Esmee M. Reijnierse

The Impact of Different Diagnostic Criteria on the Prevalence of Sarcopenia in Healthy Elderly Participants and Geriatric Outpatients

Background: A consensus on the diagnostic criteria for sarcopenia, a common syndrome in the elderly, has not been reached yet. Prevalence rates vary between studies due to the use of different criteria encompassing different measures, correction factors and cutoff points. Objective: This study compared prevalence rates of sarcopenia using nine sets of diagnostic criteria applied in two different elderly populations. Methods: The study population encompassed 308 healthy elderly participants (152 males, 156 females; mean age 74 years) and 123 geriatric outpatients (54 males, 69 females; mean age 81 years). Diagnostic criteria included relative muscle mass, absolute muscle mass, muscle strength and physical performance. Results: Prevalence rates of sarcopenia varied between 0 and 15% in healthy elderly participants and between 2 and 34% in geriatric outpatients. Conclusion: This study clearly demonstrates the dependency of sarcopenia prevalence rates on the applied diagnostic criteria.

Common Ground? The Concordance of Sarcopenia and Frailty Definitions.

OBJECTIVES This study aimed to explore the concordance between definitions of sarcopenia and frailty in a clinically relevant population of geriatric outpatients. DESIGN Data were retrieved from a cross-sectional study. SETTING The study was performed in a geriatric outpatient clinic of a middle-sized teaching hospital. PARTICIPANTS The study included 299 geriatric outpatients (mean age 82.4, SD 7.1) who were consecutively referred to the outpatient clinic. MEASUREMENTS Prevalence rates and subsequent concordance evolving from 3 definitions of sarcopenia and 2 definitions of frailty were compared. Definitions of sarcopenia included the European Working Group on Sarcopenia in Older People (gait speed, handgrip strength, muscle mass), International Working Group on Sarcopenia (gait speed, muscle mass) and the definition by Janssen (muscle mass). Definitions of frailty included the Fried frailty phenotype (weight loss, exhaustion, physical inactivity, handgrip strength, walk time) and the definition of Rockwood (use of walking aid, activities of daily living, incontinence, and cognitive impairment). RESULTS Prevalence rates for sarcopenia varied between 17% and 22% and between 29% and 33% for frailty. There was little concordance in intraindividual prevalence rates of sarcopenia and frailty using different definitions. None of the outpatients was classified as having sarcopenia and frailty according to all applied definitions. Outpatients with sarcopenia were more likely to be frail than frail outpatients to be sarcopenic. CONCLUSION This study clearly indicates that sarcopenia and frailty are 2 separate conditions based on the current definitions. It is important to diagnose sarcopenia and frailty as separate entities, as each may require specific treatment.

The Association between Parameters of Malnutrition and Diagnostic Measures of Sarcopenia in Geriatric Outpatients.

Objectives Diagnostic criteria for sarcopenia include measures of muscle mass, muscle strength and physical performance. Consensus on the definition of sarcopenia has not been reached yet. To improve insight into the most clinically valid definition of sarcopenia, this study aimed to compare the association between parameters of malnutrition, as a risk factor in sarcopenia, and diagnostic measures of sarcopenia in geriatric outpatients. Material and Methods This study is based on data from a cross-sectional study conducted in a geriatric outpatient clinic including 185 geriatric outpatients (mean age 82 years). Parameters of malnutrition included risk of malnutrition (assessed by the Short Nutritional Assessment Questionnaire), loss of appetite, unintentional weight loss and underweight (body mass index <22 kg/m2). Diagnostic measures of sarcopenia included relative muscle mass (lean mass and appendicular lean mass [ALM] as percentages), absolute muscle mass (total lean mass and ALM/height2), handgrip strength and walking speed. All diagnostic measures of sarcopenia were standardized. Associations between parameters of malnutrition (independent variables) and diagnostic measures of sarcopenia (dependent variables) were analysed using multivariate linear regression models adjusted for age, body mass, fat mass and height in separate models. Results None of the parameters of malnutrition was consistently associated with diagnostic measures of sarcopenia. The strongest associations were found for both relative and absolute muscle mass; less stronger associations were found for muscle strength and physical performance. Underweight (p = <0.001) and unintentional weight loss (p = 0.031) were most strongly associated with higher lean mass percentage after adjusting for age. Loss of appetite (p = 0.003) and underweight (p = 0.021) were most strongly associated with lower total lean mass after adjusting for age and fat mass. Conclusion Parameters of malnutrition relate differently to diagnostic measures of sarcopenia in geriatric outpatients. The association between parameters of malnutrition and diagnostic measures of sarcopenia was strongest for both relative and absolute muscle mass, while less strong associations were found with muscle strength and physical performance.

