The clinical usefulness of muscle mass and strength measures in older people: a systematic review

Abstract

Background sarcopenia is the loss of muscle mass and quality and is diagnosed using measures of muscle strength, size and mass. We evaluated the literature on whether sarcopenia measures are predictive of motor outcomes in older people in clinical settings. Methods electronic databases (MEDLINE Ovid, EMBASE, CINAHL and Web of Science) were searched for articles on measures of muscle mass, volume, thickness or strength, in older people in clinical settings, which reported cross-sectional or longitudinal associations with motor outcomes. Clinical cohorts included geriatric medical inpatients and outpatients, patients with hip fracture, geriatric rehabilitation and care home residents. Motor outcomes were mobility, falls, balance and activities of daily living (ADL). Due to high study heterogeneity, standardised mean differences were used to compare strength of associations. Results in total, 83 articles were identified. The most frequently studied measures were grip strength (47 studies), knee extension strength (21 studies) and bioelectrical impedance analysis (18 studies). Handgrip strength (HGS) had evidence for cross-sectional associations with mobility (14 of 16 studies, 2,088 participants), balance (6 of 6 studies, 1,177 participants) and ADL independence (10 of 11 studies, 3,228 participants), and evidence of longitudinal associations with mobility (3 of 3 studies, 883 participants) and ADL independence (7 of 10 studies, 1,511 participants). There was no conclusive evidence for association with falls. Conclusions HS was the most studied measure and was associated with mobility, balance and ADL outcomes. There was a paucity of studies, particularly with longitudinal follow-up, measuring muscle mass, volume or thickness using gold-standard approaches.

Association between Skeletal Muscle Mass Index and Convalescent Rehabilitation Ward Achievement Index in Older Patients

“…1A). 6) Although the actual CRWAI is calculated for an entire hospital, the CRWAI score in this study was calcu-lated for each patient to allow comparisons between the two groups (Fig. 1B).…”

“…20,21) Consequently, a loss of muscle mass is more likely to affect functional outcomes in older men than in older women. 20) Furthermore, several studies have reported an association of hand-grip strength with ADLs 1,3,4,6,19,[22][23][24] that was retained for 1 year after hospital discharge in longitudinal studies. 6) Therefore, hand-grip strength could be a good predictor of ADLs in patients admitted to rehabilitation wards.…”

“…5) However, it is sometimes not possible to measure muscle strength and gait speed in patients admitted to rehabilitation wards because of their physical disabilities. 6) In such cases, it is important to measure the skeletal muscle mass index (SMI), which is one of the diagnostic criteria for sarcopenia. 4) Evaluating the efficacy of rehabilitation interventions in the convalescent rehabilitation ward is critical in determining Objective: The aim of the current study was to investigate the association between the skeletal muscle mass index (SMI) and the convalescent rehabilitation ward achievement index (CRWAI) in older patients with functional impairment.…”

Research into ageing and frailty

“…An example is how muscle mass and quality indices developed in heathy volunteers can have limited utility in clinical populations which are similar in chronological age, because of markedly diminished muscle mass in clinical cohorts. 73 Clinical trials for hypertension offer an example where there has been a focus on recruiting healthy older people with consequent lack of generalisability to clinical cohorts. Even when the mean age in trials is high, the populations studied are much healthier than typical patients seen in clinic.…”

Type II muscle fibre properties are not associated with balance recovery following large perturbations during walking in young and older adults

“…Specifically, the leg extensor muscle-tendon groups critical for gait [2][3][4] show reduced muscle strength and altered tendon mechanical properties in older, compared to younger adults [5][6][7][8]. Lower limb muscle strength [9][10][11][12], power [11,13,14] and quality [15,16] have been associated with daily life falls incidence in older adults, although findings are not unequivocal [12,13,[17][18][19]. The majority of falls in community-dwelling older adults occur following large balance disturbances (like trips and slips) during walking [20][21][22][23][24][25][26][27].…”