Muscle, Health and Costs: A Glance at their Relationship

D M Mijnarends, Y C Luiking, R J G Halfens, S M A A Evers, E L A Lenaerts, S Verlaan, M Wallace, J M G A Schols, J M M Meijers, D M Mijnarends, Y C Luiking, R J G Halfens, S M A A Evers, E L A Lenaerts, S Verlaan, M Wallace, J M G A Schols, J M M Meijers

Abstract

Objective: To assess the association between muscle parameters (mass, strength, physical performance) and activities of daily living (ADL), quality of life (QoL), and health care costs.

Design: Cross-sectional Maastricht Sarcopenia Study (MaSS).

Setting: Community-dwelling, assisted-living, residential living facility.

Participants: 227 adults aged 65 and older.

Measurements: Muscle mass, hand grip strength and physical performance were assessed by bio-electrical impedance, JAMAR dynamometer and the Short Physical Performance Battery, respectively. Health outcomes were measured by the Groningen Activity Restriction Scale (disability in ADL) and the EQ-5D-5L (QoL). Health care costs were calculated based on health care use in the past three months.

Results: Muscle strength and physical performance showed a strong correlation with ADL, QoL, and health care costs (P<.01); for muscle mass no significant correlations were observed. Regression analyses showed that higher gait speed (OR 0.06, 95%CI 0.01-0.55) was associated with a lower probability of ADL disability. Furthermore, slower chair stand (OR 1.23, 95%CI 1.08-1.42), and more comorbidities (OR 1.58, 95%CI 1.23-2.02) were explanatory factors for higher ADL disability. Explanatory factors for QoL and costs were: more disability in ADL (OR 1.26, 95%CI 1.12-1.41 for QoL; B = 0.09, P<.01 for costs) and more comorbidities (OR 1.44, 95%CI 1.14-1.82 for QoL; B = 0.35, P<.01 for costs).

Conclusion: Lower gait speed and chair stand were potential drivers of disability in ADL. Disability in ADL and comorbidities were associated with QoL and health care costs in community-dwelling older adults. Improving physical performance may be a valuable target for future intervention and research to impact health burden and costs.

Keywords: Muscle; activities of daily living; health care costs; quality of life.

Conflict of interest statement

This work was supported by Nutricia Research, Utrecht, the Netherlands. Study concept and design: Mijnarends, Halfens, Schols, Meijers, Verlaan, Luiking. Data acquisition: Mijnarends, Lenaerts. Statistical analyses and manuscript preparation: Mijnarends. Interpretation of data and critical revising: all. All authors read and approved the final manuscript.

Figures

Table 1
Table 1
Participant characteristics
Table 2
Table 2
Spearman correlations (r) between muscle, health and economic outcomes (n = 227)
Table 3
Table 3
Logistic regression: explanatory factors for activities of daily living (total group, n = 227)
Figure 1
Figure 1
Boxplots representing relation between muscle parameters and ADL, quality of life, and health care costs. Boxplots present the median (middle line) with IQR (boxes), the whiskers represent 1.5 times the IQR, outliers are indicated as circles, extreme outliers with a star
Figure 2
Figure 2
Schematic presentation of associations found between muscle, health and costs
Table 4
Table 4
Logistic regression: explanatory factors for quality of life (n = 227)
Table 5
Table 5
Linear regression: explanatory factors for health care costs (n = 227)

