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      Sarcopenia: European consensus on definition and diagnosis : Report of the European Working Group on Sarcopenia in Older People

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          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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          Frailty in Older Adults: Evidence for a Phenotype

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            Frailty in older adults: evidence for a phenotype.

            Frailty is considered highly prevalent in old age and to confer high risk for falls, disability, hospitalization, and mortality. Frailty has been considered synonymous with disability, comorbidity, and other characteristics, but it is recognized that it may have a biologic basis and be a distinct clinical syndrome. A standardized definition has not yet been established. To develop and operationalize a phenotype of frailty in older adults and assess concurrent and predictive validity, the study used data from the Cardiovascular Health Study. Participants were 5,317 men and women 65 years and older (4,735 from an original cohort recruited in 1989-90 and 582 from an African American cohort recruited in 1992-93). Both cohorts received almost identical baseline evaluations and 7 and 4 years of follow-up, respectively, with annual examinations and surveillance for outcomes including incident disease, hospitalization, falls, disability, and mortality. Frailty was defined as a clinical syndrome in which three or more of the following criteria were present: unintentional weight loss (10 lbs in past year), self-reported exhaustion, weakness (grip strength), slow walking speed, and low physical activity. The overall prevalence of frailty in this community-dwelling population was 6.9%; it increased with age and was greater in women than men. Four-year incidence was 7.2%. Frailty was associated with being African American, having lower education and income, poorer health, and having higher rates of comorbid chronic diseases and disability. There was overlap, but not concordance, in the cooccurrence of frailty, comorbidity, and disability. This frailty phenotype was independently predictive (over 3 years) of incident falls, worsening mobility or ADL disability, hospitalization, and death, with hazard ratios ranging from 1.82 to 4.46, unadjusted, and 1.29-2.24, adjusted for a number of health, disease, and social characteristics predictive of 5-year mortality. Intermediate frailty status, as indicated by the presence of one or two criteria, showed intermediate risk of these outcomes as well as increased risk of becoming frail over 3-4 years of follow-up (odds ratios for incident frailty = 4.51 unadjusted and 2.63 adjusted for covariates, compared to those with no frailty criteria at baseline). This study provides a potential standardized definition for frailty in community-dwelling older adults and offers concurrent and predictive validity for the definition. It also finds that there is an intermediate stage identifying those at high risk of frailty. Finally, it provides evidence that frailty is not synonymous with either comorbidity or disability, but comorbidity is an etiologic risk factor for, and disability is an outcome of, frailty. This provides a potential basis for clinical assessment for those who are frail or at risk, and for future research to develop interventions for frailty based on a standardized ascertainment of frailty.
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              A Short Physical Performance Battery Assessing Lower Extremity Function: Association With Self-Reported Disability and Prediction of Mortality and Nursing Home Admission


                Author and article information

                Age Ageing
                Age and Ageing
                Oxford University Press
                July 2010
                13 April 2010
                13 April 2010
                : 39
                : 4
                : 412-423
                [1 ]Servicio de Geriatría, simpleHospital Universitario Ramón y Cajal , Madrid, Spain
                [2 ]simpleAZ Damiaan Hospital , Oostende, Belgium
                [3 ]Department of Geriatric Medicine, simpleUniversity of Erlangen-Nürnberg , Nürnberg, Germany
                [4 ]simpleClermont Université , UFR Médecine, UMR 1019, F-63001 Clermont-Ferrand, France
                [5 ]Institutionen för Folkhälso- och Vårdvetenskap/Klinisk Nutrition och Metabolism, simpleUppsala Universitet , Uppsala, Sweden
                [6 ]Istituto di Medicina Interna e Geriatria, simpleUniversità Cattolica del Sacro Cuore , Roma, Italy
                [7 ]Department of Ageing and Health, simpleGuys and St Thomas' NHS Foundation Trust , London, UK
                [8 ]Département de Réhabilitation et Gériatrie, simpleHôpitaux Universitaires de Genève , Geneva, Switzerland
                [9 ]Gérontopôle de Toulouse, simpleHospital La Grave-Casselardit , Toulouse, France
                [10 ]Gastroentérologie et Nutrition Clinique, CHU de Nice, simpleUniversité de Nice Sophia-Antipolis , Nice, France
                [11 ]Geriatrická Klinika 1 Lékařská Fakulta, simpleUniverzita Karlova v Praze , Prague, Czech Republic
                [12 ]Department of Geriatrics, simpleUniversity of Antwerp , Ziekenhuisnetwerk Antwerpen (ZNA), Antwerp, Belgium
                [13 ]Department of Biomedical and Surgical Sciences, Division of Geriatrics, simpleUniversity of Verona , Verona, Italy
                Author notes
                Address correspondence to: Alfonso J. Cruz-Jentoft, Servicio de Geriatría, Hospital Universitario Ramón y Cajal, Ctra. Colmenar, km 9,1, 28034 Madrid, Spain. Tel: +34 913368172. Email: acruz.hrc@

                Endorsed by the European Geriatric Medicine Society (EUGMS), the European Society for Clinical Nutrition and Metabolism (ESPEN), the International Association of Gerontology and Geriatrics—European Region (IAGG-ER) and the International Association of Nutrition and Aging (IANA).

                © The Author 2010. 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 unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


                Geriatric medicine

                muscle strength, muscle mass, physical performance, elderly, sarcopenia


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