Point-of-care ultrasound measures of muscle and frailty measures
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RESEARCH PAPER
Point‑of‑care ultrasound measures of muscle and frailty measures Kenneth M. Madden1,2,3,4 · Boris Feldman1,3 · Shane Arishenkoff3 · Graydon S. Meneilly1,3 Received: 8 June 2020 / Accepted: 11 September 2020 © European Geriatric Medicine Society 2020
Key summary points Aim The aim of our study was to examine the association between a simple, point-of care (bedside) ultrasound measure of muscle thickness and two common frailty measures in older adults. Findings Point-of care ultrasound measures of muscle thickness showed a weak correlation with the Cardiovascular Health Study index of frailty, mostly due to a strong correlation with grip strength. Muscle thickness showed no association with a commonly used judgement-based measure of frailty (the Rockwood Clinical Frailty Scale). Message Despite the growing interest in ultrasound-based frailty measures in the emergency and surgical literature, our results indicate that caution is advised in using bedside ultrasound measures of muscle thickness as a clinical marker for a complex multidimensional syndrome such as frailty. Abstract Purpose Frailty is defined as a syndrome of increased vulnerability due to both age and disease that leads to an inability to cope with acute stressors. There has been growing interest in the surgical and emergency medicine literature in the potential use of Point-of-Care ultrasonic (PoCUS) measures of muscle mass to assess frailty in older adults. Our study examined the association between a simple ultrasonic measure of muscle thickness (MT, vastus medialis muscle thickness) and commonly used frailty measures (Cardiovascular Health Study, CHS; Rockwood Clinical Frailty Scale, RCFS) in older adults. Methods Participants were recruited sequentially from ambulatory geriatric medicine clinics in an academic medical centre (Vancouver General Hospital, Vancouver, Canada). Each subject had MT measured by PoCUS, as well as the CHS index and Rockwood Clinical Frailty Scale. Results 150 older adults (age ≥ 65; mean age 80.0 ± 0.5 years, 66 women, 84 men) were recruited. In our final parsimonious models, MT showed a weak inverse association with the CHS index (Standardized β = − 0.180 ± 0.080, R2 = 0.06, p = 0.027) and no association with the RCFS (p = 0.776). Within the CHS index, most of the association was due to grip strength in men (Standardized β = − 0.326 ± 0.099, R2 = 0.26, p = 0.001). Conclusion Frailty is a multifactorial syndrome, and caution must be used in trying to screen for this condition with a single ultrasonic measure. Further work might indicate associations with a more restricted syndrome, such as sarcopenia. Keywords Fraily · Point-of-care ultrasound · Geriatric medicine · Muscle thickness * Kenneth M. Madden [email protected]; [email protected] 1
Gerontology and Diabetes Research Laboratory, Division of Geriatric Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
2
Centre for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada
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