How to stop muscle loss in older people

Australian sarcopenia guidelines emphasise that losing muscle mass and strength is not an inevitable part of ageing.

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Increasing protein intake and resistance exercise are among new Australian recommendations to treat people with sarcopenia.

The condition characterised by low muscle mass and strength affects almost one in three older people and increases the risk of falls, fractures and mortality, according to recent guidelines published in the Journal of Cachexia, Sarcopenia and Muscle.

Rates of sarcopenia are higher among older people who are hospitalised, have multiple comorbidities, are frail or who live in aged care facilities, the Australian and New Zealand authors said. 

Prevention recommendations include promoting a balanced diet, adequate protein intake and regular exercise in all adults.

“Person-centred physical and dietary interventions, developed with an accredited healthcare professional … are recommended for adults with health conditions known as likely to increase the risk of sarcopenia, such as frailty.”

The authors said adequate protein and energy intake may only be beneficial when combined with resistance exercise, particularly in people with low habitual protein intake.

“We recommend all persons with sarcopenia be offered resistance-based exercise tailored to individual abilities and preferences particularly given there are presently no pharmaceutical treatments for sarcopenia.”

Adults at risk of sarcopenia need to be assessed annually, and diagnosis made using the revised European Working Group for Sarcopenia in Older People, they said

Low muscle mass was an important feature of sarcopenia. If patients were unable to perform testing due to limitations such as arthritis, or equipment was not available, clinicians could assess muscle weakness or gait speed to make a diagnosis, they said.

Cultural, ethnic and physical ability differences for muscle strength, physical performance and body composition should also be taken into account.

The new guidelines include 17 recommendations to prevent, screen, diagnose and manage sarcopenia, and to guide future research.

The authors said clinicians could consider referring patients to a dietitian to optimise their protein intake.

“Total protein intake of 1–1.5g/kg/day should be considered for older adults with sarcopenia, excepting those with significant kidney disease defined by an eGFR of <30mL/min/1.73 m².” 

“For too long people have believed losing muscle and strength is an inevitable part of ageing,” taskforce co-lead Associate Professor David Scott, from Edith Cowan University, said in a statement.

“We can all prevent, slow and in some cases reverse loss of muscle and strength,” Professor Scott said. 

Journal of Cachexia, Sarcopenia and Muscle 2022, online 9 November