My 86-year-old grandmother is having trouble performing her daily activities. Although she still drives and manages household duties, both are becoming increasingly difficult. Most of our interactions consist of discussions about her aches, pains and new difficulties. She no longer adheres to an exercise program; however, when she did participate in rehabilitative therapy she usually improved. Unfortunately, her level of function has gradually declined over the past few years.
Is this inevitable as we age and is there more that can be done to prevent this? If so, should we, as rehabilitation professionals, be the ones to intervene? When treating elderly patients, how often do you think about sarcopenia? Is this something you are actively addressing with therapy interventions?
Effects of Sarcopenia
Sarcopenia is the age-related loss of muscle mass – primarily a loss of Type II muscle fibers, leading to specific function loss. Specifically, a 10–15% loss of leg strength per decade is seen until seventy years of age 2, after which a faster loss 25% to 40% by decade occurs. Loss of strength is greater than the loss of muscle mass. This is thought to be due to a deterioration in the quality of the muscle, in addition to the quantity of the fibers.
Functionally, we use Type II muscle fibers for high force and power outputs. Power tends to have a greater effect on our function than strength. For example, an elderly person getting up from a low couch has to generate power of their lower extremities to propel themselves up. As these fibers decline, they experience increasing difficulty with these tasks. They may resort to using their arms and momentum for assistance to get up. It is also very common for the elderly to be unable to get up from the floor independently.
The effects of sarcopenia on an individual are quite alarming. The literature shows that sarcopenia is associated with:
- Hospital admissions and extended hospital stays2
- Infectious and non-infectious complications
- Falls – three times more likely to fall compared to non-sarcopenic individuals.4 Specifically, quadriceps sarcopenia is related to fall risk3
- Overall mortality5,6
Interventions for Sarcopenia
Knowing the effects of sarcopenia, how can we maximize our interventions? Here are some of the potential interventions that have been shown to have an effect on sarcopenia:
- Power training (concentric high-velocity contractions): might be a more optimal regimen to elicit positive and consistent results with respect to ADLs1
- Education – Vitamin D and adequate protein intake
- Strength training
- Endurance training
- Weight management
Aging is inevitable; however, a decline in function doesn’t have to be. Interventions such as patient education or the addition of power training to an exercise program are great places to start –both products are included in the MedBridge subscription! As for grandma, she has taken my advice to get back to her community gym with some specific recommendations for exercises.
- Hazell, T., Kenno, K., & Jakobi, J. (2007). Functional Benefit of Power Training for Older Adults. Journal of Aging and Physical Activity, 15, 349-359.
- Malafarina, V., Uriz-Otano, F., Iniesta, R., & Gil-Guerrero, L. (2012). Sarcopenia in the elderly: Diagnosis, physiopathology and treatment. Maturitas, 71(2), 109-14. doi: 10.1016/j.maturitas.2011.11.012.
- Ochi, M., Tabara, Y., Kido, T., Uetani, E., Ochi, N., Igase M., …, Kohara, K. (2010). Quadriceps sarcopenia and visceral obesity are risk factors for postural instability in the middle-aged to elderly population. Geriatr Gerontol Int, 10(3), 233-43. doi: 10.1111/j.1447-0594.2010.00610.x.
- Landi, F., Liperoti, R., Russo, A., Giovannini, S., Tosato, M., Capoluongo, E., …, & Onder, G. (2012). Sarcopenia as a risk factor for falls in elderly individuals: Results from the ilSIRENTE study. Clin Nutr, 31(5), 652-8. doi: 10.1016/j.clnu.2012.02.007.
- Landi F., Cruz-Jentoft, A. J., Liperoti, R., Russo, A., Giovannini, S., Tosato, M., …, & Onder, G. (2013). Sarcopenia and mortality risk in frail older persons aged 80 years and older: Results from ilSIRENTE study. Age Ageing, 42(2), 203-9. doi: 10.1093/ageing/afs194.
- Bunout, D., de la Maza, M. P., Barrera, G., Leiva, L., & Hirsch, S. (2011). Association between sarcopenia and mortality in healthy older people. Australas J Ageing, 30(2), 89-92. doi: 10.1111/j.1741-6612.2010.00448.x.