References

    1. Al Snih S, Markides KS, Ottenbacher KJ, Raji MA. Hand grip strength and incident ADL disability in elderly Mexican Americans over a seven-year period. Aging Clin Exp Res. 2004;16(6):481–6. doi: 10.1007/BF03327406.
    1. Cesari M, Rolland Y, van Abellan Kan G, Bandinelli S, Vellas B, Ferrucci L. Sarcopenia-related parameters and incident disability in older persons: results from the «Invecchiare in Chianti» study. J Gerontol A Biol Sci Med Sci. 2015;70(4):457–63. doi: 10.1093/gerona/glu181.
    1. Woo T, Yu S, Visvanathan R. Systematic literature review on the relationship between biomarkers of sarcopenia and quality of life in older people. J Frailty Aging. 2016;5(2):88–99.
    1. Cawthon PM, Fox KM, Gandra SR, Delmonico MJ, Chiou CF, Anthony MS, et al. Do muscle mass, muscle density, strength, and physical function similarly influence risk of hospitalization in older adults. J Am Geriatr Soc. 2009;57(8):1411–9. doi: 10.1111/j.1532-5415.2009.02366.x.
    1. Cawthon PM, Lui LY, McCulloch CE, Cauley JA, Paudel ML, Taylor B, et al. Sarcopenia and health care utilization in older women. J Gerontol A Biol Sci Med Sci. 2017;72(1):95–101. doi: 10.1093/gerona/glw118.
    1. Hirani V, Blyth F, Naganathan V L, Couteur DG, Seibel MJ, Waite LM, et al. Sarcopenia is associated with incident disability, institutionalization, and mortality in community-dwelling older men: the Concord Health and Ageing in Men Project. J Am Med Dir Assoc. 2015;16(7):607–13. doi: 10.1016/j.jamda.2015.02.006.
    1. Sousa AS, Guerra RS, Fonseca I, Pichel F, Ferreira S, Amaral TF. Financial impact of sarcopenia on hospitalization costs. Eur J Clin Nutr. 2016;70(9):1046–51. doi: 10.1038/ejcn.2016.73.
    1. Woo J, Leung J, Morley JE. Defining sarcopenia in terms of incident adverse outcomes. J Am Med Dir Assoc. 2015;16(3):247–52. doi: 10.1016/j.jamda.2014.11.013.
    1. Visser M, Schaap LA. Consequences of sarcopenia. Clin Geriatr Med. 2011;27(3):387–99. doi: 10.1016/j.cger.2011.03.006.
    1. Bianchi L, Ferrucci L, Cherubini A, Maggio M, Bandinelli S, Savino E, et al. The Predictive Value of the EWGSOP Definition of Sarcopenia: Results From the InCHIANTI Study. J Gerontol A Biol Sci Med Sci. 2016;71(2):259–64. doi: 10.1093/gerona/glv129.
    1. Mijnarends DM, Schols JM, Meijers JM, Tan FE, Verlaan S, Luiking YC, et al. Instruments to assess sarcopenia and physical frailty in older people living in a community (care) setting: similarities and discrepancies. J Am Med Dir Assoc. 2015;16(4):301–8. doi: 10.1016/j.jamda.2014.11.011.
    1. Mijnarends DM, Schols JMGA, Halfens RJG, Meijers JMM, Luiking YC, Verlaan S, et al. Burden-of-illness of Dutch community-dwelling older adults with sarcopenia: health related outcomes and costs. Eur Geriatr Med. 2016;7:276–84. doi: 10.1016/j.eurger.2015.12.011.
    1. Mijnarends D, Meijers J, Halfens R T, Borg S, Luiking Y, Verlaan S, et al. Rationale and design of a cross-sectional study of the prevalence, characterization and health and economic consequences of sarcopenia in community-dwelling older people in the Netherlands [abstract] J Nutr Health Aging. 2013;17(1):S245.
    1. Mijnarends DM, Meijers JMM, Halfens R T, Borg S, Luiking YC, Verlaan S, et al. Validity and reliability of tools to measure muscle mass, strength, and physical performance in community-dwelling older people: a systematic review. J Am Med Dir Assoc. 2013;14(3):170–8. doi: 10.1016/j.jamda.2012.10.009.
    1. Kyle UG, Bosaeus I D, Lorenzo AD, Deurenberg P, Elia M, Gomez JM, et al. Bioelectrical impedance analysis: Part I: Review of principles and methods. Clin Nutr. 2004;23(5):1226–43. doi: 10.1016/j.clnu.2004.06.004.
    1. Janssen I, Heymsfield SB, Baumgartner RN, Ross R. Estimation of skeletal muscle mass by bioelectrical impedance analysis. J Appl Physiol (1985) 2000;89(2):465–71. doi: 10.1152/jappl.2000.89.2.465.
    1. Janssen I, Baumgartner RN, Ross R, Rosenberg IH, Roubenoff R. Skeletal muscle cutpoints associated with elevated physical disability risk in older men and women. Am J Epidemiol. 2004;159(4):413–21. doi: 10.1093/aje/kwh058.
