Muscle mass refers to the amount of muscle tissues in our body. From the time we are born through to young adult years, our muscles grow and become stronger, reaching their peak during our 30s and then a decline. In other words, we start losing muscle mass naturally from our 30s. The consequence is reduced muscle strength, function and mobility as we age.
When the loss of muscle mass interferes with daily life activities, such as walking, lifting objects, and climbing stairs, we have a case of sarcopenia. The risk of sarcopenia increases with age and is particularly high among senior adults above the age of 60 and/or having a sedentary lifestyle. Left unmanaged, it can seriously affect one’s overall health and quality of life. Unfortunately, this condition is poorly recognised, because it is often seen as a natural part of the aging process.
This article discusses the prevalence of sarcopenia among the elderly in Singapore and how it can be treated and managed. For the younger audience, read on for tips to spot the early signs of this sarcopenia in your elderly loved ones and how to prevent this disorder in yourselves, thereby preserving our muscle strength and quality of life.
1. What is Sarcopenia?
Sarcopenia literally means a lack of flesh, with “sarco” implying “flesh” and “penia” implying “poverty”. Sarcopenia as a medical condition refers to a progressive and accelerated loss of muscle mass and strength due to the natural aging process. Muscle mass loss due to sarcopenia is associated with an increased risk of falls, functional decline, frailty, disability and even mortality.
Sarcopenia typically happens gradually over decades. We can lose up to 1% of our muscle mass each year from our 30s. As a result, 50% of muscle loss can occur by the age of 80s. Coupled with factors such as limited mobility and poor nutrition intake due to age or comorbidity, it comes as no surprise that sarcopenia is a serious issue among the elderly.
This skeletal muscle disorder currently affects one in three senior adults aged over 60 years in Singapore, which is significantly higher than the world’s average. Prevalence of the disease among younger Singaporeans is also found to be nontrivial, with 1 in every 14 adults affected. As the nation rapidly ages, we can expect the trend to rise, unless we take individual and collective actions to address it.
2. Risk Factors & Causes of Sarcopenia
By definition, aging is the main cause of sarcopenia. However, not every older adult suffers from the disease, suggesting that natural aging is not the only cause and that the disease is not inevitable. In fact, scientists suggest that the cause of this muscle degeneration condition is multi-factorial. Let’s have a look at the different risk factors of sarcopenia, categorised into age-related and medical causes below. Understanding the risk factors will help you manage the risks better for your senior loved ones and yourself.
Natural Age-Related Causes of Sarcopenia
Cases due to purely age-related causes are known as primary sarcopenia. Though aging is the sole cause, a number of inextricably linked risk factors contribute to the development of the disease in older individuals:
- Age-related hormonal changes in testosterone, insulin-like growth factor, and other growth hormones.
- Insufficient consumption of calories and protein, which is more common among elderlies due to poor appetite, dental problems or malabsorption.
- The decreased ability of the body to convert protein to energy.
- Lower physical activity level or complete inactivity due to age, required bed rest or other age-related conditions.
Medical Causes of Sarcopenia
Sarcopenia related to another medical condition is called secondary sarcopenia. Research suggests that the following medical conditions are associated with an increased risk of sarcopenia:
- Obesity – the combination is known as sarcopenic obesity
- Long-term inflammation, such as arthritis
- Inflammatory bowel disease
3. Symptoms of Sarcopenia
It is crucial to be able to identify the signs and symptoms of this debilitating condition, as earlier diagnosis and intervention has shown to be more effective in reversing sarcopenia. When you observe the following symptoms in yourself or elderly loved ones, it is advisable to visit a medical professional for assessment:
- Muscle weakness over time
- Trouble standing up from sitting position without assistance
- Trouble lifting and carrying daily items you used to be able to carry with ease, such as groceries from the supermarket.
- More frequent falling
- Poor balance
- Difficulty walking up staircases
- Walking more slowly
- Losing weight without trying
4. Complications of Sarcopenia
Left unchecked, sarcopenia can lead to serious health issues, including the increased risk of:
- Fall and fracture
- Disability, up to 4 times compared to those without the condition
- Dependency for ADL’s (Activities of Daily Living)
- Hospitalisation, especially among those with sarcopenic obesity
- Swallowing difficulty (sarcopenic dysphagia is the medical term for difficulty swallowing caused by sarcopenia)
- Poorer overall health and prolonged recovery from illness, injury, and surgery
Sarcopenia has also been linked with other medical conditions such as obesity, high blood pressure, type 2 diabetes. With such serious complications, preventing and managing sarcopenia is important in improving quality of life and reducing the health burden for the individuals and society.
