definitions that we consolidated into five proposed components. Fifteen studies engaged users in a consultative way, 13 studies using collaboration, and one study engaged end-users in consumer-control. No studies involved end-users in the dissemination phase. Further, no studies directly measured the effectiveness of the co-design process. Five categories of barriers and facilitators to co-design were identified including frameworks and methodologies, logistics, relationships, participation, and generalizability.There is a large degree of variability in how co-design is used to develop PA interventions for older adults. Our findings can be used by researchers to improve rigor and standardization in this emerging field.osf.io/vsw2m. 

https://bmcgeriatr.biomedcentral.com/counter/pdf/10.1186/s12877-022-03345-4

The use of co-design in developing physical activity interventions for older adults: a scoping review

Sarcopenia is an emerging disease that adversely impacts outcomes of older adults across the spectrum of fragility fractures. Few studies have examined sarcopenia in upstream fragility fractures such as the distal radius. Understanding the state of current evidence is essential in defining a research agenda in this critical area of sentinel distal radius fractures and sarcopenia. The aim of this scoping review was to summarize existing literature on sarcopenia in distal radius fracture in older adults, and to identify research areas and gaps to guide future studies. We utilized the 5-stage framework of Arksey and O’Malley. We searched studies from 2010 to 2020 relating to «Sarcopenia» and «Distal radius fractures» in major databases. Two reviewers independently screened articles for inclusion and conducted full text reviews of shortlisted articles. We extracted data on research areas, key findings, and study limitations. Thirteen studies met the inclusion and exclusion criteria. They covered the areas of epidemiology (N=9), risk factors (N=4), basic science (N=2), outcomes (N=1), and diagnostic modalities (N=1). There were no studies on screening/case finding, prognostic scoring, intervention, or health economics. Identified limitations included the lack of clear definition and diagnostic criteria for sarcopenia, and lack of, or inappropriate, control group. Majority of studies were retrospective or cross-sectional in study design. This scoping review on sarcopenia in distal radius fractures highlighted gaps in research areas and in the rigor of studies conducted, and the need for more prospective cohort and interventional studies. Building upon current consensus criteria, we propose setting a research agenda along the timeline of sarcopenia management, from screening through to intervention and follow-up, which will inform future research in this early disease cohort of fragility fractures.

Sarcopenia in Distal Radius Fractures: A Scoping Review

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The use of co-design in developing physical activity interventions for older adults: a scoping review

Sarcopenia in Distal Radius Fractures: A Scoping Review