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Introduction to Sarcopenia and frailty
This document provides an introduction to sarcopenia and frailty in older adults. It discusses how sarcopenia is the loss of muscle mass and strength that occurs with age, impacting physical function. Prevalence of sarcopenia increases with age and for those in long-term care facilities. Frailty is a geriatric syndrome characterized by increased vulnerability to stressors and reduced physiological reserves, putting older adults at higher risk for adverse health outcomes like falls and disability. Frailty varies in severity and can be assessed using tools measuring factors like gait speed, weight loss, exhaustion and physical activity levels. While both sarcopenia and frailty are linked to aging, lifestyle interventions around exercise and nutrition may help reduce their negative impacts.
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Introduction to Sarcopenia and frailty
- 1. Introduction to sarcopenia andfrailty Dr Mary Hickson Research Dietitian, Imperial College Healthcare NHS Trust Adjunct Professor, Imperial College London 1
- 2. Declarations • Consultancy: AbbottNutrition, Danone • Research grants: Abbott Nutrition, Danone • Speaker Honoraria: Nestlé, Danone 2
- 3. How many oldpeople are there? http://www.statistics.gov.uk/cci/nugget.asp?id=763
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- 5. What is theimpact on people? Increased risk of: • Morbidity • Disability • Frailty • Mortality
- 6. How much doesit cost? USA, 2000
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- 8. Loss of strength 8 TheRole of Protein and Amino Acids in Sustaining and Enhancing Performance (1999) Institute of Medicine.
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- 10. Sarcopenia is theloss of muscle mass and strength and corresponding loss of physical function that occurs with advancing age
- 11. Table 1 Comparison ofsarcopenia definitions EWGSOP European Working Group of Sarcopenia in Older Persons, SCWD Sarcopenia, Cachexia and Wasting Disorders, IANA International Association of Nutrition and Aging) 11 Definition Function Muscle mass SIG: cachexia-anorexia in chronic wasting disease Gait speed <0.8 m/s, OR other physical performance test Low muscle mass (2SD) EWGSOP Gait speed <0.8 m/s; grip strength 30 kg males, 20 kg females Low muscle mass (not defined) IWGS Sarcopenia Task Force Gait speed <1.0 m/s, grip strength Low appendicular lean mass (<7.23 kg/m 2 in men, 5.67 in women) Sarcopenia with limited mobility (SCWD) 6 min walk <400 m, OR gait speed <1.0 m/s Low appendicular lean mass/height 2 Asian Working Group for Sarcopenia Gait speed <0.8 m/s; grip strength 26 kg males, 18 kg females Low appendicular lean mass/height 2 Foundation for the National Institutes of Health Gait speed <0.8 m/s; grip strength 26 kg males, 16 kg females Appendicular lean mass/BMI
- 12. A life coursemodel of sarcopenia12 Disability threshold
- 13. • Increases withage • No difference between men and women • 1–29% (up to 30% in women) for older adults living in the community • 14–33% (up to 68% in men) for those living in long-term care institutions • 10% for those in acute hospital care Prevalence Cruz-Jentoft, (2014) Prevalence of and interventions for sarcopenia in ageing adults: a systematic review. Age and Ageing. 43:748-759.
- 14. • Lots ofinconsistencies in the methods of prevalence studies • Not many studies in some settings (acute hospital and long term care) • Only 18 studies overall • Reporting of age was inconsistent • It is not yet known what is the best cut off to use to diagnose muscle loss, strength or function. BUT
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- 16. Diagnosis: strength andfunction
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- 20. Cachexia • Cytokine-associated wasting •Loss of muscle (with or without loss of fat) • Cannot be fully reversed by conventional nutritional support and leads to progressive functional impairment • Associated with chronic diseases e.g. cancer, COPD, end-stage renal failure and congestive cardiac disease
- 21. Diagnosis of cachexia Page21 Evans et al. Clin Nutr (2008) 27, 793-799
- 22. Mechanisms of musclewasting Page 22 Adapted from: Thomas DR Clin Nutr (2007) 26, 389-399 Malnutrition intake requirements Malabsorption
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- 25. • Frailty variesin severity; you are not frail – you have frailty • Frailty is not static; it can be made better and worse • Frailty is not an inevitable part of ageing; it is a long term condition Frailty
- 26. Definition • Multidimensional geriatricsyndrome • Increased vulnerability to stressors • Reduced capacity of physiological systems • Increased risk of adverse health-related outcomes – Biological abnormalities (e.g. biomarkers of inflammation) – Falls – Disability – Hospitalizations – Mortality
- 28. Epidemiology • Increases withage • More common in those over 80 years • Prevalence varies between different populations – 4.0 to 59.1% – 8.5% in women and 4.1% in men aged 65 –74 years (phenotype model) • Higher in southern Europe compared to northern Europe – Use of different operational definitions for frailty – Use of different inclusion and exclusion criteria
- 29. Cycle of frailty LindaP. Fried et al. J Gerontol A Biol Sci Med Sci 2001;56:M146-M157 The Gerontological Society of America
- 30. Diagnosis • Phenotype model(Fried et al) – At least three of five signs/symptoms • Poor muscle strength • Slow gait speed • Unintentional weight loss • Exhaustion • Sedentary behaviour • Deficit model (Rockwood et al) – Number of deficits that an individual has Number of deficits considered (30-100) – The closer to 1, the more frail the individual
- 33. Validated frailty tools •PRISMA 7 Questionnaire: >=3/7 = frailty • Walking speed (gait speed): <0.8m/s or taking >5 secs to walk 4m • Timed up and go test: >=10s to get up from a chair, walk 3m, turn round and sit down • FRAIL questionnaire screening tool • Clinical Frailty Scale • Gérontopôle Frailty Screening Tool
- 36. What can bereversed? • Personalised interventions • Evidence is lacking in many areas • Exercise is key – strength, balance • Nutrition has a role • Social, psychological and behavioural all important too • Pharmacology 36
- 38. Resources • Fit forFrailty: British Geriatrics Society guidance on the recognition and management of older patients with frailty in community and outpatient settings • www.acutefrailtynetwork.org.uk: NHS Elect • Acute medical care for frail older people: Royal College of Physicians • www.frailty.net: Implementing frailty into clinical practice38