Twenty years ago, the term “sarcopenia” – Greek for “poverty of flesh” – was coined to describe the muscle wasting that occurs with aging.
Often unnoticed, this condition can dramatically impact quality of life and independent living. Experts propose that muscle mass, strength and function should be assessed to diagnose sarcopenia.
Awareness of sarcopenia – affecting at least a third of older Australians – is slowly gaining momentum. So too are its wide-ranging effects on health, including its potential to cause type 2 diabetes.
New research suggests it could impact lung function and breast cancer risk.
Poor lung function can lead to respiratory complications like pneumonia and bronchitis as well as broader problems like heart disease and death.
Lungs rely on healthy muscles in the respiratory system, particularly the diaphragm, to help breathe in oxygen and expel carbon dioxide.
Handgrip strength is an easy, quick measure of muscle strength. The test involves simply squeezing a small object as hard as possible to measure the strength of your grip.
Handgrip strength is a useful indicator of general health, and has been related to nutrition status and walking ability. Also a useful indicator of low muscle mass, hand-grip strength can be used to diagnose sarcopenia.
Weak lung function has been linked to poor handgrip strength in hospitals or nursing homes. Korean researchers wanted to test if handgrip strength could predict lung function, measured using standard pulmonary (lung) function tests, in a national population study of healthy community-dwelling women aged 65-79.
They found that as handgrip strength declined, so did lung capacity – after adjusting for several other factors like age, education and physical activity levels.
The researchers suggest handgrip strength could be a useful public health tool for identifying potential impairment in lung function.
Sarcopenia and excess fat have been previously related to higher risk of mortality from metastatic (secondary) breast cancer.
Researchers from the United States and Canada recently investigated whether this was the case with nonmetastatic (primary) breast cancer. They measured muscle mass, muscle quality and fat in 3,241 women with stage 2 or 3 breast cancer, i.e. cancer that has not spread to other organs, and followed them up for at least 6 years.
A third of patients had sarcopenia, and they were 41 percent more likely to die early than those without sarcopenia. Women with highest amounts of fat were 35 percent more likely to die early than those with low fat levels.
Women who had lower muscle mass and higher levels of fat were 89 percent less likely to survive. Interestingly, body mass index (BMI; height/weight ratio) was not associated with survival.
It is possible, the researchers say, that women with more aggressive cancer may have lost more muscle mass early in their cancer as a result. Women with higher muscle mass may also have had healthier lifestyle habits more generally.
They suggest, however, that clinical measures of muscle mass and fat might help provide prognostic information to help guide treatment.
These studies build on evidence that says muscle matters – more than we might realise. Better health outcomes with aging can be achieved with simple lifestyle habits that embrace physical activity and good nutrition to prevent loss of muscle mass.
Thinking of malnutrition tends to generate images of starving people in third world countries. But malnutrition is silently affecting aging people at home. It afflicts a third of older adults admitted to hospital and over half of aged care residents – and it is often overlooked.
Malnutrition in aging can have serious consequences for physical and mental health, recovery from illness and quality of life. Prevention is best, so it is important to detect malnutrition early.
How can you tell if your loved one – whether it be partner, parent, grandparent or someone you care for – is malnourished or at risk for malnutrition? Here are some clues to be aware of.
The primary, most obvious symptom is weight loss. Technically malnutrition is defined as unintentionally losing 5-10% body weight over 3-6 months. Other indicators include baggy clothes and belts. Even loose jewellery (e.g. rings) and dentures are tell-tale signs.
Food provides calories and essential nutrients needed to produce energy. Not meeting nutritional needs through diet can result in tiredness, weakness and dizziness. A clue here could be reduced levels of mobility. Look out for diminished muscle mass – a risk factor for sarcopenia.
It’s commonly recognised that depression can affect people’s appetite. But nutrients from food – carbohydrates, protein, healthy fats, vitamins and minerals – are also vital for healthy brain function. Not getting enough can impact mood and even lead to major depression.
Aging and some medications can alter taste and appetite. Eating less can, in turn, reduce appetite. Strategies to provide tasty, nutrient-rich food, small meals and regular snacks can help mitigate this.
You can’t fool your dentist. Teeth and gums are a key indicator of nutrition and health status. Swollen or bleeding gums are early oral symptoms of malnutrition. If malnutrition progresses, it can cause irreversible tooth decay.
Check brushes and clothes for excess hair. Hair loss and lack lustre hair can reflect poor nutrition status, particularly insufficient protein and iron. Nails also become dry, brittle and discoloured if essential nutrients are lacking. When iron levels drop too low, nails can start curling upwards, signalling possible iron-deficiency anaemia.
Our immune system needs nutrients to prevent and ward off disease. Frequent illness and infections can reveal poor nutrition status. Also be on the watch for easy bruising and wounds that don’t heal easily.
Chronic constipation can signal insufficient food intake to mobilise the digestive tract; it can also reflect inadequate fibre and/or dehydration – common in older adults. Conversely, watch out for persistent diarrhoea because this can decrease nutrient absorption and exacerbate malnutrition.
