Frailty and Sarcopenia

Frailty and Sarcopenia - Defining Decline

• Frailty: Clinical syndrome; ↑vulnerability to stressors from multisystem physiological decline.
  • Fried Phenotype: ≥3 criteria (weight loss >4.5kg/yr, exhaustion, weakness, slowness, low activity).
• Sarcopenia: Age-related loss of muscle mass, strength (e.g. handgrip), and/or physical performance (gait speed <0.8 m/s).

Frailty and Sarcopenia - Roots of Weakness

Underlying mechanisms driving age-related decline:

• Inflammation: Chronic low-grade ("inflammaging") with ↑ IL-6, TNF-α promoting muscle breakdown.
• Anabolic Resistance: Impaired muscle protein synthesis despite adequate stimuli.
• Neuromuscular Degeneration: Loss of motor units, ↓ nerve conduction velocity.
• Mitochondrial Dysfunction: ↓ ATP, ↑ reactive oxygen species (ROS) damaging muscle cells.
• Hormonal Dysregulation: ↓ anabolic hormones (testosterone, IGF-1), ↑ catabolic hormones (cortisol).

⭐ Sarcopenia is defined by low muscle mass, plus low muscle strength or low physical performance. Gait speed < 0.8 m/s is a critical threshold for assessing physical performance_._

Frailty and Sarcopenia - Clinical Clues & Criteria

• Frailty Clues: Weakness, fatigue, unintentional wt. loss, slow gait, ↓ physical activity.
• Sarcopenia Clues: ↓ Muscle mass, strength & performance; increased falls, slow gait.

Diagnostic Criteria:

Sarcopenia Diagnosis (EWGSOP2 Algorithm):

⭐ Sarcopenia (low muscle strength + low muscle quantity/quality) is a strong predictor of disability, morbidity, and mortality in older adults.

Frailty and Sarcopenia - Geriatric Gauges

• Key Assessment Tools:
  • Handgrip Strength: Measured by dynamometer (e.g., < 27 kg men, < 16 kg women - EWGSOP2 criteria for probable sarcopenia).
  • Gait Speed: Time to walk 4 meters; < 0.8 m/s indicates frailty/sarcopenia.
  • Short Physical Performance Battery (SPPB): Assesses balance, gait, chair stands; score ≤ 8 suggests frailty.
  • Chair Stand Test: Time for 5 sit-to-stand repetitions; > 15 seconds indicates poor function.
  • Muscle Mass: DXA (gold standard), BIA, CT/MRI.

⭐ Sarcopenia (EWGSOP2): Low muscle strength (e.g., grip strength) is the primary parameter. If low strength is present, assess for low muscle quantity/quality. If both are present, sarcopenia is confirmed. Severe sarcopenia includes low physical performance (e.g., gait speed).

Frailty and Sarcopenia - Intervention Strategies

• Exercise: Cornerstone; multi-component programs most effective.
  • Resistance training: Builds muscle mass & strength.
  • Aerobic exercise: Improves cardiovascular fitness.
  • Balance & flexibility: Reduces fall risk.
• Nutrition: Crucial for muscle health.
  • Protein intake: Target $1.2-1.5 \text{ g/kg/day}$.
  • Vitamin D: Supplement if levels low ($< \textbf{20 ng/mL}$ or $< \textbf{50 nmol/L}$).
  • Omega-3 fatty acids: Consider for anti-inflammatory effects.
• Medication Review:
  • Reduce polypharmacy; deprescribe non-essential/harmful drugs.
• Psychosocial Support:
  • Address depression, anxiety, social isolation.

⭐ Resistance exercise is the most effective single intervention to counteract sarcopenia and improve muscle strength in older adults.

High‑Yield Points - ⚡ Biggest Takeaways

• Frailty is ↑ vulnerability to stressors from ↓ physiological reserves.
• Clinical Frailty Scale (CFS) is a common tool (1-Very Fit to 9-Terminally Ill).
• Sarcopenia is age-related loss of muscle mass, strength, and function.
• Sarcopenia diagnosis: Low muscle mass plus low strength OR low physical performance.
• EWGSOP2 criteria guide sarcopenia diagnosis, prioritizing muscle strength.
• Management: Optimal protein (1.2-1.5 g/kg/day) and resistance exercise.
• Both conditions ↑ risk of falls, disability, hospitalization, and mortality.