The assessment of sarcopenia and the frailty phenotype in the outpatient care of older people: implementation and typical values obtained from the Newcastle SarcScreen project

Abstract

Purpose Sarcopenia and the frailty phenotype both indicate older adults at risk of adverse health outcomes and yet are not widely assessed in practice. We developed the Newcastle SarcScreen to enable assessment of these two ageing syndromes during clinical care. In the setting of our Older People’s Medicine Day Unit, our aims were to describe the implementation of the SarcScreen and to examine the typical values obtained. Methods The SarcScreen comprised height, weight, questions (three on the Fried frailty phenotype and five on the SARC-F questionnaire), grip strength and gait speed. We analysed data from 552 patients completing the SarcScreen. We expressed grip strength as Z-scores (number of standard deviations above the mean expected for a patient’s age and sex). Results It was possible to implement the SarcScreen. In 552 patients (65.9% females) with mean age 80.1 (7.7) years, grip strength was feasible in 98.2% and gait speed in 82.1%. Gait speed was typically not assessed due to mobility impairment. Most patients had weak grip strength (present in 83.8%), slow gait speed (88.8%) and the frailty phenotype (66.2%). We found a high prevalence of probable sarcopenia and the frailty phenotype across all age groups studied. This was reflected by low grip strength Z-scores, especially at younger ages: those aged 60–69 had grip strength 2.7 standard deviations (95% CI 2.5–2.9) below that expected. Conclusion It is possible to implement an assessment of sarcopenia and the frailty phenotype as part of the routine outpatient care of older people.

Assessing Sarcopenia, Frailty, and Malnutrition in Community-Dwelling Dependant Older Adults—An Exploratory Home-Based Study of an Underserved Group in Research

“…When assessed by low hand grip strength alone, probable sarcopenia was present in over half of participants ( n = 61, 19/31) and almost all by poor chair rise test performance (90%, n = 28/31). In a relatively similar cohort to our study group, Dodds et al [ 21 ] found similar patterns, with 84% of patients meeting the criteria for probable sarcopenia based on low hand grip strength, and 66% were frail based on Fried phenotype [ 21 ]. The latter was a large study of older adults attending an acute day unit in the UK ( n = 552) with a mean age of 80.1 ± 7.7 years.…”

“…Furthermore, low physical activity was prevalent, with participants reporting an estimated 11 daytime hours spent sitting. While these chronic conditions and patterns of sedentary behaviour have been reported in older people in acute settings and in longitudinal datasets [ 20 , 21 , 42 , 43 ], few studies have focused on older populations supported by formal home care [ 24 ]. The findings suggest opportunities for appropriate physical activity and dietary intervention to address sarcopenia, frailty, and malnutrition in this group.…”

“…Given frailty and sarcopenia predict future disability and mortality [ 5 , 12 ], potentially at-risk groups, such as those receiving routine care services, warrant formal screening and assessment [ 13 ]. In a recent study, the implementation of sarcopenia and frailty screening was assessed within an acute day-unit [ 21 ]. Dodds et al suggest it is possible to implement routine sarcopenia assessment in an acute setting and identify a high prevalence of probable sarcopenia (84%) and frailty (66%) in a group of older adults with mean age 80.1 ± 7.7 years ( n = 552) [ 21 ].…”

“…In a recent study, the implementation of sarcopenia and frailty screening was assessed within an acute day-unit [ 21 ]. Dodds et al suggest it is possible to implement routine sarcopenia assessment in an acute setting and identify a high prevalence of probable sarcopenia (84%) and frailty (66%) in a group of older adults with mean age 80.1 ± 7.7 years ( n = 552) [ 21 ]. In community-based settings, sarcopenia, frailty and malnutrition are not routinely assessed or documented in this underserved older population group, and likely remain undetected and under-treated [ 22 , 23 , 24 ].…”

Improving muscle strength and physical function in older people living with sarcopenia and physical frailty: Not all exercise is created equal

“…27,49 More directly, clinical practice has an important role to play in screening and identifying those who have sarcopenia, or are at greatest risk of developing sarcopenia, so these individuals can be prioritised for intervention. 50…”