To serve our readership better, some future editions of Clinical Interventions in
Aging will contain the editor’s comments and views on developing trends in the field
of age management, with reference to recently published journal articles that address
the issue at hand. Hopefully, these opinions will generate interest and comments from
practitioners who deal with the clinical issues, treatments, and outcomes relevant
to the topic chosen for each Editor’s Choice. The first of these will address a chronic
and universal effect of aging, ie, progressive changes in body composition, leading
to sarcopenia or loss of muscle mass. Such changes during middle age and later life
predispose individuals to functional limitations that become a common pathway for
many pathological processes, and ultimately contribute to morbidity and death. The
prevalence of sarcopenia, which may be as high as 30% for individuals aged 60 years
or older, will increase as the percentage of older individuals continues to grow in
our population. However, because loss of skeletal muscle mass and strength begins
relatively early in life, diagnosis of sarcopenia should not rely exclusively upon
quantification of functional loss.
When considering the concept of declining structure and function during aging, it
is important to determine if this is an inevitable and nonmodifiable aspect of senescence
or whether it can be modified therapeutically. This basic question relates directly
to and significantly influences clinical practice. There is probably no decline in
structure and function more dramatic than the loss of lean body (muscle mass) over
the decades of life. In fact, there may be no single feature of age-related decline
more striking than this and negatively affecting more basic aspects of life, including
ambulation, mobility, energy intake, overall nutrient intake and status, and respiration.
These changes are directly related to reduced basal metabolic rate and progressive
deficiencies in most other physiological functions that are responsible in a large
part for increased weakness, falls, and fractures, leading to nursing home admission
and loss of independence. Because of the link between sarcopenia during aging and
disability, there is a continued need for research into the use of interventions that
can prevent or at least partially reverse age-associated loss of muscle mass, including
such therapies as resistance exercise, hormone replacement, and nutritional supplementation.
To these ends, reference is now made to several papers recently published in Clinical
Interventions in Aging that address this problem.
First of all was a thorough review of interventions by Walters et al1 entitled “Advantages
of dietary, exercise-related, and therapeutic interventions to prevent and treat sarcopenia
in adult patients: an update”. This comprehensive review provides guides to a multitude
of treatments for sarcopenia, ranging from diet to exercise to hormone replacement,
and will serve practitioners as a useful reference to relevant research. Also is a
review by Burton and Sumukadas2 which is focused on clinical management of the condition,
entitled “Optimal management of sarcopenia”. This paper complements and extends that
previously published by Waters et al, and provides references to papers identifying
the mechanisms of sarcopenia, its diagnosis, and potential clinical interventions
for its treatment.
In addition to the review articles identifying exercise and nutritional status as
important interventions for treating sarcopenia, the journal also contains research
articles reporting clinical findings from application of these therapies. These include
an article by Alfieri et al3 entitled “Functional mobility and balance in community-dwelling
elderly submitted to multisensory versus strength exercises” and another by Ahmed
and Haboubi4 entitled “Assessment and management of nutrition in older people and
its importance to health”.
More recently, the relationship between weight loss and transfer to high-level care
or mortality was documented in a report by Woods et al.5 These authors studied a group
of older patients who initially lived in low-level care facilities but were subsequently
transferred to high-level care or died because of changes in body composition. While
loss of muscle mass and reduced strength were characteristic findings in the study
subjects, the acute affects of weight loss, primarily in the fat compartment, correlated
with their adverse outcomes. It should be pointed out that while sarcopenia was not
immediately responsible for the crises experienced by those subjects facing serious
disease, quality of life, or even mortality, their weakened conditions associated
with lean body mass undoubtedly initiated the cascade of failure leading to a negative
outcome. The reason fat loss was significant in these cases was because it deprived
individuals of their last energy stores, which were needed for even the most basic
aspects of independent living.
While physical exercise has been shown to oppose sarcopenia, those with limited mobility
may benefit from coordination exercise. Kwok et al6 reported that exercises with lower
requirements for locomotive ability, such as coordination training and towel exercise,
might be beneficial for sustaining and improving physical mobility and cognitive functioning
in the elderly. Upon testing their hypothesis, Kwok et al found that coordination
training was the most successful intervention, providing significant improvement in
cognitive measures in their test subjects. This paper is entitled “Effectiveness of
coordination exercise in improving cognitive function in older adults: a prospective
study”. Similar benefits of mild exercise to prevent falls associated with muscle
loss were attributed to balancing exercise and reported by Kuptniratsaikul et al7
in their article entitled “Effectiveness of simple balancing training program in elderly
patients with history of frequent falls”. A review by Hanley et al entitled “Community-based
health efforts for the prevention of falls in the elderly” was also included, providing
a broad base of information to complement prevention and treatment of age-associated
muscle loss.8
Finally, the practitioner is sometimes faced with the question of whether a diagnosis
of sarcopenia or loss of strength is more appropriate for a specific patient. This
issue was addressed in a research article by Woods et al9 entitled “Poor physical
function in elderly women in low-level aged care is related to muscle strength rather
than to measures of sarcopenia”. Upcoming articles continue to report advances in
the treatment of sarcopenia with various approaches. However, it is clear that we
require greater understanding of the underlying mechanisms leading to sarcopenia,
so that the cause(s) rather than its consequences may be targeted therapeutically.
Nonetheless, current research indicates that significant strides are being made to
develop specific interventions that will prevent disability and optimize independence,
even to the extremes of old age.