Posted: April 3rd, 2022

Prevalence of Sarcopenia in Elderly Population

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Summary

Background: Sarcopenia refers to aged associated loss of skeletal muscle mass and bodily perform. It results in not solely adversarial well being consequence but in addition elevated healthcare expenditure. Research indicated that smoking, inadequate diet, bodily inactivity, older age, gender, discount in motor unit quantity and atrophy of muscle fibers are contributing components to sarcopenia. Certainly, sarcopenia is normally discovered in aged inhabitants. There isn’t a common definition for sarcopenia. Analysis of sarcopenia, in accordance with totally different definition standards, requires complicated devices and participation of professionals. Lately, a easy questionnaire SARC-F has been developed to screening out sarcopenia.

Goal: The mission has three goals: to estimate the prevalence of sarcopenia amongst aged 65 and over aged in neighborhood setting utilizing SARC-F; to discover the distribution of SARC-F scores amongst totally different age group inhabitants; to check the prevalence of sarcopenia in Hong Kong with these in different nations.

Examine design: It is a cross-sectional examine.

Setting: Residential care properties (hostel for the aged, residence for the aged, care and a focus residence and nursing residence) in Shatin district.

Methodology: A self-design questionnaire together with demographic info, smoking behavior, alcohol consumption, power illnesses, hospitalization occasions and SARC-F might be assessed head to head when the contributors are enrolled.

Background

Sarcopenia is age associated illness with signs of loss of muscle mass, power and performance. Elderly over the age of 65 years are susceptible to sarcopenia ^[6]. It’s estimated that approximated 5-13% of older folks aged 60–70 years are suffered from sarcopenia ^[8]. The proportion is about twice increased amongst aged on the age of 80 or above ^[8]. Research additionally discovered that sarcopenia is extra probably seen in older males than older ladies ^[16,26]. Sarcopenia positive factors intensive consideration from public and rising researches indicated that it’s a main medical downside for older folks.

Danger components of sarcopenia

Present analysis discovered that life-style components, together with bodily inactivity, smoking and alcohol consuming ^[3]; and organic components, together with older age, gender, decreased hormone stage, motor unit reworking and decreased protein synthesis ^[3,25], contribute to improvement of sarcopenia.

Motor unit reworking comes up of age and results in substitute of quick twitch motor neuron^[22,25] which ends in much less exact management of actions, much less power manufacturing and slowing of muscle mechanics^[22,23,25] as transformed motor unit are smaller in measurement and slower to contract. Due to this fact, loss of quick twitch fibers will increase threat of having sarcopenia.

As well as, protein synthesis, development hormone (GH), testosterone (T) and insulin-like development issue (IGF-1) are thought of to be related to sarcopenia as nicely ^[25]. It’s well-known that protein is vital in muscle repairmen. And GH, T and IGF-1 are concerned in protein metabolism and upkeep ^[23]. Totally different research agreed that protein synthesis price decreases all through the pure growing older course of ^[24] and results in loss of muscle mass. Thus, low protein synthesis price, together with lower in these hormones stage present doable prevalence of sarcopenia ^[25].

Penalties of sarcopenia

Sarcopenia causes critical penalties not solely at particular person stage but in addition at societal stage. On the one hand, loss of muscle mass, power and performance result in adversarial well being consequence in phrases of frailty, incapacity, morbidity and mortality ^[8]. Basically, sarcopenia is about twice as frequent as frailty ^[9]. Additionally, sarcopenia happens with different morbidity in some instances. Some of the co-morbidity are weight problems ^[4,13], hypertension, osteoporosis ^[12] and kind II diabetes ^[5,14,15]. Furthermore, analysis means that loss of skeletal muscle power might predict future mortality in middle-aged and aged ^[2]. Then again, sarcopenia is linked with elevated healthcare expenditure. In United States, the estimated direct healthcare attributable to sarcopenia represented about 1.5% of complete healthcare expenditure in 2000 ^[21].

Analysis of sarcopenia in accordance with totally different consensus panels

Though analysis working in the realm of sarcopenia is increasing exponentially, a common definition continues to be underneath improvement. On common, present definitions are together with muscle mass, muscle power and even bodily perform.

In 2010, the European Working Group on Sarcopenia in Older Individuals (EWGSOP) printed pointers to Help determine sarcopenia ^[1,9]. In accordance with the EWGSOP, an individual might be labeled as having sarcopenia when two of three comply with standards have been statisfied: (A) low muscle mass and (B) low muscle power and/or (C) low bodily efficiency ^[1]. Low muscle mass is outlined as muscle mass ≥2 commonplace deviations beneath the imply of reference inhabitants ^[8], calculating by gear akin to DEXA-scanners. Low bodily efficiency is outlined as gait velocity ≤ Zero.eight m/s in the four meters stroll take a look at for each women and men ^[8].