    1. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010;39(4):412–23. doi: 10.1093/ageing/afq034.
    1. Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, et al. 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(2):M85–94. doi: 10.1093/geronj/49.2.M85.
    1. Cesari M, Kritchevsky SB, Newman AB, Simonsick EM, Harris TB, Penninx BW, et al. Added value of physical performance measures in predicting adverse healthrelated events: results from the Health, Aging And Body Composition Study. J Am Geriatr Soc. 2009;57(2):251–9. doi: 10.1111/j.1532-5415.2008.02126.x.
    1. Kempen GIJM, Miedema I, Ormel J, Molenaar W. The assessment of disability with the Groningen Activity Restriction Scale: conceptual framework and psychometric properties. Soc Sci Med. 1996;43(11):1601–10. doi: 10.1016/S0277-9536(96)00057-3.
    1. EuroQol Group. EuroQol: a new facility for the measurement of health-related quality of life. Health Policy 1990;16(3):199-208.
    1. Rabin R, Oemar M, Oppe M, Janssen B, Herdman M. EQ-5D-5L user guide: basic information on how to use the EQ-5D-5L instrument: version 1.0. Rotterdam: EuroQol Group; 2011.
    1. Hakkaart-van Roijen L, Tan SS. Bouwmans CAM. Handleiding voor kostenonderzoek: methoden en standaard kostprijzen voor economische evaluaties in de gezondheidszorg: geactualiseerde versie 2010. Diemen: CVZ; 2011.
    1. De Vries NM, Staal JB, Van der Wees PJ, Adang EM, Akkermans R, Olde Rikkert MG, et al. Patient-centred physical therapy is (cost-) effective in increasing physical activity and reducing frailty in older adults with mobility problems: a randomized controlled trial with 6 months follow-up. J Cachexia Sarcopenia Muscle. 2016;7(4):422–35. doi: 10.1002/jcsm.12091.
    1. Groessl EJ, Kaplan R C, Sweet CM, Church T, Espeland MA, Gill TM, et al. Cost-effectiveness of the LIFE physical activity intervention for older adults at increased risk for mobility disability. J Gerontol A Biol Sci Med Sci. 2016;71(5):656–62. doi: 10.1093/gerona/glw001.
    1. Lo YC, Wahlqvist ML, Huang YC, et al. Medical costs of a low skeletal muscle mass are modulated by dietary diversity and physical activity in community-dwelling older Taiwanese: a longitudinal study. Int J Behav Nutr Phys Act. 2017;14(1):31. doi: 10.1186/s12966-017-0487-x.
    1. Bauer JM, Verlaan S, Bautmans I, Brandt K, Donini LM, Maggio M, et al. Effects of a vitamin D and leucine-enriched whey protein nutritional supplement on measures of sarcopenia in older adults, the PROVIDE study: a randomized, double-blind, placebocontrolled trial. J Am Med Dir Assoc. 2015;16(9):740–7. doi: 10.1016/j.jamda.2015.05.021.
    1. Yoshimura Y, Uchida K, Jeong S, Yamaga M. Effects of Nutritional Supplements on Muscle Mass and Activities of Daily Living in Elderly Rehabilitation Patients with Decreased Muscle Mass: A Randomized Controlled Trial. J Nutr Health Aging. 2016;20(2):185–91. doi: 10.1007/s12603-015-0570-4.
    1. Beaudart C, Reginster JY, Petermans J, Gillain S, Quabron A, Locquet M, et al. Quality of life and physical components linked to sarcopenia: the SarcoPhAge study. Exp Gerontol. 2015;69:103–10. doi: 10.1016/j.exger.2015.05.003.
    1. Go SW, Cha YH, Lee JA, Park HS. Association between sarcopenia, bone density, and health-related quality of life in Korean men. Korean J Fam Med. 2013;34(4):281–8. doi: 10.4082/kjfm.2013.34.4.281.
    1. Gobbens R V, Assen MA, Schalk MJ. The prediction of disability by self-reported physical frailty components of the Tilburg Frailty Indicator (TFI) Arch Gerontol Geriatr. 2014;59(2):280–7. doi: 10.1016/j.archger.2014.06.008.
    1. Gani F, Buettner S, Margonis GA, Sasaki K, Wagner D, Kim Y, et al. Sarcopenia predicts costs among patients undergoing major abdominal operations. Surgery. 2016;160(5):1162–71. doi: 10.1016/j.surg.2016.05.002.
    1. Kirk PS, Friedman JF, Cron DC, Terjimanian MN, Wang SC, Campbell DA, et al. One-year postoperative resource utilization in sarcopenic patients. J Surg Res. 2015;199(1):51–5. doi: 10.1016/j.jss.2015.04.074.

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera