Role of sarcopenia in the frailty transitions in older adults: a population‐based cohort study

Abstract

Background Frailty and sarcopenia are age-associated syndromes that have been associated with the risk of several adverse events, mainly functional decline and death, that usually coexist. However, the potential role of one of them (sarcopenia) in modulating some of those adverse events associated to the other one (frailty) has not been explored. The aim of this work is to assess the role of sarcopenia within the frailty transitions and mortality in older people. Methods Data from the Toledo Study of Healthy Aging (TSHA) were used. TSHA is a cohort of community-dwelling older adults ≥65. Frailty was assessed according with the Frailty Phenotype (FP) and the Frailty Trait Scale-5 (FTS5) at baseline and at follow-up. Basal sarcopenia status was measured with the standardized Foundation for the National Institutes of Health criteria. Fisher's exact test and logistic regression model were used to determine if sarcopenia modified the transition of frailty states (median follow-up of 2.99 years) and Cox proportional hazard model was used for assessing mortality. Results There were 1538 participants (74.73 ± 5.73; 45.51% men) included. Transitions from robustness to prefrailty and frailty according to FP were more frequent in sarcopenic than in non-sarcopenic participants (32.37% vs. 15.18%, P ≤ 0.001; 5.76% vs. 1.12%; P ≤ 0.001, respectively) and from prefrailty-to-frailty (12.68% vs. 4.27%; P = 0.0026). Improvement from prefrail-to-robust and remaining robust was more frequent in non-sarcopenic participants (52.56% vs. 33.80%, P ≤ 0.001; 80.18% vs 61.15%, P ≤ 0.001, respectively). When classified by FTS5, this was also the case for the transition from non-frail-to-frail (25.91% vs. 4.47%, P ≤ 0.001) and for remaining stable as non-frail (91.25% vs. 70.98%, P ≤ 0.001). Sarcopenia was associated with an increased risk of progression from robustness-toprefrailty [odds ratio (OR) 2.34 (95% confidence interval, CI) (1.51, 3.63); P ≤ 0.001], from prefrailty-to-frailty [OR (95% CI) 2.50 (1.08, 5.79); P = 0.033] (FP), and from non-frail-to-frail [OR(95% CI) 4.73 (2.94, 7.62); Pvalue ≤ 0.001]. Sarcopenia does not seem to modify the risk of death associated with a poor frailty status (hazard ratios (HR, 95%) P > 0.05). Conclusions Transitions within frailty status, but not the risk of death associated to frailty, are modulated by the presence of sarcopenia.

Sarcopenia, biological age and treatment eligibility in patients with cancer

“…However, transitions are bi-directional, as improvement from prefrail-to-robust and remaining robust has been also shown, although sarcopenia again plays an important yet negative influence. Of note, sarcopenia does not seem to modify the risk of death associated with a poor frailty status, confirming that poor functional status is a robust predictor of outcome [11].…”

“…By analysing data from the Toledo Study of Healthy Aging (i.e. a cohort of community-dwelling older adults aged ≥65 years; n = 1538), Álvarez -Bustos et al [11] report that transitions from robustness to prefrailty and frailty were more frequent in sarcopenic than in nonsarcopenic participants (32.37 vs. 15.18%, P ≤ 0.001; 5.76 vs. 1.12%; P ≤ 0.001, respectively) and from prefrailty-to-frailty (12.68 vs. 4.27%; P = 0.0026). However, transitions are bi-directional, as improvement from prefrail-to-robust and remaining robust has been also shown, although sarcopenia again plays an important yet negative influence.…”

Vascular frailty, a proposal for new frailty type: A narrative review

“…A quantitative or qualitative decrease in skeletal muscle, or sarcopenia, frequently occurs in older adults and increases their risks of functional impairment, compromised mobility, and accidental injuries 29 . A recent study revealed that sarcopenia accelerated frailty progression among the elderly 30 . Aging also exerts negative effects on brain morphology, manifesting as size attenuation, microbleed emergence, and white matter hyperintensity increment.…”

Effect of Familial Longevity on Frailty and Sarcopenia: A Case–Control Study

“…Furthermore, they are dynamic processes, with the possibility of transitions from lower to higher levels and, more difficult, from higher to lower states in the case of frailty [ 11 , 12 ]. The presence of sarcopenia, on the other hand, also appears to modulate transitions in frailty status [ 13 ]. Regrettably, both syndromes are frequently detected only when one or both are well established and, often after a seemingly minor event, the individual is already suffering a health crisis with significant functional loss and dependency.…”