Ageing well: a review of sarcopenia and frailty

Abstract

Conference on 'Nutrition and age-related muscle loss, sarcopenia and cachexia' 'Ageing well' has been declared a global health priority by the World Health Organisation and the role of sarcopenia and frailty in late-life health is receiving increasing attention. Frailty is the decline in an individual's homeostatic function, strength and physiologic reserves leading to increased vulnerability, while sarcopenia describes the loss of muscle mass and function with age. The conceptual definitions of these conditions have been widely agreed but there is a lack of consensus on how to measure them. We review the different operational definitions described in the literature and the evidence that, whatever definition used, the prevalence and clinical impact of these conditions is high. We also consider the commonality of low physical function to both conditions, a feature which could provide a pragmatic way forward in terms of identifying those at risk. Objective measures of physical function such as usual walking speed are simple and feasible measures, extensively validated against health outcomes. Additionally, clinical applications of sarcopenia and frailty are reviewed with particular consideration to their potential role in the management of older people undergoing surgery. Frailty appears to outperform traditional anaesthetic and surgical risk scores in terms of its association with post-operative complications, length of hospital stay, institutionalisation and mortality. However, even within this sub-specialty area there is wide variation in the approaches used to measure frailty and there is an urgent need for studies to utilise established, validated and reproducible methods to identify sarcopenia and frailty in their study participants, in order to expedite scientific development. Sarcopenia: Frail elderly: AgeingBy 2050 the proportion of the world's population aged ⩾60 years is projected to be 22 %, double the proportion recorded at the turn of the new millennium (1) . Although population ageing is in one way a great public health success story, with mortality rates among older people continuing to fall (2) , in another way it presents significant challenges. For example, in the UK 60 % of people admitted to hospital are ⩾65 years old despite this age-group only comprising 17 % of the total UK population (3) . This disproportionate use of healthcare services by older people not only demonstrates the significant economic implications of an ageing population (4) , but also the morbidity experienced by many older people, reducing quality of life. However, it is not inevitable that *Corresponding author: Dr V. L. Keevil, fax +44 (0)1223 748676, email vlk20@cam.ac.uk Abbreviations: CGA, comprehensive geriatric assessment; FI, frailty index; PFP, physical frailty phenotype.

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