Abstract
Sarcopenia and frailty are highly prevalent conditions in older hospitalized patients, which are associated with a myriad of adverse clinical outcomes. This paper, prepared by a multidisciplinary expert working group from the Australian and New Zealand Society for Sarcopenia and Frailty Research (ANZSSFR), provides an up-to-date overview of current evidence and recommendations based on a narrative review of the literature for the screening, diagnosis, and management of sarcopenia and frailty in older patients within the hospital setting. It also includes suggestions on potential pathways to implement change to encourage widespread adoption of these evidence-informed recommendations within hospital settings. The expert working group concluded there was insufficient evidence to support any specific screening tool for sarcopenia and recommends an assessment of probable sarcopenia/sarcopenia using established criteria for all older (≥65 years) hospitalized patients or in younger patients with conditions (e.g., comorbidities) that may increase their risk of sarcopenia. Diagnosis of probable sarcopenia should be based on an assessment of low muscle strength (grip strength or five times sit-to-stand) with sarcopenia diagnosis including low muscle mass quantified from dual energy X-ray absorptiometry, bioelectrical impedance analysis or in the absence of diagnostic devices, calf circumference as a proxy measure. Severe sarcopenia is represented by the addition of impaired physical performance (slow gait speed). All patients with probable sarcopenia or sarcopenia should be investigated for causes (e.g., chronic/acute disease or malnutrition), and treated accordingly. For frailty, it is recommended that all hospitalized patients aged 70 years and older be screened using a validated tool [Clinical Frailty Scale (CFS), Hospital Frailty Risk Score, the FRAIL scale or the Frailty Index]. Patients screened as positive for frailty should undergo further clinical assessment using the Frailty Phenotype, Frailty Index or information collected from a Comprehensive Geriatric Assessment (CGA). All patients identified as frail should receive follow up by a health practitioner(s) for an individualized care plan. To treat older hospitalized patients with probable sarcopenia, sarcopenia, or frailty, it is recommended that a structured and supervised multi-component exercise program incorporating elements of resistance (muscle strengthening), challenging balance, and functional mobility training be prescribed as early as possible combined with nutritional support to optimize energy and protein intake and correct any deficiencies. There is insufficient evidence to recommend pharmacological agents for the treatment of sarcopenia or frailty. Finally, to facilitate integration of these recommendations into hospital settings organization-wide approaches are needed, with the Spread and Sustain framework recommended to facilitate organizational culture change, with the help of ‘champions’ to drive these changes. A multidisciplinary team approach incorporating awareness and education initiatives for healthcare professionals is recommended to ensure that screening, diagnosis and management approaches for sarcopenia and frailty are embedded and sustained within hospital settings. Finally, patients and caregivers’ education should be integrated into the care pathway to facilitate adherence to prescribed management approaches for sarcopenia and frailty.
Original language | English |
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Pages (from-to) | 637-651 |
Number of pages | 15 |
Journal | Journal of Nutrition, Health and Aging |
Volume | 26 |
Issue number | 6 |
Early online date | 31 May 2022 |
DOIs | |
Publication status | Published - Jun 2022 |
Bibliographical note
Funding Information:Disclosures: No conflict of interest: JJF, BK, MQT, ED, ORLW, SY. RMD reports a grant form Fonterra Co-operative Group Ltd, honoraria for presentations from Abbott Australia and Nutricia Research and to serve as a member of an expert advisory committee; SI reports honoraria for presentations and to serve as a member of an expert advisory committee for Abbott Australia; DS reports a grant (fellowship) from the National Health and Medical Research Council (NHMRC); KF reports honoraria for presentations from Abbott Australia, Baxter, Avonos and Nutricia and support to attend a conference from Abbott Australia; GSL reports a grant from Nestlé Institute of Health Sciences, Lausanne; JZ reports honoraria for presentations from NW Primary Health network and is a Director of Aria Health; SK reports a grant from the National Health and Medical Research Council (NHMRC); RV reports a grant from the National Health and Medical Research Council (NHMRC), Australia Research Council (ARC) and National Institute for Healthy (Malaysia); consulting fees as a member of an expert advisory committee and honoraria for presentations and travel support from Nestle, Nutricia and Abbott Australia; ABM reports a grant from Nutricia Research and honoraria for presentations from Nutricia Research.
Publisher Copyright:
© 2022, The Author(s).
Keywords
- aged
- frailty
- hospitalization
- Sarcopenia/diagnosis
- sarcopenia/therapy
- screening/methods