Functional and Clinical Characteristics for Predicting Sarcopenia in Institutionalised Older Adults: Identifying Tools for Clinical Screening

Maria A Cebrià I Iranzo, Anna Arnal-Gómez, Maria A Tortosa-Chuliá, Mercè Balasch-Bernat, Silvia Forcano, Trinidad Sentandreu-Mañó, Jose M Tomas, Natalia Cezón-Serrano, Maria A Cebrià I Iranzo, Anna Arnal-Gómez, Maria A Tortosa-Chuliá, Mercè Balasch-Bernat, Silvia Forcano, Trinidad Sentandreu-Mañó, Jose M Tomas, Natalia Cezón-Serrano

Abstract

Background: Recently, the European Working Group on Sarcopenia in Older People (EWGSOP2) has updated the sarcopenia definition based on objective evaluation of muscle strength, mass and physical performance. The aim of this study was to analyse the relationship between sarcopenia and clinical aspects such as functionality, comorbidity, polypharmacy, hospitalisations and falls in order to support sarcopenia screening in institutionalised older adults, as well as to estimate the prevalence of sarcopenia in this population using the EWGSOP2 new algorithm.

Methods: A multicentre cross-sectional study was conducted on institutionalised older adults (n = 132, 77.7% female, mean age 82 years). Application of the EWGSOP2 algorithm consisted of the SARC-F questionnaire, handgrip strength (HG), appendicular skeletal muscle mass index (ASMI) and Short Physical Performance Battery (SPPB). Clinical study variables were: Barthel Index (BI), Abbreviated Charlson's Comorbidity Index (ACCI), number of medications, hospital stays and falls.

Results: Age, BI and ACCI were shown to be predictors of the EWGSOP2 sarcopenia definition (Nagelkerke's R-square = 0.34), highlighting the ACCI. Sarcopenia was more prevalent in older adults aged over 85 (p = 0.005), but no differences were found according to gender (p = 0.512).

Conclusion: BI and the ACCI can be considered predictors that guide healthcare professionals in early sarcopenia identification and therapeutic approach.

Keywords: clinical; functionality; institutionalised; older adults; sarcopenia.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Sarcopenia: EWSGOP2 algorithm for case-finding, diagnosis and quantification of severity in practice.
Figure 2
Figure 2
Percentages of no sarcopenia and severity sarcopenia levels (EWSGOP2, 2019) according to gender: no sarcopenia, probable sarcopenia, and severe sarcopenia.