5. How is Sarcopenia Diagnosed?
Sarcopenia can be diagnosed by symptoms a patient experiences. Patients are also often asked to perform quick tests such as a hand-grip-strength test, chair-stand test and walking speed test.
In some cases, a doctor orders dual-energy X-ray absorptiometry (DXA), bioelectrical impedance analysis (BIA), MRI or CT scans to diagnose the severity of sarcopenia. Other existing related conditions are also evaluated by the doctor to determine the most suitable treatment.
6. Treatment Options for Sarcopenia
The primary treatment for sarcopenia is exercise, but nutrition can also help reverse sarcopenia. Usage of pharmaceutical drugs such as hormonal therapy is not common and needs further research for effectiveness to be proven. However, if sarcopenia is caused by another disease that needs to be treated with drugs, the patient may receive a prescription for medication.
In the following section, we focus on exercises and nutrition – 2 treatment options that have shown to be effective in counteracting sarcopenia.
6.1. Exercises & Sarcopenia
Studies have shown that performing resistance training stimulates growth signals by creating tension in the muscle fibers, resulting in increased muscle strength. Resistance training has become the principal ‘prescription’ for sarcopenia. Recommended resistance exercises to build muscle mass include:
- Moving your body against gravity
- Pulling against resistance bands
- Weight lifting
Performing two to four exercise sessions per week and progressively increasing repetitions, duration or frequency can help fight and even reverse sarcopenia.
As with any lifestyle changes, the key is starting small, increasing intensity over time and keeping it up. For example, you may start with resistance training using just body weight, then gradually adding light dumbbells (or a water bottle) then heavier dumbbells (or bigger water bottles). It is very useful to have active family members or friends as training buddies to keep you motivated.
Fitness training often has aerobics, endurance and resistance training components in it, which can contribute to preventing and reversing early sarcopenia. Additionally, aerobic training improves gait and balance, alertness, overall health and strength, thereby preventing diseases that are linked to sarcopenia.
With a wide variety of activities to choose from such as walking, yoga, swimming, hiking, jogging and cycling, fitness training is relatively easier to schedule regularly. For example, combining hiking, swimming, and yoga during 3 days of the week with resistance training during the other 3 days can be an effective and exciting training program to follow.
Check out more exercising ideas for elderlies of different health and fitness levels in Singapore in our article here.
6.2. Nutrition & Sarcopenia
Poor nutrition and malnutrition accelerates the loss of muscle mass and muscle function. Elderlies are at higher risk of nutrition deficiency, due to appetite, digestion problems and other age-related factors. To prevent and treat sarcopenia, it is important to maintain a nutritious and balanced diet, with sufficient protein and micro-nutrient daily intake.
In general, it is beneficial to consume a sufficient amount of protein-rich foods, such as lean cuts of beef, skinless poultry, fatty fish (salmon), and beans. If foods do not provide the necessary nutrients, consider taking dietary supplements, such as:
- Vitamin D for strengthening muscle and bones
- Whey protein for restoring muscle mass
- Creatine for maintaining muscle mass
Some seniors may find it downright challenging to consume food, due to loss of appetite, a difficulty chewing, swallowing or other existing medical conditions. In those cases, consulting the relevant doctor and treating the underlying disease will help to improve eating habits and nutrition intake. Read our article on common causes of loss of appetite and digestion issues among elderly for pointers.
7. Preventing & Managing Sarcopenia with Exercise & Diet
Muscle loss is an integral part of aging but sarcopenia is not. If left untreated, sarcopenia can cause injury, disability, dependency, and significantly affect our quality of life. Fortunately, the best prevention and treatment measures are at our disposal, which are exercise and diet.
We hope the article brings attention to the rising prevalence of sarcopenia in Singapore and its serious implications. However, it is not too late for us to act. By maintaining a healthy lifestyle, we can slow down muscle deterioration, prevent and reverse sarcopenia and make the best of our golden years.