ReviewSarcopenia in Nursing Home Residents
Section snippets
Definitions of Sarcopenia
At present, there is still no consensus definition of this syndrome. According to Baumgartner et al,12 sarcopenia is diagnosed when the muscle mass of an elderly individual falls below the second standard deviation of a young reference population. Baumgartner and coworkers measured muscle mass by dual energy x-ray absorptiometry (DEXA). In analogy to the body mass index, they used the ratio of appendicular muscle mass and squared body height (Table 1).
Alternatively, Janssen et al9 estimated
Practical Approaches Toward a Diagnosis of Sarcopenia in Nursing Home Residents
Taking the above-mentioned difficulties into account, a more practical approach toward the diagnosis of sarcopenia is warranted in this population. Anthropometric measurements have to be regarded as first choice under these circumstances.
In elderly persons, one has to be aware that steady or even increasing weight often masks the loss of muscle mass. This may be especially true for nursing home residents. Therefore, body mass index (BMI) measurement alone is not a reliable indicator of
Prevalence of Low Muscle Mass in Nursing Home Residents
Up to now, anthropometric parameters have been used to estimate muscle mass in the nursing home population. The number of residents included varied between 16 and 227 participants. As mentioned before, not a single study was performed applying the criteria for diagnosing sarcopenia introduced by Baumgartner and Janssen.
An early study in 1980 on 115 nursing home residents in the United States found a prevalence of 85% for low arm muscle circumference, thus pointing toward a high prevalence of
Pathophysiology
The pathophysiology of sarcopenia is complex and at present there is no concept that integrates all the potential causal factors in one model. There is a series of internal and external processes that contribute to the development of sarcopenia (Table 2). With regard to internal processes, the most important influences are a reduction of anabolic hormones (testosterone, estrogens, growth hormone, insulin like growth factor-1), an increase of proinflammatory cytokines (especially TNF α, IL-6),
Treatment Options for Sarcopenia in Nursing Home Inhabitants
Treatment options in sarcopenic nursing home inhabitants comprise physical training, modifications of nutritional intake, and pharmacological substances (Table 3).
Training
The participation in activities of daily living may be regarded as a first step toward stabilization of the individual level of physical performance. Residents should be regularly encouraged by the nursing staff to use their capabilities in doing so.
Physical exercise has been proven successful for the treatment of sarcopenia in the community-dwelling elderly.31 In nursing home inhabitants, only a very limited number of intervention studies have addressed muscle mass and muscle strength. In
Nutrition
Adequate nutritional intake has to be regarded as a fundamental prerequisite for any successful therapeutic regime in sarcopenic elderly persons. To ensure this, the individual caloric demand has to be calculated and the appropriate meal size has to be provided for all nursing home residents. If oral intake is inadequate or weight loss is documented, potential causes have to be considered. A more detailed discussion of the diagnosis and therapy of malnutrition is beyond the scope of this
Pharmacological Therapy
Testosterone has repeatedly been shown to increase muscle mass in elderly men and in most studies it also increased muscle strength.61 These effects did not correspond regularly with a benefit in functionality. To our knowledge, there are no studies that specifically addressed testosterone application in men who lived in nursing homes or long-term care. The relevance of the above-mentioned studies for the male nursing home population is uncertain and therefore there is no clear indication for
General Recommendations
Acute and chronic inflammatory conditions like infections of the urinary and respiratory tract, rheumatoid arthritis, or inflammatory bowel disease cause catabolic effects on muscle mass. Therefore, they should be treated resolutely in the elderly sarcopenic nursing home resident. In this context, it should also be reflected that corticosteroids may have negative effects on muscle mass and muscle strength and should be given only over a short period of time, if possible.
Hypo- and
Conclusion
Further studies on sarcopenia in nursing home inhabitants are necessary to clarify its impact on morbidity and mortality in this population. The optimal approach for successful intervention still needs to be evaluated. Apart from this, the creation of a widely accepted working definition in line with a standard diagnostic procedure for sarcopenia would be the first steps into the right direction of bringing this issue to relevance for those colleagues that care for nursing home patients.
References (73)
Summary comments
Am J Clin Nutr
(1989)- et al.
Do objective measurements of physical function in ambulatory nursing home women improve assessment of functional status?
J Am Med Dir Assoc
(2007) - et al.
Dietary intake and biochemical indicators of nutritional status in an elderly institutionalized and non-institutionalized population
Nutr Research
(1999) Weight loss in the nursing home
J Am Med Dir Assoc
(2007)- et al.
Is weight loss in the nursing home a reversible problem?
J Am Med Dir Assoc
(2006) - et al.
