Background In 2010, the European Working Group on Sarcopenia in Older People (EWGSOP) published a sarcopenia definition that aimed to foster advances in identifying and caring for people with sarcopenia. In early 2018, the Working Group met again (EWGSOP2) to update the original definition in order to reflect scientific and clinical evidence that has built over the last decade. This paper presents our updated findings. Objectives To increase consistency of research design, clinical diagnoses, and ultimately, care for people with sarcopenia. Recommendations Sarcopenia is a muscle disease (muscle failure) rooted in adverse muscle changes that accrue across a lifetime; sarcopenia is common among adults of older age but can also occur earlier in life. In this updated consensus paper on sarcopenia, EWGSOP2: (1) focuses on low muscle strength as a key characteristic of sarcopenia, uses detection of low muscle quantity and quality to confirm the sarcopenia diagnosis, and identifies poor physical performance as indicative of severe sarcopenia; (2) updates the clinical algorithm that can be used for sarcopenia case-finding, diagnosis and confirmation, and severity determination, and (3) provides clear cut-off points for measurements of variables that identify and characterize sarcopenia. Conclusions EWGSOP2’s updated recommendations aim to increase awareness of sarcopenia and its risk. With these new recommendations, EWGSOP2 calls for healthcare professionals who treat patients at risk for sarcopenia to take actions that will promote early detection and treatment. We also encourage more research in the field of sarcopenia in order to prevent or delay adverse health outcomes that incur a heavy burden for patients and healthcare systems.

Long follow-up of a general aged population explains several inconsistencies of earlier reports. In 75+ individuals, general ill health is a strong associate of cognitive deficits. The strongest predictors of both cognitive decline and mortality are age, APOE4, manifest vascular diseases, and diabetes. The role of new potential predictors, feelings of loneliness and hypercalcemia, needs clinical testing.

Background: Emotional loneliness and social isolation are major problems in old age. These concepts are interrelated and often used interchangeably, but few studies have investigated them simultaneously thus trying to clarify their relationship. Objectives: To describe the prevalence of loneliness among aged Finns and to study the relationship of loneliness with the frequency of social contacts, with older people’s expectations and satisfaction of their human relationships. Especially, we wanted to clarify whether emotional loneliness is a separate concept from social isolation. Methods:The data were collected with a postal questionnaire. Background information, feelings of loneliness, number of friends, frequency of contacts with children, grandchildren and friends, the expectations of frequency of contacts as well as satisfaction of the contacts were inquired. The questionnaire was sent to a random sample of 6,786 aged people (>74 years) in various urban and rural areas in Finland. We report here the results of community-dwelling respondents (n = 4,113). Main Results: More than one third of the respondents (39.4%) suffered from loneliness. Feeling of loneliness was not associated with the frequency of contacts with children and friends but rather with expectations and satisfaction of these contacts. The most powerful predictors of loneliness were living alone, depression, experienced poor understanding by the nearest, and unfulfilled expectations of contacts with friends. Conclusion: Our findings support the view that emotional loneliness is a separate concept from social isolation. This has implications for practice. Interventions aiming at relieving loneliness should be focused on enabling an individual to reflect her own expectations and inner feelings of loneliness.

Objective: To acquire information about nutritional problems and factors associated with them in all nursing homes in Helsinki, Finland. Design: Descriptive, cross-sectional study. The residents were assessed by the Mini Nutritional Assessment test (MNA) and information was gathered about residents' backgrounds, functional status, diseases and about daily routines in institutions providing nutritional care. Setting: All nursing homes in Helsinki community, the capital of Finland. Subjects: Of 2424 eligible subjects, 2114 (87%) aged residents, mean age 82 y, were examined. Results: One-third (29%) of the studied residents suffered from malnutrition (MNAo17), and 60% were at risk (MNA 17-23.5). Malnutrition was associated with the female gender, a longer stay in the nursing home, functional impairment, dementia, stroke, constipation and difficulties in swallowing. In addition, eating less than half of the offered food portion, not eating snacks and resident's weight control at long intervals were associated with malnutrition. In logistic regression analysis mainly patientrelated factors predicted malnutrition: impaired functioning (OR 3.71, 95% CI 2.76-4.99), swallowing difficulties (OR 3.03, 95% CI 2.10-4.37), dementia (OR 2.06, 95% CI 1.45-2.93), constipation (OR 1.84, 95% CI 1.38-2.47), but also eating less than half of the offered food portion (OR 3.03, 95% CI 2.21-4.15). Conclusions: Although internal factors explain most about the poor nutritional status of aged residents in nursing homes, the factors related to nutritional care need further investigation to clarify their role in maintaining the nutritional status of aged residents.

We report secondary findings from a randomized controlled trial on the effects of exercise on memory in older adults with probable MCI. We randomized 86 women aged 70–80 years with subjective memory complaints into one of three groups: resistance training, aerobic training, or balance and tone (control). All participants exercised twice per week for six months. We measured verbal memory and learning using the Rey Auditory Verbal Learning Test (RAVLT) and spatial memory using a computerized test, before and after trial completion. We found that the aerobic training group remembered significantly more items in the loss after interference condition of the RAVLT compared with the control group after six months of training. In addition, both experimental groups showed improved spatial memory performance in the most difficult condition where they were required to memorize the spatial location of three items, compared with the control group. Lastly, we found a significant correlation between spatial memory performance and overall physical capacity after intervention in the aerobic training group. Taken together, our results provide support for the prevailing notion that exercise can positively impact cognitive functioning and may represent an effective strategy to improve memory in those who have begun to experience cognitive decline.

Loneliness may be regarded as a ‘geriatric giant’, leading to impaired quality of life, greater need for institutional care and increased mortality. For the past 30 years, a growing number of studies have focused on loneliness. However, the majority of these have been descriptive and cross-sectional. Further longitudinal studies are needed to understand the causal relationship between life-events and loneliness, its prognostic significance and, in particular, whether negative consequences may be alleviated.

This qualitative study investigated medical students' experiences of and conceptions concerning their professional development during their first clinical year. Twenty-two medical students participated in a portfolio course. Their personal writings were analysed by qualitative content analysis. Self-image as a future doctor rapidly evolved during patient contacts in the first clinical year. At the beginning, students felt lacking in credibility in front of their patients but towards the end they enjoyed their role as student-physicians. The medical students felt intense stress but the majority of this may stem from strong emotional experiences rather than the medical knowledge to be absorbed. Students were afraid of being humiliated by hospital staff and they felt themselves to be outsiders. No cynicism or suppression of feelings was observed in writings. The first clinical year is a period of intense emotional experiences and rapid development. Portfolios as learning tools may help in recognizing key experiences and in supporting professional development.

Faster alleviation of delirium and improved cognition justify good, comprehensive geriatric care for these patients although treatment produced no significant improvements in hard endpoints of prognosis.