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Sarcopenia is age-related loss of muscle mass and strength with resulting decrease in function that affects balance, gait, and overall ability to perform tasks of daily living. Decline in skeletal muscle mass begins around age 30 with a significant acceleration after age 65, accompanied by a concomitant reduction in muscle strength (Curcio, et al., 2016). Muscle strength is a critical component of walking and its decrease in the older adult contributes to a high prevalence of falls (Dhillon & Hasni, 2017). Early recognition and intervention can modify some of these detrimental outcomes. Some major risk factors for sarcopenia include; lack of exercise, age-related decreases in hormone concentrations and a decrease in the body's ability to synthesize protein, combined with inadequate caloric and/or protein intake (Dhillon & Hasni, 2017). Acute and chronic illnesses raise the risk level. Screening for sarcopenia may not be routine in many clinical practices. However, screening for impairment in physical function and activities of daily living (ADL's) should be routine for all older adults. Individuals with impaired ADLs and those who describe a noticeable decline in function, strength, or overall health status should have more specific testing for sarcopenia (Brown & McCarthy, 2015). The European Working Group on Sarcopenia in Older people (EWGSOP), in their consensus document, outlined an algorithm to aid the screening and diagnosis of sarcopenia (Cruz-Jentoft, et al., 2010).

BackgroundFalls and fractures are extremely frequent in long-term care facilities (LTCFs). Therefore, a fall and fracture prevention program was started in nearly 1000 LTCFs in Bavaria/Germany between 2007 and 2010. The components of the program were exercise classes, the documentation of falls, environmental adaptations, medication reviews, the recommendation to use hip protectors and education of staff. The present study aimed to provide a comprehensive evaluation of the implementation process of the program regarding results of the implementation phase and the follow-up of 3–9 years after start of implementation.MethodsData from numerous sources were used, including data from published studies, statistical data, health insurance claims data and unpublished data from an online questionnaire. To incorporate different aspects, time periods and results, the RE-AIM framework was applied.ResultsThe program was adopted by 942 of the 1150 eligible LTCFs and reached about 62,000 residents. During the implementation phase exercise classes and recommendation about environmental adaptations were offered in nearly all LTCFs. 13.5% of the residents participated in exercise classes. Hip protectors were available for 9.2% of all residents. In the first implementation wave, femoral fracture rate was significantly reduced by 18% in the first year. At follow-up nearly 90% of all LTCFs still offered exercise classes, which were attended by about 11% of residents. However, only 10% of the exercise classes completely fulfilled the requirements of an effective strength and balance training. Individual advice about environmental adaptations was provided in 74.3% of the LTCFs and nearly all LTCFs claimed to offer hip protectors to their residents. A long-term effect of the program on femoral fractures could not be detected.ConclusionsThe program did not affect the femoral fracture rate in the long run. Possible reasons could be a high turn-over of the staff, a reduced fidelity of training components or a shift in daily priorities among the staff.

BackgroundFragility fractures are one of the leading causes for disability in old people. The main underlying mechanisms are osteoporosis and falls. Evidence-based measures to prevent either falls or fractures are available. However, coordinated preventive approaches combining bone health and fall prevention are rare.The objective of the study is to evaluate a health care fund driven program, which encourages insured persons to adhere to national guidelines regarding bone health and physical activity and falls prevention. The health care fund cooperates with the ‘German Association of Rural Women’ and the ‘German Gymnastics Association’. The program consists of mobility and falls prevention classes, the examination of bone health by a DXA scan, and a consultation about ‘safety in the living environment’.MethodsCluster-randomized study in 47 intervention and 143 control districts in 5 federal states of Germany. The program is offered to a) community-living women and men aged 70 to <85 years with a prior fragility fracture or b) community-living women aged 75 to <80 years. Within two years more than 10,000 persons will be directly contacted and motivated to make use of the components of the program. The primary outcome is a combined measure of incident osteoporotic fractures. Secondary outcomes include the rate of referrals to a mobility and falls prevention class or a bone mass density measurement. An economic evaluation will be conducted.DiscussionThe study evaluates a complex preventive intervention in a routine health care setting which may serve as model for similar approaches in other areas or countries.Trial registrationDRKS-ID: DRKS00009000; date of registration: 06.08.2015

ObjectiveTo investigate variation of care dependency after hip fracture across German regions based on the assessment by the German statutory long-term care insurance. Data sources/study settingPatient-level statutory health and long-term care insurance claims data from 2009-2011 and official statistical data from Germany. Study designWe performed a retrospective cohort study. Investigated multinomial outcome categories were increase in care dependency (new onset or a higher care dependency than pre-fracture), no change as reference and death as competing risk in the quarterly period following hip fracture (follow-up 3 months). Regional variation was operationalized with the variance of regional-level random intercepts based on generalized linear mixed models. We adjusted for patient and regional characteristics. Principal findingsThe study included 122,887 hip fracture patients in 95 German postal code regions. Crude outcomes were 30.87% increase in care dependency and 14.35% death. Results indicated modest variation on regional level. Male sex, increasing age, increasing comorbidity, pertrochanteric and subtrochanteric fracture site compared to femoral neck, time from hospital admission to surgery of 3 or more days, as well as increasing inpatient length of stay, nonparticipation in rehabilitation and regions with lower hospital density were positively associated with an increase in care dependency. PLOS ONEPLOS ONE | https://doi.org/10.1371/journal.pone.). In order to fulfill the legal requirements to obtain that kind of data, researchers must obtain a permission for a specific ConclusionsSeveral characteristics on patient and regional level associated with the outcome were identified. Variation in the increase in care dependency after hip fracture appeared to be attributable primarily to patient characteristics. Variation on regional level was only modest.