References

    1. United Nations, Department of Economic and Social Affairs Population Division. World population prospects: The 2017 revision, Key findings and Advance Tables, 2017. Working Paper No. ESA/P/WP/248. [(accessed on 24 April 2020)]; Available online: .
    1. Bauer J.M., Kaise M.J., Sieber C.C. Sarcopenia in nursing home residents. J. Am. Med. Dir. Assoc. 2008;9:545–551. doi: 10.1016/j.jamda.2008.04.010.
    1. Cruz-Jentoft A.J., Landi F., Schneider S.M., Zúñiga C., Arai H., Boirie Y., Chen L.K., Fielding R.A., Martin F.C., Michel J.P., et al. Prevalence of and interventions for sarcopenia in ageing adults: A systematic review. Report of the International Sarcopenia Initiative (EWGSOP and IWGS) Age Ageing. 2014;43:748–759. doi: 10.1093/ageing/afu115.
    1. Malafarina V., Uriz-Otano F., Gil-Guerrero L. Nutritional assessment and treatment of sarcopenia. Rev. Esp. Geriatr. Gerontol. 2013;48:153–154. doi: 10.1016/j.regg.2013.03.005.
    1. Cruz-Jentoft A.J., Baeyens J.P., Bauer J.M., Boirie Y., Cederholm T., Landi F., Martin F.C., Michel J.P., Rolland Y., Schneider S.M., et al. European Working Group on Sarcopenia in Older People. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010;39:412–414. doi: 10.1093/ageing/afq034.
    1. Witham M.D., Stott D.J. A new dawn for sarcopenia. Age Ageing. 2019;48:2–3. doi: 10.1093/ageing/afy171.
    1. Cruz-Jentoft A.J., Bahat G., Bauer J., Boirie Y., Bruyère O., Cederholm T., Cooper C., Landi F., Rolland Y., Sayer A.A., et al. Sarcopenia: Revised European consensus on definition and diagnosis. Age Ageing. 2019;48:16–31. doi: 10.1093/ageing/afy169.
    1. Lauretani F., Russo C.R., Bandinelli S., Cavazzini C., di Iorio A., Corsi A.M., Rantanen T., Guralnik J.M., Ferrucci L. Age-associated changes in skeletal muscles and their effect on mobility: An operational diagnosis of sarcopenia. J. Appl. Physiol. 2003;95:1851e60. doi: 10.1152/japplphysiol.00246.2003.
    1. Luppa M., Luck T., Weyerer S., König H.H., Brähler E., Riedel-Heller S.G. Prediction of institutionalization in the elderly. A systematic review. Age Ageing. 2010;39:31–38. doi: 10.1093/ageing/afp202.
    1. Marzetti E., Calvani R., Tosato M., Cesari M., di Bari M., Cherubini A., Collamati A., d’Angelo E., Pahor M., Bernabei R., et al. Sarcopenia: An overview. Aging Clin. Exp. Res. 2017;29:11–17. doi: 10.1007/s40520-016-0704-5.
    1. Landi F., Calvani R., Cesari M., Tosato M., Martone A.M., Ortolani E., Savera G., Salini S., Sisto A., Picca A., et al. Sarcopenia: An overview on current definitions, diagnosis and treatment. Curr. Protein Pept. Sci. 2018;19:633–638. doi: 10.2174/1389203718666170607113459.
    1. Cruz-Jentoft A.J., Landi F., Topinková E., Michel J.P. Understanding sarcopenia as a geriatric syndrome. Curr. Opin. Clin. Nutr. Metab. Care. 2010;13:1–7. doi: 10.1097/MCO.0b013e328333c1c1.
    1. Silva T.A.A., Frisoli Junior A., Pinheiro M.M., Szejnfeld V.L. Sarcopenia and aging: Etiological aspects and therapeutic options. Rev. Bras. Reumatol. 2006;46:391–397.
    1. Bahat G., Yilmaz O., Oren M.M., Karan M.A., Reginster J.Y., Bruyère O., Beaudart C. Cross-cultural adaptation and validation of the SARC-F to assess sarcopenia: Methodological report from European Union Geriatric Medicine Society Sarcopenia Special Interest Group. Eur. Geriatr. Med. 2018;9:23–28. doi: 10.1007/s41999-017-0003-5.
    1. Bravo-José P., Moreno E., Espert M., Romeu M., Martínez P., Navarro C. Prevalence of sarcopenia and associated factors in institutionalised older adult patients. Clin. Nutr. ESPEN. 2018;27:113–119. doi: 10.1016/j.clnesp.2018.05.008.
