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      Sarcopenia: revised European consensus on definition and diagnosis

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          in 2010, the European Working Group on Sarcopenia in Older People (EWGSOP) published a sarcopenia definition that aimed to foster advances in identifying and caring for people with sarcopenia. In early 2018, the Working Group met again (EWGSOP2) to update the original definition in order to reflect scientific and clinical evidence that has built over the last decade. This paper presents our updated findings.


          to increase consistency of research design, clinical diagnoses and ultimately, care for people with sarcopenia.


          sarcopenia is a muscle disease (muscle failure) rooted in adverse muscle changes that accrue across a lifetime; sarcopenia is common among adults of older age but can also occur earlier in life. In this updated consensus paper on sarcopenia, EWGSOP2: (1) focuses on low muscle strength as a key characteristic of sarcopenia, uses detection of low muscle quantity and quality to confirm the sarcopenia diagnosis, and identifies poor physical performance as indicative of severe sarcopenia; (2) updates the clinical algorithm that can be used for sarcopenia case-finding, diagnosis and confirmation, and severity determination and (3) provides clear cut-off points for measurements of variables that identify and characterise sarcopenia.


          EWGSOP2's updated recommendations aim to increase awareness of sarcopenia and its risk. With these new recommendations, EWGSOP2 calls for healthcare professionals who treat patients at risk for sarcopenia to take actions that will promote early detection and treatment. We also encourage more research in the field of sarcopenia in order to prevent or delay adverse health outcomes that incur a heavy burden for patients and healthcare systems.

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          Sarcopenia: European consensus on definition and diagnosis

          The European Working Group on Sarcopenia in Older People (EWGSOP) developed a practical clinical definition and consensus diagnostic criteria for age-related sarcopenia. EWGSOP included representatives from four participant organisations, i.e. the European Geriatric Medicine Society, the European Society for Clinical Nutrition and Metabolism, the International Association of Gerontology and Geriatrics—European Region and the International Association of Nutrition and Aging. These organisations endorsed the findings in the final document. The group met and addressed the following questions, using the medical literature to build evidence-based answers: (i) What is sarcopenia? (ii) What parameters define sarcopenia? (iii) What variables reflect these parameters, and what measurement tools and cut-off points can be used? (iv) How does sarcopenia relate to cachexia, frailty and sarcopenic obesity? For the diagnosis of sarcopenia, EWGSOP recommends using the presence of both low muscle mass + low muscle function (strength or performance). EWGSOP variously applies these characteristics to further define conceptual stages as ‘presarcopenia’, ‘sarcopenia’ and ‘severe sarcopenia’. EWGSOP reviewed a wide range of tools that can be used to measure the specific variables of muscle mass, muscle strength and physical performance. Our paper summarises currently available data defining sarcopenia cut-off points by age and gender; suggests an algorithm for sarcopenia case finding in older individuals based on measurements of gait speed, grip strength and muscle mass; and presents a list of suggested primary and secondary outcome domains for research. Once an operational definition of sarcopenia is adopted and included in the mainstream of comprehensive geriatric assessment, the next steps are to define the natural course of sarcopenia and to develop and define effective treatment.
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            The timed "Up & Go": a test of basic functional mobility for frail elderly persons.

            This study evaluated a modified, timed version of the "Get-Up and Go" Test (Mathias et al, 1986) in 60 patients referred to a Geriatric Day Hospital (mean age 79.5 years). The patient is observed and timed while he rises from an arm chair, walks 3 meters, turns, walks back, and sits down again. The results indicate that the time score is (1) reliable (inter-rater and intra-rater); (2) correlates well with log-transformed scores on the Berg Balance Scale (r = -0.81), gait speed (r = -0.61) and Barthel Index of ADL (r = -0.78); and (3) appears to predict the patient's ability to go outside alone safely. These data suggest that the timed "Up & Go" test is a reliable and valid test for quantifying functional mobility that may also be useful in following clinical change over time. The test is quick, requires no special equipment or training, and is easily included as part of the routine medical examination.
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              Frailty in elderly people.

