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BackgroundThe determinants of altered balance in older subjects and, particularly, the contribution of muscle strength and cognitive impairment are still uncertain. We hypothesized that both these conditions and their interactions could affect balance in older persons. To address this hypothesis, we studied the cross-sectional association between handgrip strength and balance performance in subjects with and without cognitive impairment.MethodsTwo hundred and sixty-three elderly outpatients (104 men and 159 women, aged 81.44 ± 7.36 years) were evaluated for the comprehensive geriatric assessment. The patients were enrolled from the cross-sectional observational Traumatic Risk Identikit Parma study that was aimed at identifying risk factors for falling in older outpatients.ResultsBalance deficit, defined as an inability to maintain tandem position for at least 10 seconds, was present in 185 patients (70.34%). The mean mini-mental state examination score was 20.79 ± 6.5, the median short physical performance battery score was 5.0 and the mean grip strength was 18.54 ± 9.14 kg. After dividing the subjects into four categories according to the presence of low grip strength and/or cognitive impairment, we found that the mini nutritional assessment short-form scale score was negatively and independently (β: −0.02 ± 0.01; p=0.04) associated with balance deficit in the group with low grip strength and cognitive impairment. In the other three categories, grip strength was negatively and significantly associated with balance deficit.ConclusionThe loss of muscle strength, presence of cognitive impairment and their interaction, influenced probably by malnutrition, could affect balance in older persons.

The assistance to older community-dwellers provided by family caregivers is crucial for the maintenance of an acceptable quality of life, especially when dementia is present. The caregiver burden may be extremely high, but few data are available on what patient domains mainly affect the caregiver. The aim of this cross-sectional study, performed in older outpatients, was to examine the impact of cognitive, physical and nutritional status of elderly community-dwellers on the caregiver burden, as evaluated by the Caregiver Burden Inventory (CBI). A group of 406 elderly outpatients (161 M, 245 F, mean age of 83.20 ± 6.40) was enrolled. A significant correlation was observed between Mini Nutritional Assessment Instrument-Short Form (MNA-SF) and CBI (r = −0.34; p < 0.001), suggesting that a poor nutritional status is significantly associated with the caregiver burden. There was also a significant correlation between CBI and Short Physical Performance Battery score (r = −0.29; p < 0.001), hand grip strength (r = −0.25; p < 0.001), Mini-Mental State Examination score (r = −0.39; p < 0.001), Geriatric Depression Scale (r = 0.23; p < 0.001), Body Mass Index (BMI) (r = 0.01; p = 0.03), Activities of Daily Living and Instrumental Activities of Daily Living (ADL/IADL) (r = −0.61 and −0.62, respectively; p < 0.001), and with the 4-m walking speed (r = −0.42; p < 0.001). In the multivariate analysis, only the relationships of the CBI (in particular the physical subcomponent) with ADL, IADL and MNA-SF remained statistically significant (β ± SE −0.89 ± 0.20, p < 0.001; −0.58 ± 0.15, p < 0.001 and −0.25 ± 0.11, p = 0.02, respectively). The relationship between CBI and BMI remained statistically significant only for the physical subcomponent (β ± SE 0.14 ± 0.05; p = 0.006). Thus, in this study, we confirmed that the impairment in the activities of daily living is associated with a significant impact on the caregiver burden, and we found also that a poor nutritional status of the older outpatient is independently more associated with the caregiver burden than cognitive and physical disability. The combined evaluation of both patients and caregivers can improve the knowledge and assistance to the elderly subjects.

Background One of the most problematic expression of ageing is frailty, and an approach based on its early identification is mandatory. The Sunfrail-tool (ST), a 9-item questionnaire, is a promising instrument for screening frailty. Aims To assess the diagnostic accuracy and the construct validity between the ST and a Comprehensive Geriatric Assessment (CGA), composed by six tests representative of the bio-psycho-social model of frailty; To verify the discriminating power of five key-questions of the ST; To investigate the role of the ST in a clinical-pathway of falls’ prevention. Methods In this retrospective study, we enrolled 235 patients from the Frailty-Multimorbidity Lab of the University-Hospital of Parma. The STs’ answers were obtained from the patient’s clinical information. A patient was considered frail if at least one of the CGAs’ tests resulted positive. Results The ST was associated with the CGA’s judgement with an Area Under the Curve of 0.691 (CI 95%: 0.591–0.791). Each CGA’s test was associated with the ST total score. The five key-question showed a potential discriminating power in the CGA’s tests of the corresponding domains. The fall-related question of the ST was significantly associated with the Short Physical Performance Battery total score (OR: 0.839, CI 95%: 0.766–0.918), a proxy of the risk of falling. Discussion The results suggest that the ST can capture the complexity of frailty. The ST showed a good discriminating power, and it can guide a second-level assessment to key frailty domains and/or clinical pathways. Conclusions The ST is a valid and easy-to-use instrument for the screening of frailty.

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