The Cumulative Impact of Sarcopenia, Frailty, Malnutrition, and Cachexia on Other Geriatric Syndromes in Hospitalized Elderly

Abstract

Background: Sarcopenia, frailty, malnutrition, and cachexia are overlapping conditions in hospitalized older adults; they are characterized by altered body composition and are associated with poor outcomes. Aim: to quantify the effect of this overlap on other geriatric giants e.g., delirium, cognitive impairment, and functional disability in hospitalized older adults. Methods: A cross sectional observational study involving 206 hospitalized older adults was conducted. Each patient was assessed using Arabic validated versions of mini mental state examination, geriatric depression scale-15, the mini nutritional assessment, activities of daily living and instrumental activities of daily living. Furthermore, Johns Hopkins fall risk assessment tool, bioelectrical impedance analysis, handgrip strength, and timed up and go test were performed. Comorbidities were measured using the age adjusted Charlson Comorbidity Index. Results: 21.4% of the participants had only one syndrome, 13.1%, 14.1%, and 3.4% had two, three, and four coexisting syndromes, respectively. In the adjusted model for age, gender, and comorbidities, the combined effect of overlapping syndromes was significantly higher than the isolated presence of a single syndrome on the risk of delirium, cognitive impairment, community acquired infections, severe functional disability, high risk of falls, and pressure ulcers. Conclusions: The overlap between frailty, sarcopenia, malnutrition, and cachexia, increases the risk of many other geriatric giants. The application of the comprehensive geriatric assessment at hospital admission would help clinicians identify this overlap. Moreover, the existing screening protocols for older adults should include these four conditions.

Instruments Used in the Assessment of Functional Capacity, Frailty and Sarcopenia in the Elderly: Integrative Review

“…Its evaluation shows the severity of processes that the individual may be suffering in the decline of their functional capacities 18,25 . This multifactorial character of decline is identified in the studies of this review, in which low rates in BADL were revealed 18,20,21,25,27 .…”

“…From the analysis of the articles chosen for this study, the main instruments for the evaluation of each domain were identified. Regarding functional capacity, the most used instruments were Katz Index 18,[20][21]25,27 , Lawton, and Brody Index 18,[20][21][22]26,28 , and Barthel Index 26 .…”

“…Functional capacity Katz Index 18,[20][21]25,27 Lawton and Brody Index 18,[20][21][22]26,28 Barthel Index 26 Frailty Criteria proposed by Fried et al 6,[18][19][20][22][23][24][25][26][28][29] Sarcopenia European Working Group on Sarcopenia in the Elderly People 6,[19][20][21][22]24,[26][27]29 Asian Working Group for Sarcopenia 23 SARC-F 18 Questionnaire…”

“…Source: The authors (2022) Chart 3 presents the assessment of the methodological quality of the quantitative studies identified in this review. Studies that used the concept of functional capacity identified the assessment of variables such as fear of falling, geriatric syndromes, fractures, frailty, sarcopenia and functional dependence 18,[20][21][22][25][26][27][28] . Research has also focused on the association between frailty, sarcopenia and functional capacity 6,[18][19][20][21][22][23][24][25][26]28,29 .…”

Associations of medicine use and ejection fraction with the coexistence of frailty and sarcopenia in a sample of heart failure outpatients: a cross-sectional study

“…Sousa-Santos et al found a frequency of 2.2% of coexistence of these conditions in a sample of community-dwelling Portuguese older adults ( n = 1454, age ≥ 65 years) [ 25 ]. Rasheedy & EL-Kawaly reported an overlap of 25.3% of frailty and sarcopenia in a sample of 206 hospitalized Egyptian patients with ages ≥ 60 years and with multiple comorbidities and diseases, including 21.4% of HF patients who were not stratified for the co-occurrence [ 26 ]. Both these studies used the same assessment methods (Fried et al and EWGSOP2) for classifying frailty and sarcopenia as the present work.…”