Introduction to sarcopenia

and frailty

Dr Mary Hickson

Research Dietitian, Imperial College

Healthcare NHS Trust

Adjunct Professor, Imperial College

London

1

Declarations

• Consultancy: Abbott Nutrition, Danone

• Research grants: Abbott Nutrition, Danone

• Speaker Honoraria: Nestlé, Danone

2

How many old people are there?

http://www.statistics.gov.uk/cci/nugget.asp?id=763

Who is affected?

What is the impact on people?

Increased risk of:

• Morbidity

• Disability

• Frailty

• Mortality

How much does it cost?

USA, 2000

Loss of Mass

7

Loss of strength

8

The Role of Protein and Amino Acids in Sustaining and

Enhancing Performance (1999) Institute of Medicine.

Loss of performance

9

Sarcopenia is the loss of

muscle mass and strength

and corresponding loss of

physical function that

occurs with advancing

age

Table 1 Comparison of sarcopenia 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/m2 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/height2

Asian Working Group for

Sarcopenia

Gait speed <0.8 m/s; grip

strength 26 kg males, 18 kg

females

Low appendicular lean

mass/height2

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

A life course model of sarcopenia 12

Disability threshold

• Increases with age

• 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.

• Lots of inconsistencies 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

Stages of sarcopenia

Diagnosis: strength and function

Diagnosis: Muscle mass

Obesity and sarcopenia

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

Diagnosis of cachexia

Page 21

Evans et al. Clin Nutr

(2008) 27, 793-799

Mechanisms of muscle wasting

Page 22

Adapted from: Thomas DR Clin Nutr (2007) 26, 389-399

Malnutrition

intake

requirements

Malabsorption

Page 23

Malnutrition

Cachexia Sarcopenia

Frailty

• Frailty varies in 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

Definition

• Multidimensional geriatric syndrome

• 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

Epidemiology • Increases with age

• 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

Cycle of frailty

Linda P. Fried et al. J Gerontol A Biol Sci Med Sci

2001;56:M146-M157

The Gerontological Society of America

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

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

What can be reversed?

• 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

Resources

• Fit for Frailty: 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 practice 38