Worldwide Working Group on Sarcopenia (IWGS) instructed diagnosing sarcopenia when the next standards are fulfilled: (a) gait velocity was < 1 m/s and (b) low muscle mass (cutoff worth is much like EWGSOP) ^[8].

The European Society of Parenteral and Enteral Vitamin Particular Curiosity Teams carried out that the lower off values for low muscle mass is outlined as share of muscle mass > 2 SDs beneath the imply of reference people; for strolling velocity is < Zero.eight m/s in the four meters stroll take a look at ^[1].

Measurement of muscle mass and muscle power

Muscle power is especially assessed by handgrip ^[8]. Whereas bodily efficiency will be measured utilizing easy checks such because the brief bodily efficiency battery take a look at, regular gait velocity or the timed get-up-and-go take a look at ^[8]; it’s tough to evaluate muscle mass in follow. Twin-energy X-ray absorptiometry (DEXA) is lately proposed because the gold commonplace for muscle mass measurement ^[8]. Different strategies embrace bioelectrical impedance, computed tomography, magnetic resonance imaging, urinary excretion of creatinine, anthropometric assessments, and neutron activation assessments can be utilized for measurement of muscle mass as nicely ^[8]. The method is difficult and wish participation of professionals. Prevalence of sarcopenia varies as use of cut-off factors depends on totally different devices used for assessing muscle mass and power and performance.

SARC-F questionnaire

SARC-F, a newly developed easy questionnaire, has been considered fast analysis take a look at for sarcopenia. It comprises 5 parts: power, help in strolling, rise from a chair, climb stairs and falls ^[7]. A Question Assignment might be requested to evaluate every part variable. Scores vary from Zero-10, with Zero-2 for every part ^[7]. Members with complete rating increased than four are labeled as having sarcopenia. Particulars of SARC-F are proven in desk 1.

Desk 1 SARC-F display for sarcopenia

A analysis performed in Hong Kong checks the validation of SARC-F as a screening software for sarcopenia in neighborhood. It discovered that SARC-F is ready to predict future adversarial outcomes with comparable energy to different standards. It additionally discovered that SARC-F has wonderful specificity (94.four%) and damaging predictive worth however poor sensitivity. With excessive specificity, SARC-F is helpful for screening out older adults with sarcopenia. Poor sensitivity might as a result of quantity of contributors labeled as having sarcopenia symbolize solely a small proportion of the overall inhabitants studied ^[10]. Poor sensitivity might implicate that contributors have gentle signs can’t meet the edge of standards or solely few particular person in this neighborhood have sarcopenia.

One other analysis performed in mainland China utilized SARC-F to screening sarcopenia and bodily incapacity. It printed that poor bodily efficiency and grip power have been related to SARC-F outlined sarcopenia. However there was a really weak correlation to muscle mass in bodily energetic outpatients. It carried out potential clarification that the weak correlation might partly resulting from solely small pattern measured by DXA or BIA ^[11].

Drawback Identification and Definition of Job

Though it’s well-known that sarcopenia is said to numerous critical penalties talked about above, many gaps stay and new horizons want future examine. Whereas researches persistently counsel that resistance power coaching helps stop sarcopenia, few research level out that fitness center train and residential train intervention is much less helpful for aged inhabitants ^[21]. Estimation of prevalence is vital to seek out out totally different contributing components to sarcopenia and discover cost-effective healthcare intervention to cut back prevalence of sarcopenia. Nonetheless, it’s tough to evaluate muscle mass resulting from lack of gear or human useful resource. Due to this fact, this mission will use a easy questionnaire containing 5 inquiries to screening out aged with sarcopenia in Hong Kong neighborhood.

Relevance to Public Well being

Sarcopenia is coming of age. Elderly inhabitants is anticipated to stay on a rising pattern in most of developed nations. In Hong Kong the proportion of the inhabitants aged 65 and over is projected to rise markedly from 13% in 2012 to 30% in 2041. It implies that rising inhabitants will undergo from sarcopenia.

It isn’t shock that sarcopenia improve the danger of bodily incapacity. The danger of incapacity is 1.5 to four.6 instances increased in older individuals with sarcopenia than in older individuals with regular muscle. Males are at larger threat of sarcopenia associated incapacity than ladies ^[16]. Latest estimates point out that roughly 45% of the older U.S. inhabitants is sarcopenic and that roughly 20% of the older U.S. inhabitants is functionally disabled ^[21]. It is very important notice that bodily incapacity is related to an elevated threat of nursing residence placement, residence healthcare and hospital use ^[21]. And these healthcare companies want additional healthcare expenditure to Help. To sum up with info above, sarcopenia is changing into huge problem in public together with the rise of older inhabitants. It’s trigger critical well being penalties in individuals and make financial burden in nations.

Setting

There are 21 license residential care properties in Shatin district. Residential care companies for elders goal to offer residential care and services for elders aged 65 or above who, for private, social, well being and/or different causes, can’t adequately be taken care of at residence.

To satisfy totally different care wants of elders, vary stage of care from low to excessive, residential care house is class into 4 varieties: hostel for the aged, residence for the aged, care and a focus residence and nursing residence.

Undertaking timeline

Under is the timeline of my mission. Knowledge assortment and information Assessment might be completed in March and April respectively.

Determine 1 Undertaking timeline

Goal and Goal

The general goal of this capstone mission is to use SARC-F questionnaire in Hong Kong inhabitants. The three particular goals are confirmed beneath:

1. To estimate the prevalence of sarcopenia amongst aged 65 and over aged in neighborhood setting utilizing SARC-F;
2. To discover the distribution of SARC-F scores amongst totally different age group inhabitants;
3. To match the prevalence of sarcopenia in Hong Kong with these in different nations.

Methodology

It is a cross-sectional examine. Members who’re enrolled in this mission might be categorized into two teams (with sarcopenia and with out sarcopenia) by SARC-F. These with complete rating of increased than 4 are labeled as having sarcopenia.

Pattern measurement calculation

For inhabitants of 20000, at a confidence stage of 95% and 5% margin of error, with 50% response distribution, the calculated pattern measurement is 377.

Knowledge assortment

Sampling body is all previous ladies and men on the age of 65 and over in residential care properties. Elderly who’s consent to take part might be recruited. We exclude those that (1) had a bilateral hip substitute; (2) weren’t competent to provide knowledgeable consent; (Three) affected by acute exacerbation of any illness or acute ache.

Recruit topic inhabitants utilizing cluster sampling as title record of sampling body will not be accessible. A self-design questionnaire together with demographic info, smoking behavior, alcohol consumption, power illnesses, hospitalization occasions and SARC-F might be assessed head to head when the contributors are enrolled. To make the interview extra complete and prosperous, two or extra questions might be assessed every part variable in SARC-F. Particulars are proven in the desk beneath:

Desk 2 Variables of SARC-F for sarcopenia

In accordance with the desk, power might be measured by questions: do you discover it tough in case you have been to carry up a ten-pound object (akin to a bag of rice) up from the ground? If the reply is sure, contributors might be requested yet one more Question Assignment: how a lot issue do you’ve gotten doing this? Variables for power measurement are reply of this Question Assignment: some issue, a lot issue or unable to do. Help in strolling might be assessed by three questions: do you’ve gotten any difficulties strolling 2 to three blocks exterior on stage floor? If the reply is sure, contributors might be requested one other Question Assignment: how a lot tough do you’ve gotten doing this? Variables for this part measurement are reply of this Question Assignment: some issue, a lot issue or unable to do. An additional Question Assignment is: do you employ strolling aids, akin to a cane? Rise from a chair might be measured by one Question Assignment: might the participant rise up one time unHelped? Possibility consists of stands with out utilizing arms, unable to face, rises utilizing arms and didn’t try or refused. Climb stairs might be measured by two questions: do you’ve gotten any difficulties climbing up 10 steps with out resting? If the reply is sure, contributors might be requested: how a lot tough do you’ve gotten doing this? Possibility consists of some issue, a lot issue or unable to do. The final part falls might be measured by questions: in the previous 12 months, have you ever fallen and landed on the ground, or fallen and hit an object like a desk or a chair? If the reply is sure, contributors might be requested: what number of instances have you ever fallen in the previous 12 months? Possibility consists of as soon as to a few instances or 4 instances and above.

Statistics Assessment

Predictive variables embrace demographics (age, gender), life-style (smoker/non-smoker, alcohol consumption) and power illnesses (weight problems, hypertension, osteoporosis, kind II diabetes). People who smoke are labeled by having ever smoked greater than 5 packs of cigarettes in the previous. Drinkers are labeled by having consumed greater than 5 items of alcohol per day ever. To measure above predictive variables, a number of questions might be assessed to every participant. Particulars as following:

Smoking – Do you’ve gotten ever smoked greater than 5 packs of cigarettes per day in the previous? Members are categorized as smoker if the reply is sure. Alcohol consuming – Do you’ve gotten ever consumed greater than 5 items of alcohol per day?, Members are labeled as drinker if the reply is sure. Persistent illness historical past – Do you’ve gotten any power illnesses (e.g. hypertension, kind II diabetes, coronary heart illness, weight problems)?

Potential confounders embrace age and gender. To regulate impact of confounders, subgroup Assessment might be completed in teams of ladies and men inside totally different age group (65-69, 70-74, >= 75).

Consequence variables are sarcopenia and hospitalization occasion. Sarcopenia is measured by SARC-F questionnaire. The cut-off rating is 4. Hospitalization occasions in the previous two years from the enrolling day have been verified might be counted.

Look at utilizing logistic regression the bivariate associations between sarcopenia and weight problems, diabetes, smoking and alcohol use.

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