Serum albumin and muscle measures in a cohort of healthy young and old participants

Consensus on clinically valid diagnostic criteria for sarcopenia requires a systematical assessment of the association of its candidate measures of muscle mass, muscle strength, and physical performance on one side and muscle-related clinical parameters on the other side. In this study, we systematically assessed associations between serum albumin as a muscle-related parameter and muscle measures in 172 healthy young (aged 18–30 years) and 271 old participants (aged 69–81 year) from the European MYOAGE study. Muscle measures included relative muscle mass, i.e., total- and appendicular lean mass (ALM) percentage, absolute muscle mass, i.e., ALM/height2 and total lean mass in kilograms, handgrip strength, and walking speed. Muscle measures were standardized and analyzed in multivariate linear regression models, stratified by age. Adjustment models included age, body composition, C-reactive protein and lifestyle factors. In young participants, serum albumin was positively associated with lean mass percentage (p = 0.007) and with ALM percentage (p = 0.001). In old participants, serum albumin was not associated with any of the muscle measures. In conclusion, the association between serum albumin and muscle measures was only found in healthy young participants and the strongest for measures of relative muscle mass.

Instrumented Assessment of Physical Activity Is Associated With Muscle Function but Not With Muscle Mass in a General Population

Objectives: Self-reported physical activity has shown to affect muscle-related parameters. As self-report is likely biased, this study aimed to assess the association between instrumented assessment of physical activity (I-PA) and muscle-related parameters in a general population. Method: Included were 156 young-to-middle-aged and 80 older community-dwelling adults. Seven days of trunk accelerometry (DynaPort MoveMonitor, McRoberts B.V.) quantified daily physical activity (i.e., active/inactive duration, number and mean duration of active/inactive periods, and number of steps per day). Muscle-related parameters included muscle mass, handgrip strength, and gait speed. Results: I-PA was associated with handgrip strength in young-to-middle-aged adults and with gait speed in older adults. I-PA was not associated with muscle mass in either age group. Discussion: The association between I-PA and muscle-related parameters was age dependent. The lack of an association between I-PA and muscle mass indicates the relevance of muscle function rather than muscle mass.

Lack of knowledge and availability of diagnostic equipment could hinder the diagnosis of sarcopenia and its management

Objectives Sarcopenia is an emerging clinical challenge in an ageing population and is associated with serious negative health outcomes. This study aimed to assess the current state of the art regarding the knowledge about the concept of sarcopenia and practice of the diagnostic strategy and management of sarcopenia in a cohort of Dutch healthcare professionals (physicians, physiotherapists, dietitians and others) attending a lecture cycle on sarcopenia. Material and methods This longitudinal study included Dutch healthcare professionals (n = 223) who were asked to complete a questionnaire before, directly after and five months after (n = 80) attending a lecture cycle on the pathophysiology of sarcopenia, diagnostic strategy and management of sarcopenia, i.e. interventions and collaboration. Results Before attendance, 69.7% of healthcare professionals stated to know the concept of sarcopenia, 21.4% indicated to know how to diagnose sarcopenia and 82.6% had treated patients with suspected sarcopenia. 47.5% used their clinical view as diagnostic strategy. Handgrip strength was the most frequently used objective diagnostic measure (33.9%). Five months after attendance, reported use of diagnostic tests was increased, i.e. handgrip strength up to 67.4%, gait speed up to 72.1% and muscle mass up to 20.9%. Bottlenecks during implementation of the diagnostic strategy were experienced by 67.1%; lack of awareness among other healthcare professionals, acquisition of equipment and time constraints to perform the diagnostic measures were reported most often. Before attendance, 36.4% stated not to consult a physiotherapists or exercise therapists (PT/ET) or dietitian for sarcopenia interventions, 10.5% consulted a PT/ET, 32.7% a dietitian and 20.5% both a PT/ET and dietitian. Five months after attendance, these percentages were 28.3%, 21.7%, 30.0% and 20.0% respectively. Conclusion The concept of sarcopenia is familiar to most Dutch healthcare professionals but application in practice is hampered, mostly by lack of knowledge, availability of equipment, time constraints and lack of collaboration.

Standing Up Slowly Antagonises Initial Blood Pressure Decrease in Older Adults with Orthostatic Hypotension

Background: Orthostatic hypotension (OH) is common in older adults and associated with increased morbidity and mortality, loss of independence and high health-care costs. Standing up slowly is a recommended non-pharmacological intervention. However, the effectiveness of this advice has not been well studied. Objectives: The aim of this study was to investigate whether standing up slowly antagonises posture-related blood pressure (BP) decrease in a clinically relevant population of geriatric outpatients. Methods: In this cross-sectional study, 24 community-dwelling older adults referred to a geriatric outpatient clinic and diagnosed with OH were included. BP was measured continuously during 3 consecutive transitions from supine to standing position during normal, slow and fast transition. Results: The relative BP decrease at 0-15 s after slow transition was significantly lower than after normal transition (p = 0.003 for both systolic BP and diastolic BP) and fast transition (p = 0.045 for systolic BP; diastolic BP: non-significant). The relative diastolic BP decrease at 60-180 s after normal transition was significantly lower than after fast transition (p = 0.029). Conclusion: Standing up slowly antagonises BP decrease predominantly during the first 15 s of standing up in a clinically relevant population of geriatric outpatients diagnosed with OH. Results support the non-pharmacological intervention in clinical practice to counteract OH.

