Overview: What is sarcopenia?
It’s a vicious circle: the body breaks down muscles, making movement more laborious and people prefer to remain seated in an armchair. Without exercise, however, the muscles atrophy more and more. This results in sarcopenia (from the Greek “sarx” = flesh and “penia” = loss). Only in recent years has research focused more intensively on this excessive muscle wasting. While sarcopenia was originally primarily defined as a reduction in muscle mass, doctors expanded the definition in 2018. Now both low muscle mass and (reduced) functionality are taken into account in the diagnosis. This is because some older people are still very agile and fit despite their low muscle mass. These are mainly senior citizens who continue to do sport.
However, sarcopenia does not necessarily mean that those affected look thin: In all patients, fatty tissue can form in place of the broken down muscle fibers. Therefore, neither appearance nor weight are suitable indicators to determine sarcopenia.
Sarcopenia is a disease of old age
Everyone loses muscle as they get older. On average, around one to two percent of skeletal muscle mass is lost every year after the age of 50. As a result, many 80-year-olds have already lost 40 percent of their muscle mass. Exact figures on how many senior citizens are affected by sarcopenia are not available. After all, there has only been an official diagnosis for sarcopenia since 2016. However, doctors estimate that between five and 13 percent of people between the ages of 60 and 70 are affected. Among the over-80s, some doctors assume that every second person suffers from sarcopenia. People who live in a retirement home or are hospitalized are particularly at risk of eating too little and getting too little exercise. Men and women are equally affected by this disease.
Sarcopenia: causes and risk factors
Ageing influences most metabolic processes in the body. Muscle mass and strength also decrease as a result. Among other things, the body releases fewer of the hormones responsible for muscle building. This lack of stimulating (anabolic) signals is often accompanied by a chronic inflammatory reaction that increases with age. Together with the decreasing ability of the older body to synthesize protein and in conjunction with insufficient calorie and/or protein intake, this eventually leads to an excessive decrease in muscle mass and function, which is referred to as sarcopenia.
However, there are several factors that contribute significantly to the development of sarcopenia:
- Malnutrition, especially with regard to proteins
- Lack of movement
- pronounced vitamin D deficiency
- Hormone deficiency, especially testosterone or estrogen
- Inflammatory processes that promote muscle breakdown
As appetite decreases with decreasing muscle mass, many older people eat too little. In addition, people who live alone have little desire to cook and resort to ready meals. These often contain too few valuable ingredients. A good supply of protein and vitamin D is particularly important. Senior citizens need around 25 percent more protein than young people. At the same time, however, many of them have problems chewing and therefore tend to avoid wholemeal products, even though they contain a lot of protein. Some old, cognitively impaired people simply forget to eat.
Sarcopenia often occurs together with osteoporosis (bone loss). Another risk factor for sarcopenia can be a rheumatic disease such as rheumatoid arthritis with its chronic inflammatory processes. This is because the pain associated with the inflammation leads to avoidance of movement. In addition, inflammatory messengers in the blood promote the breakdown of muscles.
Symptoms: Problems in everyday life with sarcopenia
Walking is difficult, every flight of stairs becomes a challenge. Sarcopenia makes many everyday activities difficult. Opening a bottle or a jar of fruit becomes just as much of a problem with sarcopenia as getting dressed or shopping. Another indication of the disease is frequent falls or the need to hang from handrails and handholds. Muscle atrophy means that those affected feel less and less confident and often develop a fear of leaving the house. Basically, the strength simply diminishes in all areas.
Sarcopenia: Diagnosis with us
It is difficult for us to distinguish between the normal ageing process and the excessive muscle atrophy of sarcopenia. The European medical group, which has established guidelines for the diagnosis of sarcopenia, calls for a reduction in the following areas:
- Muscle mass
- Muscular strength
- Physical performance
In addition to reduced muscle mass, the values in at least one of the other two areas must also be low.
The doctor measures the muscle mass either with a bio-impedance analysis (lying down with the help of electrodes) or with dual X-ray absorptiometry, a special X-ray procedure. The strength of an affected person is determined using a grip strength meter. It works in a similar way to a handshake. For the physical performance test, the doctor has the patient walk a set distance. If it covers less than 0.8 meters per second, this is considered a restricted walking speed. Getting up from the chair five times can also be used as a test.
Sarcopenia: prevention, early detection, prognosis
To avoid sarcopenia, two factors are important: plenty of exercise and a healthy diet. It is therefore advisable to establish good habits at an early stage. Regular attendance at a gymnastics group can not only strengthen all parts of the body, but can also be fun and provide social support. Many gyms have special programs for older people that take their particular needs into account. This allows you to train your muscles at times that suit you. It is also convenient if shopping facilities are within walking distance and thus encourage daily walking.
When it comes to nutrition, it helps if you enjoy cooking. That’s how good fresh herbs or baked goods smell in the oven. This quickly prepared lentil soup tastes so delicious. Meat, fish and eggs are particularly rich in protein. However, pulses, wholegrain cereals and milk and dairy products also contain a lot of protein. Nuts are also good sources of protein.
Course and prognosis
If you do nothing about your sarcopenia, it can shorten your life. A long-term study of 8800 men over 19 years showed a clear link between weak muscles and increased mortality. Sarcopenia is very often accompanied by osteoporosis – when the muscles shrink, the bone substance also suffers.
Above all, however, sarcopenia means a significant loss of quality of life. Many sufferers feel weak and helpless. They often even avoid things that they used to enjoy – because they are afraid that they will no longer be able to do them or that they will fall.
Sarcopenia: treatment through gymnastics
We recommend that senior citizens suffering from sarcopenia combine exercise with a high protein intake. This promotes muscle building. The focus of gymnastics is on strength building, balance and coordination training. These skills are also promoted through dancing accompanied by music.