    1. Rodríguez-Rejón A.I., Artacho R., Puerta A., Zúñiga A., Ruiz-López M.D. Diagnosis of sarcopenia in long-term care homes for the ederly: The sensitivity and specificity of two simplified algorithms with respect to the EWGSOP Consensus. J. Nutr. Health Aging. 2018;22:796–801. doi: 10.1007/s12603-018-1004-x.
    1. Kurosawa Y., Hara K., Tohara H., Namiki C., Chantaramanee A., Nakane A., Nagakawa K., Yamaguchi K., Yoshimi K., Furuya J., et al. Calf circumference is a useful index for assessing dysphagia. Tohoku J. Exp. Med. 2019;248:201–208. doi: 10.1620/tjem.248.201.
    1. Tufan A., Bahat G., Ozkaya H., Taşcıoğlu D., Tufan F., Saka B., Akin S., Karan M.A. Low skeletal muscle mass index is associated with function and nutritional status in residents in a Turkish nursing home. Aging Male. 2016;19:182–186. doi: 10.1080/13685538.2016.1188069.
    1. Shiraishi A., Yoshimura Y., Wakabayashi H., Tsuji Y. Prevalence of stroke-related sarcopenia and its association with poor oral status in post-acute stroke patients: Implications for oral sarcopenia. Clin. Nutr. 2018;37:204–207. doi: 10.1016/j.clnu.2016.12.002.
    1. Lobo A., Saz P., Marcos G., Día J.L., de la Cámara C., Ventura T., Morales Asín F., Pascual L.F., Montañés J.A., Aznar S., et al. Revalidación y normalización del Mini-Examen Cognoscitivo (primera versión en castellano del Mini-Mental Status Examination) en la población general geriátrica. Med. Clin. 1999;112:767–774.
    1. Malmstrom T.K., Miller D.K., Simonsick E.M., Ferrucci L., Morley J.E. SARC-F: A symptom score to predict persons with sarcopenia at risk for poor functional outcomes. J. Cachexia Sarcopenia Muscle. 2016;7:28–36. doi: 10.1002/jcsm.12048.
    1. Roberts H.C., Denison H.J., Martin H.J., Patel H.P., Syddall H., Cooper C., Sayer A.A. A review of the measurement of grip strength in clinical and epidemiological studies: Towards a standardised approach. Age Ageing. 2011;40:423–429. doi: 10.1093/ageing/afr051.
    1. Dodds R.M., Syddall H.E., Cooper R., Benzeval M., Deary I.J., Dennison E.M., Der G., Gale C.R., Inskip H.M., Jagger C., et al. Grip strength across the life course: Normative data from twelve British studies. PLoS ONE. 2014;9:e113637. doi: 10.1371/journal.pone.0113637.
    1. Landi F., Liperoti R., Fusco D., Mastropaolo S., Quattrociocchi D., Proia A., Russo A., Bernabei R., Onder G. Prevalence and Risk Factors of Sarcopenia Among Nursing Home Older Residents. J. Gerontol. Ser. A Biol. Sci. Med. Sci. 2012;67:48–55. doi: 10.1093/gerona/glr035.
    1. Sergi G., de Rui M., Veronese N., Bolzetta F., Berton L., Carraro G., Bano G., Coin A., Manzato E., Perissinotto E. Assessing appendicular skeletal muscle mass with bioelectrical impedance analysis in free-living Caucasian older adults. Clin. Nutr. 2015;34:667–673. doi: 10.1016/j.clnu.2014.07.010.
    1. Working group on functional outcome measures for clinical trials Functional outcomes for clinical trials in frail older persons: Time to be moving. J. Gerontol. Ser. A Biol. Sci. Med. Sci. 2008;63:160–164. doi: 10.1093/gerona/63.2.160.
    1. Studenski S., Perera S., Patel K. Gait speed and survival in older adults. JAMA. 2011;305:50–58. doi: 10.1001/jama.2010.1923.
