Continuing Education
Sarcopenia: What Every NP Needs to Know

https://doi.org/10.1016/j.nurpra.2015.05.017Get rights and content

Highlights

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    Sarcopenia is insidious and requires health care providers to be vigilant.

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    Sarcopenia is a complex geriatric condition that manifests in the loss of muscle mass and function.

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    Negative outcomes include significant health care costs and significant morbidity.

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    Diagnosis requires screening, performance of simple tests, and imaging.

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    Diet and exercise are fundamental to the treatment, and collaboration ensures optimal outcomes.

Abstract

Sarcopenia is a complex geriatric condition resulting in age-related loss of muscle mass, strength, and function. Onset occurs in adults as young as 40 years old and affects up to 50% of those over 80 years of age. Sarcopenia results in reduced quality of life, disability, and significant health care costs. Diagnosis involves a history, physical, and imaging tests. Treatment requires a multidisciplinary approach to address comorbidities, diet, and exercise prescription. As gatekeepers in primary care, nurse practitioners' knowledge of evidenced-based interventions for sarcopenia is critical if they are to be an effective part of the solution for this significant health care challenge.

Section snippets

Economic Burden

A United States census report projects more than doubling of the population of those over the age of 65 from 35 million in 2000 to 86.6 million in 2050.5 The prevalence of sarcopenia ranges from 13% in individuals 60 to 70 years old and as high as 50% in those over 80 years of age.6 Past estimates of US health care costs associated with the treatment of sarcopenia ranged from $11.8 to $26.2 billion7 and are likely much higher today. In comparison, fracture-related costs of osteoporosis, a more

Physiology of Skeletal Muscle Loss with Aging

The rate of decline in muscle mass during normal aging is 3% to 8% per decade after the age of 40; this rate accelerates after age 65. The decline in muscle strength occurs more rapidly than muscle mass with a reduction in strength of 20% to 40% in upper and lower limb muscles by 70 years of age.10 Muscle loss in sarcopenia can be categorized as either physiologic or pathologic.11 Physiologic sarcopenia results from the functional decline of many systems of the body that occurs with normal

Assessment

The onset and progression of sarcopenia are insidious and often not recognized until significant limitations occur. It is important that nurse practitioners (NPs) remain vigilant because accurate assessment, early diagnosis, and intervention may decrease premature morbidity and mortality. From a clinical perspective, sarcopenia can be categorized as either primary (ie, aging related) or secondary (ie, numerous causal factors such as endocrine disorders, neurodegenerative diseases, cachexia,

Diagnosis

Screening and diagnosis of sarcopenia can proceed from questionnaires to physical examination and imaging tests. Specific blood tests may help categorize the diagnosis as primary or secondary. Because NPs often have limited appointment time, comprehensive assessment of all patients is impractical at every appointment. Fortunately, a rapid screening test can help identify those patients requiring additional examination and testing. The Strength; Assistance in walking; Rise from a chair; Climb

Treatment

Several evidence-based strategies can help prevent, attenuate, or reverse the effects of sarcopenia categorized as dietary, hormonal, and physical activity. A nutrient-dense diet is critical to provide the essential macronutrients and micronutrients required to optimize muscle growth. As people age, dietary intake needs to adjust as well to meet their specific needs. Hormonal interventions may correct underlying deficiencies resulting from primary or secondary hypogonadism. Most importantly,

Conclusions

This review underscores the effort needed to address the importance of a healthy diet and increased physical activity with older adult patients. We now have evidence that the sedentary lifestyle, increased body fatness, and chronic illness profile of many older adults exaggerates inflammation, insulin resistance, nutritional deficiencies, and muscle degradation. Counseling the individual with sarcopenia about exercise and a healthy diet may prevent further deterioration in health, falls,

All authors are affiliated with the Center for Nursing Science and Clinical Inquiry, Madigan Army Medical Center in Tacoma, WA. LTC William J. Brown, PhD, FNP-BC, is a nurse scientist and can be reached at [email protected].

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    All authors are affiliated with the Center for Nursing Science and Clinical Inquiry, Madigan Army Medical Center in Tacoma, WA. LTC William J. Brown, PhD, FNP-BC, is a nurse scientist and can be reached at [email protected].

    Mary S. McCarthy, PhD, RN, is a senior nurse scientist.

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    Published by Elsevier Inc.