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Prevalence of Probable Sarcopenia in Community-Dwelling Older Swiss People – a Cross-Sectional Study Julia Wearing1,2, Peter Konings3, Rob A

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Prevalence of Probable Sarcopenia in Community-Dwelling Older Swiss People – a Cross-Sectional Study Julia Wearing1,2, Peter Konings3, Rob A Wearing et al. BMC Geriatrics (2020) 20:307 https://doi.org/10.1186/s12877-020-01718-1 RESEARCH ARTICLE Open Access Prevalence of probable sarcopenia in community-dwelling older Swiss people – a cross-sectional study Julia Wearing1,2, Peter Konings3, Rob A. de Bie1, Maria Stokes4,5 and Eling D. de Bruin6,7* Abstract Background: The European Working Group on Sarcopenia in Older People has recently defined new criteria for identifying “(probable) sarcopenia” (EWGSOP2). However, the prevalence of probable sarcopenia, defined by these guidelines, has not been determined extensively, especially in the oldest old. This study aims to determine the prevalence of probable sarcopenia in older, community-living people and its association with strength-related determinants. Methods: Handgrip strength and reported determinants (age, height, weight, osteoarthritis of hands, medications, fall history, physical activity, activities of daily living (ADL) and global cognitive function) were collected in a cross- sectional study of 219 community-living Swiss people (75 years and over). Probable sarcopenia was estimated based on cut-off values for handgrip strength as recommended by EWGSOP2. Spearman correlations, binary-regression analyses and contingency tables were used to explore relationships between variables. Results: The prevalence of probable sarcopenia in women (n = 137, age 84.1 ± 5.7 years) and men (n = 82, age 82.6 ± 5.2 years) was 26.3 and 28.0%, respectively. In women, probable sarcopenia correlated positively with age and falls (rs range 0.332–0.195, p < .05), and negatively with weight, cognition, physical activity, using stairs regularly, participating in sports activities and ADL performance (rs range = − 0.141 - -0.409, p < .05). The only significant predictor of probable sarcopenia at the multivariate level was ADL performance (Wald(1) = 5.51, p = .019). In men, probable sarcopenia was positively correlated with age (rs = 0.33, p < .05) and negatively with physical activity, participation in sports and ADL performance (rs range − 0.221 – − 0.353, p < .05). ADL performance and age (Wald(1) = 4.46, p = .035 and Wald(1) = 6.30, p = .012) were the only significant predictors at the multivariate level. Men and women with probable sarcopenia were 2.8 times more likely to be dependent in ADL than those without. Conclusion: Probable sarcopenia affected one in every four community-living, oldest old people and was independently associated with impaired ADL performance in both sexes. This highlights the importance of detection of handgrip strength in this age group in clinical practice. Although prospective studies are required, independence in ADL might help to protect against probable sarcopenia. Keywords: Older people, Probable sarcopenia, EWGSOP2, ADL independence * Correspondence: [email protected] 6Department of Health Sciences and Technology, Insitute of Human Movement Sciences and Sport (IBWS) ETH, ETH Zurich, HCP H 25.1, Leopold-Ruzicka-Weg 4, 8093 Zürich, Switzerland 7Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Wearing et al. BMC Geriatrics (2020) 20:307 Page 2 of 8 Background evaluation of probable sarcopenia provides important Sarcopenia is a generalized, progressive muscle disease/ information, relevant for sarcopenia prevention and disorder [1] that has considerable, negative health- health promotion. related consequences such as an increased rate of falls The handgrip strength test is easily applicable to older and incidence of hospitalization [2]. It is characterized adults and provides important information on current by quantitative and qualitative alterations in muscles and future health status. Low muscle strength increases that may emerge from middle age onwards [3] and cu- the probability of mobility limitations [12], impaired per- mulatively occur in people with chronic diseases and an formance in daily activities [13–15] and is a marker of inactive lifestyle [4]. The prevalence of sarcopenia in frailty [16]. In older people, high grip strength has a pro- Europe was between 11 and 20% in healthy men and tective effect for developing disability [17] while low women aged ≥60 years in 2016 [5, 6] and an accumu- handgrip strength is a direct, disease-independent pre- lated 17% in a recently studied Swiss sample in the dictor of mortality [18, 19]. Therefore, detection of low Italian speaking part of Switzerland where seven differ- handgrip strength in older individuals is particularly im- ent Sarcopenia definitions were applied [7]. The preva- portant to evaluate the status of sarcopenia, which bears lence significantly increases with age and is expected to relevance for timely initiation of preventive or curative rise within the next 30 years, particularly in the highest interventions [1]. Since the detection of pre−/probable age groups [5]. Through concomitant diseases, sarcope- sarcopenia is now based on muscle strength rather than nia is accompanied by a high personal and social burden muscle mass, applying the new guidelines (EWGSOP2) when it remains untreated [1]. Sarcopenia can be pre- might lead to different population proportions identified vented, delayed and probably counteracted by physical with pre-sarcopenia that would qualify for preventive or training and nutritional adaptations [4, 8]. However, in curative associated care. clinical practice sarcopenia is not contemplated suffi- To date, information about the prevalence of probable ciently as a determinant of health deterioration [9] not- sarcopenia, defined by low muscle strength according to withstanding the fact that an ICD-10-CM code for the latest guidelines of the EWGSOP is rare, especially sarcopenia was established in 2016. Therefore, sarcope- in oldest old men, and not evaluated yet for community nia can gradually lead to mobility limitations with loss of living, non-hospitalized women [20–23]. The primary independence in activities of daily living (ADL) [10] and objective of this study was, therefore, to provide data re- a decrease of life quality [11]. garding the prevalence of probable sarcopenia in older, The European Working Group on Sarcopenia in community-living women and men in Switzerland. The Older People (EWGSOP) published a consensus paper secondary objective was to evaluate the association be- in 2010 on the definition of sarcopenia in older tween probable sarcopenia and strength-related people based on clinical measures [6]. Pre-sarcopenia determinants. was diagnosed by low muscle mass, and sarcopenia was defined by low muscle mass and either low Methods muscle strength (e.g. handgrip strength) or low Study design and recruitment muscle performance (e.g. low gait speed). Certain cut- A cross-sectional study, adhering to reporting guidelines off values were set for each assessment. In 2018, the [24], was carried out between June 2016 and March algorithm of clinical measures was updated based on 2017 in the Basel and St Gallen urban regions of scientific evidence of the previous decade (EWG- Switzerland. The aim was to evaluate handgrip strength SOP2) [1] and takes into account the dominant role of community-living Swiss-German older adults. Re- of muscle strength in age-associated muscle wasting cruitment was targeted towards people 75 years and rather than muscle mass. According to the new over, living independently at their own home. Written guidelines, a muscle strength test, such as handgrip information about the study was given to the target strength, is recommended as the initial assessment in population through employees of the study sites (rela- detecting sarcopenia, therewith identifying individuals tives, friends, communities) and organizations for se- with probable sarcopenia when handgrip strength is niors (senior education center and service organization) <16kg for women and<27kg for men. Confirmation in the related cities. Interested potential participants of the diagnosis sarcopenia is received by an add- were screened for inclusion and exclusion criteria via itional detection of low muscle mass or quality. How- phone call. Volunteers were included when they had no ever, low strength on its own is considered enough to self-reported upper extremity pain or stiffness on more initiate interventions [1] since negative consequences than 50% of days of the past month, no acute diseases, of untreated
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