    1. Guralnik J.M., Simonsick E.M., Ferrucci L., Glynn R.J., Berkman L.F., Blazer D.G., Scherr P.A., Wallace R.B. A short physical performance battery assessing lower extremity function: Association with self-reported disability and prediction of mortality and nursing home admission. J. Gerontol. 1994;49:M85–M94. doi: 10.1093/geronj/49.2.M85.
    1. Koo T.K., Li M.Y. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J. Chiropr. Med. 2016;15:155–163. doi: 10.1016/j.jcm.2016.02.012.
    1. Batzan J.J., Pérez del Molino J., Alarcón T., San Cristobal E., Izquierdo G., Manzarbeitia J. Indice de Barthel: Instrumento válido para la valoración funcional de pacientes con enfermedad cerebrovascular. Rev. Esp. Geriatr. Gerontol. 1993;28:32–40.
    1. Madruga F., Castellote F.J., Serrano F., Pizarro A., Luengo C., Jiménez E.F. Índice de Katz y escala de Barthel como indicadores de respuesta funcional en el anciano. Rev. Esp. Geriatr. Gerontol. 1992;27:130.
    1. Shah S., Vanclay F., Cooper B. Improving the sensitivity of the Barthel Index for stroke rehabilitation. J. Clin. Epidemiol. 1989;42:703–709. doi: 10.1016/0895-4356(89)90065-6.
    1. Berkman L.F., Leo-Summers L., Horwitz R.I. Emotional support and survival after myocardial infarction. A prospective, population-based study of the elderly. Ann. Intern. Med. 1992;117:1003–1009. doi: 10.7326/0003-4819-117-12-1003.
    1. Rodríguez-Rejón A.I., Ruiz-López M.D., Artacho Martín-Lagos R. Diagnóstico y prevalencia de sarcopenia en residencias de mayores: EWGSOP2 frente al EWGSOP1. Nutr. Hosp. 2019;36:1074–1080. doi: 10.20960/nh.02573.
    1. Woo J., Leung J., Morley J.E. Validating the SARC-F: A suitable community screening tool for sarcopenia? JAMDA. 2014;15:630–634. doi: 10.1016/j.jamda.2014.04.021.
    1. Ida S., Murata K., Nakadachi D., Ishihara Y., Imataka K., Uchida A., Monguchi K., Kaneko R., Fujiwara R., Takahashi H. Development of a Japanese version of the SARC-F for diabetic patients: An examination of reliability and validity. Aging Clin. Exp. Res. 2017;29:935–942. doi: 10.1007/s40520-016-0668-5.
    1. Parra-Rodríguez L., Szlejf C., García-González A.I., Malmstrom T.K., Cruz-Arenas E., Rosas-Carrasco O. Cross-cultural adaptation and validation of the Spanish-language version of the SARC-F to assess sarcopenia in Mexican community-dwelling older adults. J. Am. Med. Dir. Assoc. 2016;17:1142e1146. doi: 10.1016/j.jamda.2016.09.008.
    1. Wu T.Y., Liaw C.K., Chen F.C., Kuo K.L., Chie W.C., Yang R.S. Sarcopenia screened with SARC-F questionnaire is associated with quality of life and 4-year mortality. J. Am. Med. Dir. Assoc. 2016;17:1129e1135. doi: 10.1016/j.jamda.2016.07.029.
    1. Cawthon P.M., Peters K.W., Shardell M.D., McLean R.R., Dam T.T.L., Kenny A.M., Fragala M.S., Harris T.B., Kiel D.P., Guralnik J.M., et al. Cutpoints for low appendicular lean mass that identify older adults with clinically significant weakness. J Gerontol. A Biol. Sci. Med. Sci. 2014;69:567–575. doi: 10.1093/gerona/glu023.
    1. Gould H., Brennan S.L., Kotowicz M.A., Nicholson G.C., Pasco J.A. Total and appendicular lean mass reference ranges for Australian men and women: The geelong osteoporosis study. Calcif. Tissue Int. 2014;94:363–372. doi: 10.1007/s00223-013-9830-7.
    1. Baumgartner R.N., Koehler K.M., Gallagher D., Romero L., Heymsfield S.B., Ross R.R., Garry P.J., Lindeman R.D. Epidemiology of sarcopenia among the elderly in New Mexico. Am. J. Epidemiol. 1998;147:755–763. doi: 10.1093/oxfordjournals.aje.a009520.
    1. Frisoli A., Chaves P.H., McNeill Ingham S.J., Fried L.P. Severe osteopenia and osteoporosis, sarcopenia, and frailty status in community-dwelling older women: Results from the women’s health and aging study (WHAS) II. Bone. 2011;48:952–957. doi: 10.1016/j.bone.2010.12.025.
