Prevalence of Sarcopenia in Geriatric Hospitalized Patients

doi:10.1016/j.jamda.2013.11.027

Journal of the American Medical Directors Association

Volume 15, Issue 4, April 2014, Pages 267-272

https://doi.org/10.1016/j.jamda.2013.11.027 Get rights and content

Abstract

Objectives

Sarcopenia, a common syndrome in older individuals, is characterized by a progressive loss of muscle mass and muscle strength. Although data exist on the prevalence of sarcopenia in community-dwelling older individuals and nursing home residents, there has been no systematic research in hospitalized older patients according to newly developed criteria.

Design

Cross-sectional study design.

Setting

Acute geriatric ward of a general hospital.

Participants

Geriatric inpatients.

Measurements

Hand grip strength was measured with the Jamar dynamometer, skeletal muscle index was calculated from raw data obtained from the bioelectrical impedance analysis, and physical function was assessed with the Short Physical Performance Battery. Sarcopenia was defined according to the criteria of the European Working Group on Sarcopenia in Older People (EWGSOP).

Results

This study involved 198 patients from a geriatric acute ward. Mean age was 82.8 ± 5.9 years and 70.2% (n = 139) of the study participants were women. Thirteen patients (6.6%) were defined as sarcopenic and 37 (18.7%) were defined as severely sarcopenic. In a group comparison, patients with sarcopenia had a poorer nutritional status. In a binary logistic regression analysis, only body mass index was associated with sarcopenia, whereas gender, age, length of stay, cognitive function, and self-care capacity were not.

Conclusion

The prevalence of sarcopenia in geriatric hospitalized patients is high and does not differ from those of other older individuals. Nutritional status is associated with sarcopenia. The predictive value of sarcopenia regarding outcome for older individuals still requires evaluation.

Section snippets

Patient Population and Inclusion Criteria

Patients are admitted to the geriatric acute care ward because of various acute medical problems. Between May and October 2012, consecutively admitted patients from a geriatric acute care ward were recruited prospectively into the study. Inclusion criteria were as follows: age older than 65 years, Mini Mental State Examination (MMSE) higher than 19 or MMSE higher than 10 with good ability to perform tests and informed consent. Patients who were very unwell (eg, in a palliative situation) were

Results

In this study, 198 patients from a geriatric acute ward were included. Mean age was 82.8 ± 5.9 years and 139 (70.2%) of the study participants were women. Mean BMI was 26.0 ± 5.4 kg/m². According to the MNA, 52 (26.3%) of the participants had a good nutritional status, 79 (39.9%) were at risk of malnutrition, and 67 (33.8%) were malnourished. Although 99 (50.0%) of the study participants did not exhibit cognitive deficits, 76 (38.4%) were mildly or questionably cognitively impaired and 23

Discussion

To our knowledge, this is the first study to investigate the prevalence of sarcopenia in a geriatric hospital population according to the definition of the EWGSOP.⁵ In our study sample, the prevalence of sarcopenia (mild and severe forms) was 25.3%. In a recent study by Gariballa and Alessa,¹⁶ who intended to study the prevalence in older hospitalized patients, sarcopenia was observed in 10% of patients. However, the authors assessed muscle mass and hand grip strength only, but not physical

Limitations

The cutoffs for BIA-derived SMI were based on the cutoffs suggested in the EWGSOP consensus definition.⁵ It has to be noted that these cutoffs were generated in a young Asian population.¹⁴ In body composition studies, South Asian populations exhibit lower lean body mass at a given BMI when compared with white participants.³⁶ This could make the choice of cutoffs arguable. However, they seem to agree with cutoffs obtained in studies in European populations by Tichet et al³⁷ and Masanes et al,³⁸

Conclusion

Sarcopenia is highly prevalent in older individuals. Prevalence data of geriatric hospitalized patients do not differ substantially from those of other older individuals. Our data underline the potential role of nutritional state in sarcopenia. Whether sarcopenia is more predictive for poor outcome than muscle mass or function alone still has to be proven in follow-up studies.

Acknowledgments

We thank the staff of the departments of occupational therapy and physiotherapy for their help in acquiring hand grip measurements and SPPB scores, and Britta Gantefort for her help in data management. We thank Steven Black for proofreading the text.

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All participants displayed probable sarcopenia; 46% and 20% were sarcopenic depending on whether muscle mass was estimated by DXA or CC. Malnutrition according to the GLIM criteria was prevalent in 64% or 60% (muscle mass by DXA or CC, respectively). Nine in ten with sarcopenia were also malnourished. Twenty-six participants (46%) died within two years. Sarcopenia defined by CC <31 cm, but not by DXA, was associated with increased mortality; e.g. 2-y mortality HR was 3.19 (95% CI 1.31–7.75). Similarly, malnutrition according to GLIM related to increased 1-y mortality (HR 4.83, 95% CI 1.04–22.39) when DXA was used for muscle mass estimation. All of the participants with CC <31 cm were categorised as both sarcopenic and malnourished.
In this small set of well-characterised geriatric inpatients all displayed probable sarcopenia. Prevalence of sarcopenia (EWGSOP2) and malnutrition (GLIM) was 20–46% and 60–64%, respectively. Both conditions related to mortality. CC <31 cm hold promises to be an acceptable alternative for DXA as a proxy for low muscle mass.
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The following variables were selected by stepwise regression modeling: sex, body mass index, max grip strength, and fat mass derived by BIA. The model was internally validated with 10 fold cross validation. Using the FNIH definition, the model was found to have a sensitivity of 80%, a specificity of 91%, a positive predictive value of 73% and a negative predictive value of 93%.
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: This work has not received any financial support.

: The authors declare no conflicts of interest.

View full text

Original StudyPrevalence of Sarcopenia in Geriatric Hospitalized Patients

Abstract

Objectives

Design

Setting

Participants

Measurements

Results

Conclusion

Section snippets

Patient Population and Inclusion Criteria

Results

Discussion

Limitations

Conclusion

Acknowledgments

J Nutr Health Aging

J Nutr Health Aging

J Nutr Health Aging

Nutrition

J Chronic Dis

Clin Nutr

Clin Nutr

Am J Prev Med

J Am Med Dir Assoc

Clin Nutr

Biomed Pharmacother

J Nutr Health Aging

J Biol Chem

J Am Med Dir Assoc

Sarcopenia: An undiagnosed condition in older adults. Current consensus definition: Prevalence, etiology, and consequences

J Am Med Dir Assoc

An overview of sarcopenia: Facts and numbers on prevalence and clinical impact

J Cachexia Sarcopenia Muscle

Sarcopenia: European consensus on definition and diagnosis

Age Ageing

Functional evaluation: The Barthel Index

Md State Med J

Screening, detection and management of depression in elderly primary care attenders. I: The acceptability and performance of the 15 item Geriatric Depression Scale (GDS15) and the development of short versions

Fam Pract

The mini-mental state examination

Arch Gen Psychiatry

Original Study
Prevalence of Sarcopenia in Geriatric Hospitalized Patients