Resources for the Comprehensive Geriatric Assessment based
Proactive and Personalised Primary Care of the Elderly
Sarcopenia
Sarcopenia is a progressive and generalised skeletal muscle disorder that is associated with increased likelihood of adverse outcomes including falls, fractures, physical disability and mortality (1)
SARC-F
Strength, Ambulation, Rising from a chair, Stair climbing and history of Falling
Screening test for sarcopenia
5 min.
MSRA
Mini Sarcopenia Risk assessment
Screening test for sarcopenia
5 min.
Grip Strength
Grip Strength
Measurement of grip strength in the assessment of sarcopenia
5 min.
Chair Stand Test - 30 sec.
Timed Chair Stand Test
Strength and endurance test in the assessment of sarcopenia (risk of falls)
3 min.
4 Stage Balance Test
4 Stage Balance Test
Assessment of static balance in the assessment of sarcopenia (risk of falls)
3 min.
GST-4
Gait Speed Test (4 metre)
Simple assessment of functional mobility
5 min.
TUG Test
Timed Up and Go Test
Assessment of mobility, balance, walking ability, and fall risk in older adults
10 min.
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. (2)
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 (1)
Sarcopenia is now formally recognised as a muscle disease with an ICD-10-MC Diagnosis Code that can be used to bill for care in some countries (3,4)
EWGSOP2 emphasises that practitioners have ever-increasing possibilities for preventing, delaying, treating, and sometimes even reversing sarcopenia by way of early and effective interventions
OPERATIONAL DEFINITION
In its 2018 definition, EWGSOP2 uses low muscle strength as the primary parameter of sarcopenia; muscle strength is presently the most reliable measure of muscle function (Table 1).
Specifically, sarcopenia is probable when low muscle strength is detected.
A sarcopenia diagnosis is confirmed by the presence of low muscle quantity or quality. When low muscle strength, low muscle quantity/quality and low physical performance are all detected, sarcopenia is considered severe.
Table 1.
2018 operational definition of sarcopenia
Probable sarcopenia is identified by Criterion 1.
Diagnosis is confirmed by additional documentation of Criterion 2.
If Criteria 1, 2 and 3 are all met, sarcopenia is considered severe.
-
Low muscle strength
-
Low muscle quantity or quality
-
Low physical performance
CATEGORIES of SARCOPENIA and SARCOPENIA-LIKE CONDITIONS
Primary and secondary sarcopenia
In some individuals, sarcopenia is largely attributable to ageing; in many cases, other causes can be identified.
Sarcopenia is considered ‘primary’ (or age-related) when no other specific cause is evident, while sarcopenia is considered ‘secondary’ when causal factors other than (or in addition to) ageing are evident.
Sarcopenia can occur secondary to a systemic disease, especially one that may invoke inflammatory processes, e.g. malignancy or organ failure.
Physical inactivity also contributes to development of sarcopenia, whether due to a sedentary lifestyle or to disease-related immobility or disability (28).
Further, sarcopenia can develop as a result of inadequate intake of energy or protein, which may be due to anorexia, malabsorption, limited access to healthy foods or limited ability to eat.
Acute and chronic sarcopenia
EWGSOP2 newly identifies subcategories of sarcopenia as acute and chronic.
Sarcopenia that has lasted less than 6 months is considered an acute condition, while sarcopenia lasting ≥6 months is considered a chronic condition.
Acute sarcopenia is usually related to an acute illness or injury, while chronic sarcopenia is likely to be associated with chronic and progressive conditions and increases the risk of mortality.
This distinction is intended to underscore the need to conduct periodic sarcopenia assessments in individuals who may be at risk for sarcopenia in order to determine how quickly the condition is developing or worsening.
Such observations are expected to facilitate early intervention with treatments that can help prevent or delay sarcopenia progression and poor outcomes.
Sarcopenic obesity
Sarcopenic obesity is a condition of reduced lean body mass in the context of excess adiposity (29).
Sarcopenic obesity is most often reported in older people, as both risk and prevalence increase with age (30).
Obesity exacerbates sarcopenia, increases the infiltration of fat into muscle, lowers physical function and increases risk of mortality (31, 32, 33,34).
Malnutrition-associated sarcopenia
The sarcopenia phenotype is also associated with malnutrition, regardless of whether the malnourished condition is rooted in low dietary intake (starvation, inability to eat), reduced nutrient bioavailability (e.g. with diarrhea, vomiting) or high nutrient requirements (e.g. with inflammatory diseases such as cancer or organ failure with cachexia) (35, 36).
Low muscle mass has recently been proposed as part of the definition of malnutrition (37).
Also in malnutrition, low fat mass is usually present, which is not necessarily the case in sarcopenia (38, 39).
SARCOPENIA CASE FINDING, DIAGNOSIS and SEVERITY
SARC-F and MRSA are quick screening tests for sarcopenia.
The combined use of the 7-item SARC-F and MSRA improved the accuracy in sarcopenia diagnosis (Rossi AP, 2021).
Muscle strength, quality and performance may be tested with tools such as Grip Strength, Chair Stand - 30 sec., GST-4,
4 Stage Balance Test and TUG Test
Excercises for older people - Balance
NHS Choices UK.
Excercises for older people - Flexibility
NHS Choices UK.
Excercises for older people - Strength
NHS Choices UK.
Excercises for older people - Sitting
NHS Choices UK.