Single Physical Performance Measures Cannot Identify Geriatric Outpatients with Sarcopenia

BackgroundSarcopenia is highly prevalent in the older population and is associated with several adverse health outcomes. Equipment to measure muscle mass and muscle strength to diagnose sarcopenia is often unavailable in clinical practice due to the related expenses while an easy physical performance measure to identify individuals who could potentially have sarcopenia is lacking.ObjectivesThis study aimed to assess the association between physical performance measures and definitions of sarcopenia in a clinically relevant population of geriatric outpatients.Design, setting and participantsA cross-sectional study was conducted, consisting of 140 community-dwelling older adults that were referred to a geriatric outpatient clinic. No exclusion criteria were applied.MeasurementsPhysical performance measures included balance tests (sideby- side, semi-tandem and tandem test with eyes open and -closed), four-meter walk test, timed up and go test, chair stand test, handgrip strength and two subjective questions on mobility. Direct segmental multi-frequency bioelectrical impedance analysis was used to measure muscle mass. Five commonly used definitions of sarcopenia were applied. Diagnostic accuracy was determined by sensitivity, specificity and area under the curve.ResultsPhysical performance measures, i.e. side-by-side test, tandem test, chair stand test and handgrip strength, were associated with at least one definition of sarcopenia. Diagnostic accuracy of these physical performance measures was poor.ConclusionsSingle physical performance measures could not identify older individuals with sarcopenia, according to five different definitions of sarcopenia.

Knee extension strength measurements should be considered as part of the comprehensive geriatric assessment.

BackgroundComprehensive geriatric assessment (CGA) generally includes handgrip strength (HGS) as a measure of overall muscle strength that is associated with various health characteristics in geriatric outpatients. Whether this is also true for knee extension strength (KES) is yet unknown. This study aims to compare the associations between health characteristics from the CGA with both HGS and KES in geriatric outpatients.MethodsData were retrieved from a cross-sectional study. A total of 163 community-dwelling older adults referred to a geriatric outpatient clinic of a middle-sized teaching hospital were included. Health characteristics included physical, nutritional, social, psychological, diseases, cognitive, and behavioural factors. HGS and KES were assessed three times for each limb and the best performance was used for analysis. Sex-specific z-scores of HGS and KES were used to allow comparison of effect estimates. Associations between health characteristics with standardized HGS and KES were analysed with linear regression adjusted for age, sex and further adjustment for standardized KES (for model of HGS) or standardized HGS (for model of KES).ResultsPhysical, nutritional and psychological health characteristics were positively associated with both HGS and KES after adjustment for age and sex, with overall stronger associations with KES compared to HGS. All significant associations with HGS were lost after further adjustment for KES; significant associations with KES remained after further adjustment for HGS, except for nutritional characteristics.ConclusionsStronger associations of health characteristics with KES compared to HGS indicate its additional value and therefore inclusion of KES in the CGA is recommended.

Orthostatic hypotension and physical functioning in older adults: A systematic review and meta-analysis

BACKGROUND Orthostatic hypotension (OH) may negatively affect physical functioning and aggravate morbidities, but existing evidence is contradictory. METHODS MEDLINE (from 1946), PubMed (from 1966) and EMBASE databases (from 1947) were systematically searched for studies on the association of OH and physical functioning in older adults, categorized as: balance, gait characteristics, walking speed, Timed Up and Go time, handgrip strength (HGS), physical frailty, exercise tolerance, physical activity, activities of daily living (ADL), and performance on the Hoehn and Yahr scale (HY) and Unified Parkinsons Disease Rating Scale (UPDRS). Study quality was assessed using the Newcastle Ottawa Scale. RESULTS Forty-two studies were included in the systematic review (29,421 individuals) and 29 studies in the meta-analyses (23,879 individuals). Sixteen out of 42 studies reported a significant association of OH with worse physical functioning. Meta-analysis showed a significant association of OH with impaired balance, ADL performance and HY/UPDRS III performance, but not with gait characteristics, mobility, walking speed, TUG, HGS, physical frailty, exercise tolerance, physical activity and UPDRS II performance. CONCLUSIONS OH was associated with impaired balance, ADL performance and HY/UPDRS III performance, but not with other physical functioning categories. The results suggest that OH interventions could potentially improve some aspects of physical functioning.