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Sarcopenia is a common age-related disease that is known to have skeletal muscle loss which affects the muscle mass and strength. Sarcopenia is a major cause of frailty in older adults and has greatly impact their quality of life by reducing the ability to perform activities of daily living (ADLs). It leads to the loss of independence, self-confidence, and the need for long-term nursing care.
Even though sarcopenia is age-related, it does not happen only at old age. It is a process that manifests as you age. Starting from 30 to 40 years old, sarcopenia begins at a slow and inconspicuous rate (1 to 2%). Every decade, the loss can progressively range from 3 to 5%. After the age of 60, the rate of muscle loss increases to as high as 11 to 50%.
Interesting facts about sarcopenia
- Sarcopenia is more prominent in people aged 60 and above. It is estimated that 5–13% of elderly aged 60–70 years suffer sarcopenia. While the population increases to 11–50% for elderly aged 80 or above.
- Sarcopenia is more prevalent in males than females. Data in 2019 shows that the prevalence of sarcopenia was 19.2% in males and 8.6% in females.
- Obese person with sarcopenia is at higher risk of cardiovascular diseases and death as compared to non-obese person.
- The highest sarcopenia and sarcopenic obesity rates were found in Asian males (40.6%, 14.4%) and females (30.1%, 8.0%)
- Only 10-20% of older adults are diagnosed with sarcopenia. The rest are either healthy or not being diagnosed yet.
- Higher incident rates are reported in developed countries with significantly huge ageing population, for example, United States, Japan, Germany, South Korea, Italy, etc.
How it happens?
Sarcopenia is a condition that happens naturally as part of ageing. There are 4 major risk factors that play important roles in determining the severity and early onset of sarcopenia.
- Lifestyle
Inactive lifestyle (sedentary) is a common cause of loss of muscle mass and strength that eventually lead to sarcopenia.
- Diet
Over-consumption of unhealthy foods, weight loss supplements, reduced intake of foods, imbalanced diet, starvation, and so forth can cause malnutrition. Over time, it can develop into sarcopenia. - Physiology
Changes in hormone levels such as growth hormones, testosterone, insulin-like growth factor (IGF-1), androgen, and oestrogen could lead to the progression of sarcopenia.
- Obesity
Obesity is correlated with sedentary lifestyle. Sarcopenic obesity is a condition where an obese adult develops sarcopenia and exposed to a greater risk of cardiovascular and mortality.
What are the symptoms of sarcopenia?
Adults with sarcopenia often show the symptoms of overall weakness and low stamina. Other symptoms may include:
- Muscle frailty
- Reduced muscle mass
- Walking slowly with small steps
- Weak in climbing stairs
- Difficult in performing activities of daily living (ADLs)
- Poor balancing, and potential fall risk
What could make sarcopenia worse?
With the manifestation of the above symptoms, there are other things that can make the condition worse. For example:
- A fall
As your muscles become weak, you are unable to react fast. If you happen to trip on something or feel giddy out of a sudden, you can fall pretty hard on the floor or hit on hard objects. You may get a cut, bruise, or even bone fractures. - Prolonged bed rest
In the event of hospitalisation because of injuries or illnesses, the older you are, the more time is required for recovery. Prolonged bed rest can make you weak, the weaker you become, the less you want to move. The less you move, the more muscles you lose. This can take even longer to recover from sarcopenia. - Pressure ulcers
For many older adults, being immobalised on bed or wheel-chair can lead to the formation of pressure ulcers. This can be even more serious if you have diabetes where would healing is almost impaired.
- Personal Mobility Vehicle (PMV)
Nowadays, many elderly can enjoy short-distance traveling, thanks to the invention of PMV. However, there are also many ambulant adults who are in good health but riding electric scooter and PMV on daily basis. They are basically too reliant on these motorised vehicles and give up working out their muscles. Sooner or later, it will worsen the condition of sarcopenia.
Diagnosis for sarcopenia
The common tests to assess your muscle strength and performance are such as:
- Handgrip test
- Chair stand test
- Gait speed test
- Short physical performance battery (SPPB)
- Timed-up and go test (TUG)
In a healthcare setting, doctor may perform any of the following tests to measure your muscle mass:
- Dual-energy X-ray absorptiometry (DEXA)
- Bioelectrical Impedance Analysis (BIA)
- Computed Tomography (CT)
- Magnetic Resonance Imaging (MRI)
- Urinary Creatinine Excretion Rate (CER)
- Anthropometric assessments
- Neutron activation assessments
Treatments for sarcopenia
There are several treatment options that your healthcare professionals may prescribe if you are diagnosed with sarcopenia.
- Diet modification
Your dietitian usually advise you to eat more high-protein foods, such as cheese, milk, meat, fatty fish, eggs, tofu, soy products, and many more. Sometimes, supplements like essential amino acid (leucine), hydroxymethylbutyrate (HMB), whey, and vitamin D are also helpful in improving the muscle quality in elderly person. - Exercise
The loss of muscle mass is mostly reversible. Physiotherapist may recommend progressive resistance-based strength training such as sit ups, squats, push ups, leg raises, planks, resistance bands, weights, and so on to improve your strength, gait speed, and reverse your overall muscle loss. Other exercises include walking, stair climbing, swimming, Tai Chi Quan, yoga, etc. also help to prevent muscle loss in older adults. - Medication
Doctor or pharmacist may prescribe myostatin, exercise mimetics, anabolic hormones, enzyme/protein replacement therapy, ryanodine receptor, activin receptors, etc. to treat sarcopenia. Natural products such as ursolic acid in apples, tomatidine in unripe tomatoes, urolithin A in pomegranates are also very beneficial compounds.
Conclusion
Inevitably, your limbs will get weaker as you age. It is important to maintain an active lifestyle over an inactive one. Instead of fast-past exercises, you can adopt slow and leisure time exercises, such as stretching, walking, swimming, tai chi, yoga, etc.
If you are undergoing recovery from a surgery, try not to allow yourself to be bed ridden for too long. If possible, even walking with a crutch or walking frame will help you recover faster.
Aside from exercise and assistive devices, maintaining a healthy and balanced diet is equally important. Dietitian recommends that an average older adult needs about 1.2 to 1.5 grams of protein per kilogram of body weight daily. However, people with kidney disease should only consume 0.6 to 1.2 grams of protein per kilogram of body weight.