    1. Sanada K., Miyachi M., Tanimoto M., Yamamoto K., Murakami H., Okumura S., Gando Y., Suzuki K., Tabata I., Higuchi M. A cross-sectional study of sarcopenia in Japanese men and women: Reference values and association with cardiovascular risk factors. Eur. J. App. Physiol. 2010;110:57–65. doi: 10.1007/s00421-010-1473-z.
    1. Kim K.M., Jang H.C., Lim S. Differences among skeletal muscle mass indices derived from height-, weight-, and body mass index-adjusted models in assessing sarcopenia. Korean J. Intern. Med. 2016;31:643–650. doi: 10.3904/kjim.2016.015.
    1. Beaudart C., Rolland Y., Cruz-Jentoft A.J., Bauer J.M., Sieber C., Cooper C., Al-Daghri N., Araujo de Carvalho I., Bautmans I., Bernabei R., et al. Assessment of muscle function and physical performance in daily clinical practice. Calcif. Tissue Int. 2019;105:1–14. doi: 10.1007/s00223-019-00545-w.
    1. Janssen I., Heymsfield S.B., Ross R. Low relative skeletal muscle mass (sarcopenia) in older persons Is associated with functional impairment and physical disability. J. Am. Geriatr. Soc. 2002:50. doi: 10.1046/j.1532-5415.2002.50216.x.
    1. Yang M., Liu Y., Zuo Y., Tang H. Sarcopenia for predicting falls and hospitalization in community-dwelling older adults: EWGSOP versus EWGSOP2. Sci. Rep. 2019;9:17636. doi: 10.1038/s41598-019-53522-6.
    1. Vieira E.R., Palmer R.C., Chaves P.H. Prevention falls in older living in the community. BMJ. 2016;353:i1419. doi: 10.1136/bmj.i1419.
    1. Vellas B.J., Guigoz Y., Garry P.J., Albarede J.L., editors. The Mini Nutritional Assessment: MNA. 3rd ed. Serdi Publishing; Paris, France: 1997.
    1. Rolfson D.B., Majumdar S.R., Tsuyuki R.T., Tahir A., Rockwood K. Validity and reliability of the Edmonton Frail Scale. Age Ageing. 2006;35:526–529. doi: 10.1093/ageing/afl041.
    1. Beaudart C., Zaaria M., Pasleau F., Reginster J.Y., Bruyère O. Health outcomes of sarcopenia: A systematic review and meta-analysis. PLoS ONE. 2017;12:e0169548. doi: 10.1371/journal.pone.0169548.
    1. Sánchez-Rodríguez D., Marco E., Miralles R., Guillén-Solà A., Vázquez-Ibar O., Escalada F., Muniesa J. Does gait speed contribute to sarcopenia case-finding in a postacute rehabilitation setting? Arch. Gerontol. Geriatr. 2015;61:176–181. doi: 10.1016/j.archger.2015.05.008.
    1. Landi F., Cruz-Jentoft A.J., Liperoti R., Russo A., Giovannini A., Tosato M., Capoluongo E., Bernabei R., Onder G. Sarcopenia and mortality risk in frail older persons aged 80 years and older: Results from ilSIRENTE study. Age Ageing. 2013;42:203–209. doi: 10.1093/ageing/afs194.
    1. Rodríguez-Rejón A.I., Ruiz-López M.D., Wanden-Berghe C., Artacho R. Prevalence and diagnosis of sarcopenia in residential facilities: A systematic review. Adv. Nutr. 2019;10:51–58. doi: 10.1093/advances/nmy058.
    1. Salvà A., Serra-Rexach J.A., Artaza I., Formiga F., Rojano I., Luque X., Cuesta F., López-Soto A., Masanés F., Ruiz D., et al. Prevalence of sarcopenia in Spanish nursing homes: Comparison of the results of the ELLI study with other populations. Rev. Esp. Geriatr. Gerontol. 2016;51:260–264. doi: 10.1016/j.regg.2016.02.004.
    1. Smoliner C., Sieber C.C., Wirth R. Prevalence of sarcopenia in geriatric hospitalized patients. J. Am. Med. Dir. Assoc. 2014;15:267e72. doi: 10.1016/j.jamda.2013.11.027.

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