              Frailty is the most problematic expression of population ageing. It is a state of vulnerability to poor resolution of homoeostasis after a stressor event and is a consequence of cumulative decline in many physiological systems during a lifetime. This cumulative decline depletes homoeostatic reserves until minor stressor events trigger disproportionate changes in health status. In landmark studies, investigators have developed valid models of frailty and these models have allowed epidemiological investigations that show the association between frailty and adverse health outcomes. We need to develop more efficient methods to detect frailty and measure its severity in routine clinical practice, especially methods that are useful for primary care. Such progress would greatly inform the appropriate selection of elderly people for invasive procedures or drug treatments and would be the basis for a shift in the care of frail elderly people towards more appropriate goal-directed care. Copyright © 2013 Elsevier Ltd. All rights reserved.

                Author and article information

                Age Ageing
                Age Ageing
                Age and Ageing
                Oxford University Press
                January 2019
                24 September 2018
                24 September 2018
                : 48
                : 1
                : 16-31
                [1 ]Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
                [2 ]Department of Internal Medicine, Division of Geriatrics, Istanbul Medical School, Istanbul University, Istanbul, Turkey
                [3 ]Center for Geriatric Medicine, University Heidelberg, Agaplesion Bethanien Krankenhaus, Heidelberg, Germany
                [4 ]Research Department, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
                [5 ]Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
                [6 ]Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, and Theme Ageing, Karolinska University Hospital, Stockholm, Sweden
                [7 ]MRC Lifecourse Epidemiology Unit, University of Southampton; Southampton, UK; and Department of Epidemiology, University of Oxford, OX, UK
                [8 ]Instituto di Medicina Interna e Geriatria, Università Cattolica del Sacro Cuore, Roma, Italy
                [9 ]Department of Geriatrics, Hospital and University of Toulouse, Toulouse, France
                [10 ]NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Faculty of Medical Sciences, Newcastle University, Newcastle, UK
                [11 ]Department of Gastroenterology and Clinical Nutrition, Centre Hospitalier Universitaire de Nice, Université Côte d’Azur, Nice, France
                [12 ]Department of Internal Medicine-Geriatrics, Institute for Biomedicine and Ageing, Friedrich-Alexander-University, Erlangen-Nürnberg, Germany
                [13 ]Department of Geriatrics, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague, Czech Republic
                [14 ]Department Geriatrics, University of Antwerp, Ziekenhuisnetwerk Antwerpen (ZNA), Antwerp, Belgium
                [15 ]Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam; and the Amsterdam Public Health Research Institute; Amsterdam, The Netherlands
                [16 ]Department of Medicine, Geriatric section, University of Verona, Verona, Italy
                [17 ]Department of Gerontology and Department of Frailty in Ageing, Vrije University Brussel; Brussels, Belgium
                [18 ]Geriatrician at the Teaching Hospital AZ Alma; Eeklo, Belgium; and University of Luxembourg; Luxembourg City, Luxenbourg
                [19 ]Geriatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Università di Milano; Milan, Italy
                [20 ]Geriatria, Accettazione geriatrica e Centro di ricerca per l’invecchiamento, IRCCS INRCA, Ancona, Italy
                [21 ]Center for Metabolic Bone Diseases, University of Sheffield Medical School; Sheffield, UK and Institute for Health and Ageing, Australian Catholic University; Melbourne, Australia
                [22 ]Geriatric Clinic Unit, Geriatric Rehabilitation Department, University-Hospital of Parma, Department of Medicine and Surgery
                [23 ]Department of Ageing and Health, Guys and St Thomas’ NHS Foundation Trust; London, UK
                [24 ]Department of Rehabilitation and Geriatrics, University of Geneva; Geneva, Switzerland
                [25 ]Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Central Hospital, Unit of Primary Health Care; Helsinki, Finland
                [26 ]Bone and Cartilage Metabolism Unit, University of Liège; Liège, Belgium
                [27 ]Department of Bone Disease, University of Geneva; Geneva, Switzerland
                [28 ]Geriatrics Department, Parc Salut Mar. Rehabilitation Research Group, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM). Universitat Autònoma de Barcelona, Universitat Pompeu Fabra; Barcelona, Spain
                [29 ]Department of Health Services Research, Maastricht University; Maastricht, the Netherlands
                Author notes
                Address correspondence to: Alfonso J. Cruz-Jentoft, MD, Servicio de Geriatría, Hospital Universitario Ramón y Cajal, Ctra. Colmenar, km 9.1, 28034 Madrid, Spain. Tel: +34 913368172; Fax: +34 913368172. Email: alfonsojose.cruz@
                © The Author(s) 2018. Published by Oxford University Press on behalf of the British Geriatrics Society.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (, which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@

                Page count
                Pages: 16
                Funded by: European Working Group on Sarcopenia in Older People 2


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