Cachexia: Pathophysiology and clinical relevance
Am J Clin Nutr
(2006) - et al.
Determinants of vitamin D levels in nursing home residents
J Am Med Dir Assoc
(2007) - et al.
Pharmacological treatment of geriatric cachexia: Evidence and safety in perspective
J Am Med Dir Assoc
(2007) - et al.
Aging does not impair the anabolic response to a protein-rich meal
Am J Clin Nutr
(2007) - et al.
Essential amino acids are primarily responsible for the amino acid stimulation of muscle protein anabolism in healthy elderly adults
Am J Clin Nutr
(2003)
Effect of amino acid supplementation on muscle mass, strength and physical function in elderly
Clin Nutr
Vitamin D deficiency in residents of academic long-term care facilities despite having been prescribed vitamin D
J Am Med Dir Assoc
Vitamin D deficiency in residents of academic long-term care facilities despite having been prescribed vitamin D
J Am Med Dir Assoc
Higher 25-hydroxyvitamion D concentrations are associated with better lower-extremity function in both active and inactive persons > or = 60 y
Am J Clin Nutr
Should all long-term care residents receive vitamin D?
J Am Med Dir Assoc
Andropause: a quality-of-life issue in older males
Med Clin North Am
The effect of megestrol acetate on oral food and fluid intake in nursing home residents: A pilot study
J Am Med Dir Assoc
Orexigenic and anabolic agents
Clin Geriatr Med
Attenuation of skeletal muscle and strength in the elderly: The Health ABC Study
J Appl Physiol
Handgrip strength among nonagenarians and centenarians in three European regions
J Gerontol A Biol Sci Med Sci
Epidemiology of sarcopenia
J Am Geriatr Soc
Sarcopenia: Effects on body composition and function
J Gerontol A Biol Sci Med Sci
Sarcopenia and sarcopenic-obesity
The loss of skeletal muscle strength, mass, and quality in older adults: The Health, Aging and Body Composition Study
J Gerontol A Biol Sci Med Sci
Mitochondrial abnormalities are more frequent in muscles undergoing sarcopenia
J Appl Physiol
Low relative skeletal muscle mass (sarcopenia) in older persons is associated with functional impairment and physical disability
J Am Geriatr Soc
Functional impact of relative versus absolute sarcopenia in healthy older women
J Am Geriatr Soc
The healthcare costs of sarcopenia in the United States
J Am Geriatr Soc
Epidemiology of sarcopenia among the elderly in New Mexico
Am J Epidemiol
Estimation of skeletal muscle mass by bioelectrical impedance analysis
J Appl Physiol
Nutritional parameters, body composition, and progression of disability in older disabled residents living in nursing homes
J Gerontol A Biol Sci Med Sci
New norms of upper limb fat and muscle areas for assessment of nutritional status
Am J Clin Nutr
A longitudinal study on the nutritional state of elderly women at a nursing home in Japan
Intern Med
Sarcopenia, calf circumference, and physical function of elderly women: A cross-sectional study
J Am Geriatr Soc
Age-associated changes in skeletal muscles and their effect on mobility: An operational diagnosis of sarcopenia
J Appl Physiol
Cited by (108)
Prevalence of physical and oral frailty in geriatric patients in Kerala, India
2024, Journal of Oral Biology and Craniofacial ResearchExercise Guidelines to Counteract Physical Deconditioning in Long-Term Care Facilities: What to Do and How to Do It?
2023, Journal of the American Medical Directors AssociationLife-Space Mobility in Aged Care Residents: Frailty In Residential Sector over Time (FIRST) Study Findings
2022, Journal of the American Medical Directors AssociationFrailty, sarcopenia and health related outcomes among elderly patients in Saudi Arabia
2021, Saudi Journal of Biological SciencesConsiderations for the optimal management of antibiotic therapy in elderly patients
2020, Journal of Global Antimicrobial ResistanceImpact of drugs with anti-inflammatory effects on skeletal muscle and inflammation: A systematic literature review
2018, Experimental GerontologyCitation Excerpt :Three articles using NSAIDs showed evidence for a reduction in the number of inflammatory markers; in addition, an improvement in some muscle performance parameters was observed (EMS, GW and FR), and, in animals, protection from muscle mass loss. However, the use of fosinopril could not confirm a beneficial effect on inflammation and physical performance that earlier observations had suggested (Bauer et al., 2008; Brull et al., 2002; Carter et al., 2004; Cohn et al., 2007; Onder et al., 2002; Sumukadas et al., 2008, 2007, 2006; Witham et al., 2008). Future specially designed intervention trials are needed to evaluate other drugs for long-term treatment with anti-inflammatory effects for their action on muscle mass and performance.