Several strategies can prevent and alleviate malnutrition. Most important are regular meals and snacks containing protein and energy, a variety of food from the key food groups, and regular drinks to avoid dehydration.
Barriers and catalysts of eating need to be identified and addressed, and every effort made to help older people enjoy food and the enhanced wellbeing that it delivers.
One of our staff recently spoke with someone whose father is in an aged care facility. They discovered he had a hairline fracture in his hip – about a week after it happened. The nurse accidentally dropped him when she was helping him out of bed, and it wasn’t reported.
Around one in three older adults suffer from falls, and up to 60 percent will suffer an injury. Three times more people tumble in long-term aged care.
Most injuries are superficial cuts, grazes, bruises and sprains. Some are more serious. Falls cause 40 percent of injury-related deaths in older adults. Hip fractures are the most serious and costly fall-related injuries, resulting in 19,000 hospital admissions for older Australians from 2011 to 2012.
More broadly, falls – and fear of falling – can impact independence and quality of life. But it’s not a cross lotto. Older people can reduce their risk of falls with nutrition and exercise.
Assessment tools can predict risk of falls, to help tailor prevention strategies. These tend to assess physical capacity like mobility, balance, strength and gait. But nutrition status is also a key predictor for likelihood of falling and the gravity of injuries.
Malnutrition and low body weight result from depleted protein and energy stores. This carries multiple adverse outcomes including bone loss and fragility, poorer movement coordination, slower reaction time and diminished muscle strength – all of which increase risk of falling.
Low calcium and vitamin D impact bone health and risk of falls. Low vitamin K also increases bone fragility. Poor eyesight can compound propensity to fall, also impacted by nutrition status. Low levels of vitamins A, C and E contribute to weak vision.
Insufficient vitamin B12 and folic acid can reduce nerve function in extremities, and in the brain lead to confusion. Dehydration, a common problem in older adults, can also cause delirium, as well as constipation and low blood pressure; all increasing fall risk.
Providing a healthy, tasty diet high in protein from eggs, dairy, fish, chicken, nuts and legumes and a variety of foods from the core food groups is an important step towards preventing nutrient depletion and associated risk of falling.
Regular physical activity is important to reduce age-related loss in muscle mass and bone density. Recently, the SUNBEAM trial (Strength and Balance Exercise in Aged Care), tested a program of individually tailored physical activity in aged care.
The program reduced falls by 55 percent, larger than any other study to date according to lead investigator Jennie Hewitt, physiotherapist from Feros Care and PhD candidate at the University of Sydney.
Over 200 aged care residents from 16 facilities in New South Wales and Queensland took part – half of them were randomised to do the program and the other half continued normal activities.
Participants in the program engaged in 50 hours of group-based resistance (strength) training and balance activities over 25 weeks, then a six-month maintenance period.
Not only did falls decrease dramatically in the exercise program group, but participants had considerably better balance and mobility. Some found the enhanced independence life-changing, and rejoiced at being able to go out with their families.
It’s not just about falls; healthier lifestyles and greater mobility have positive ripple effects for happy aging.
Aging brings rewards and challenges. It can be a fulfilling time of rest and relaxation; enjoying respite from a life of working and raising children. It is also a time when the body starts its graceful decline. Unfortunately, this decline can bring various health problems, for instance loss of muscle mass. Age-related loss of muscle mass and strength is called sarcopenia.
Functional loss of muscle strength with age is not only associated with diminished quality of life and problems with activities of daily living; it can have serious effects including increased risk of falls, fractures, disability, hospitalisation and death. As well as aging, chronic diseases like diabetes factor among sarcopenia causes.
A recent review now suggests sarcopenia could even lead to type 2 diabetes.
Around 1 in 6 Australians over 65 suffer from diabetes, increasing to nearly 1 in 5 adults over 85. Type 2 diabetes makes up 90% of all cases, affecting one million Australians, 90% of whom are over 40. Unlike type 1 diabetes, an autoimmune disease, type 2 is associated with unhealthy lifestyle factors like poor diet, inactivity, smoking and obesity, and is therefore preventable.
Diabetes happens when there is too much glucose in the blood – either because the pancreas stops producing enough insulin (needed by most tissues to take up glucose), and/or because cells lose their capacity to take up glucose (become insulin resistant).
This can happen when the body is bombarded with too much sugar or refined carbohydrates, and the glucose receptors that let sugar into cells go on strike. The pancreas keeps producing insulin to try and lower blood sugar, and eventually wears itself out.
The body then goes into overdrive trying to keep blood sugar levels down, and the strain can cause a plethora of serious problems include heart attack, stroke, kidney damage, vision loss, nerve damage and poor wound healing – which can also result in amputation of limbs.
Sarcopenia research has been dominated by functional outcomes. But a recent review drew attention to possible metabolic consequences, focussing on various pathways that could lead to diabetes:
Therefore, the importance of preventing or reducing muscle loss and chronic disease with age cannot be understated. Prime targets are diet quality – particularly protein and vitamin D for muscle and generally a healthy diet to prevent chronic disease – and appropriately tailored physical activity.