Experts call for greater awareness of sarcopenia among elderly

SINGAPORE — It is not as well known as other ageing-related conditions such as dementia, but geriatrics doctors here say there should be greater awareness of sarcopenia, the progressive loss of skeletal muscle in the ageing process, in managing the health of the elderly.

An ongoing local study on 200 older adults aged between 50 and 99 years who are living independently in their own homes, has found that 25 per cent of the participants were found to be sarcopenic, and were more likely at risk of malnutrition.

Conversely, the 7 per cent who were found to be at risk of malnutrition were also 2.4 times more likely to have sarcopenia, said Dr Lim Wee Shiong, senior consultant at the Institute of Geriatrics and Active Ageing (IGA) at Tan Tock Seng Hospital, who led the study which began in 2013.

No definitive figures on local prevalence are available, but Dr Lim said that estimates based on the Asian Working Group for Sarcopenia criteria indicated that between 4.1 and 11.5 per cent of the older population in Asian countries have sarcopenia.

In the first 30 years of a person’s life, muscles usually grow bigger and stronger.

But when the process of ageing sets in, people start to lose muscle mass and function, in what doctors are increasingly recognising as age-related sarcopenia.

It is often linked to frailty, a common geriatric syndrome that puts a person at greater risk of falls, among other things.

According to Associate Professor Francesco Landi, who specialises in internal medicine at the Catholic University of Rome, a person can reach maximum muscle mass at around 25 to 30 years of age, and maintain it until 40 to 45 years of age before decline sets in.

Citing a large-scale study in Italy that assessed the muscle function and strength of 4,000 people aged 18 to 100 living independently, Assoc Prof Landi said older adults lose muscle mass at a faster rate, and can experience more than a quarter of muscle mass loss between 40 and 70 years of age. People lose an additional 15 per cent of muscle mass each decade after reaching the age of 70.

Assoc Prof Landi, who was speaking to TODAY at the Asia Pacific Geriatrics Conference earlier this month, said: “Physical frailty is a proxy of disability. So it’s a proxy of adverse events ... for example falls, low quality of life, loss of independence in activities of daily living.”

Dr Carol Tan, a geriatrician at The Good Life Medical Center at Mount Alvernia Hospital, said sarcopenia makes the elderly more vulnerable to poor health and illnesses.

“Sarcopenia, which occurs in advanced cases of muscle loss, has been shown by multiple studies to be associated with the risk of adverse outcomes such as reduced mobility, increased risk of falls, slower recovery from illnesses, frailty and even death,” she said.

“It lowers the quality of life because of the loss of independence from declined muscle strength and function that limit movements and thus leads to social isolation.”

Sarcopenia, she said, should not be seen as a normal part of ageing, and prevention is key. Increasing protein intake and exercise are among the ways of doing so.

“Numerous studies have shown that physical exercise, particularly resistance-type exercises, and nutritional intervention can help slow down the natural loss of muscle mass and strength in adults,” said Dr Melvin Chua, president of the Society of Geriatric Medicine Singapore.

Added Dr Tan: “A well-balanced diet that includes increased protein intake is crucial to maintain muscle mass as protein is a key component of muscles.”

A dietary supplement, beta-Hydroxy beta-Methylbutyrate (HMB), has also been recommended for promoting muscle growth. HMB can be found in very small amounts in foods such as avocado, citrus fruits, cauliflower and catfish, but the recommended HMB intake is three grams a day — equivalent to eating about 6,000 avocados.

RAISING AWARENESS

Dr Lim noted that sarcopenia is not as widely recognised as a geriatric syndrome compared to dementia or falls. “It is thus imperative to raise awareness about sarcopenia and what can be done to prevent or delay the onset of sarcopenia,” he said.

Dr Terence Tang, head and senior consultant of Geriatric Medicine at Khoo Teck Puat Hospital, said that frailty is a condition seen in the elderly, but regular physical exercise and proper nutrition should start from a younger age to delay its consequences.

But it is not that easy to screen, diagnose and treat elderly patients for a condition that is still under study. Dr Tang noted that the proposed “clinical cutoff” for determining whether a person is sarcopenic varies.

Furthermore, the diagnosis of sarcopenia is also often not incorporated into routine care of the elderly as formal diagnosis requires fairly elaborate investigations, added Dr Lim. Newer screening tools like a five-item questionnaire have also yet to be validated before it can be recommended for routine clinical use, he said.

Nonetheless, given that it is possible to prevent muscle loss, doctors agreed that channels such as Senior Activity Centres, the Health Promotion Board and even the People’s Association can help spread the message on the importance of leading healthy lifestyles.