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The little-known condition affecting up to 30% of over-60s

<img width="125" height="156" src="https://oversixtydev.blob.core.windows.net/media/43999/kate-gregorevic_125x156.jpg" alt="Kate Gregorevic (1)" style="float: right;"/>Dr Kate Gregorevic is a geriatrician with a research interest in health and lifestyle factors that are associated with healthy ageing and recovery from illness. Are you at risk for sarcopenia? Here’s how to recognise and manage this common condition. Sarcopenia occurs when there is a loss of muscle mass associated with a loss of function. This leads to an increased risk of falls, fractures and, if severe, loss of mobility and disability. Around <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4248415/" target="_blank">30 per cent of women and 10 per cent of men</a> aged 60 and older have sarcopenia. Sarcopenia usually has multiple causes including poor nutrition, inactivity, inflammation and chronic disease. Once sarcopenia is identified there are multiple lifestyle interventions that can improve muscle function and avoid the consequences of sarcopenia. How do people develop sarcopenia? As we age, there is a loss of muscle mass. Muscle mass peaks in the fourth decade and from there around one per cent is lost per year. As people age, there is decreased blood flow to muscles. There are also changes in the mitochondria (the powerhouses of cells), which make muscles less efficient. There can also be a loss of the number of muscle fibres, which is particularly associated with inflammation and disease. There are also non-age-related factors. Poor nutrition, particularly poor intake of protein and inactivity are the two most important. Vitamin D deficiency may also play a causative role. How do you know if you are at risk sarcopenia? The best way to identify loss of muscle mass is by having a body composition scan called a DEXA. This uses low energy x-rays and can look at the body composition. This also measures bone density, so can also identify osteoporosis (thin bones), which is frequently linked with sarcopenia. The <a href="https://www.ncbi.nlm.nih.gov/pubmed/27066316" target="_blank">clinical definition</a> of includes not only low muscle mass, but also impaired function. There are some simple questions based on everyday activities that can predict if you are at risk: <ol> <li>Do you have difficulty rising from a chair?</li> <li>Do you have trouble walking across a room?</li> <li>Do you have trouble climbing a flight of stairs?</li> <li>Are you able to carry something heavy (e.g. grocery shopping)?</li> <li>Have you had any falls?</li> </ol> If any of these questions raise concerns, you may be at risk for sarcopenia and associated adverse outcomes. Why is poor muscle strength a problem? If muscle mass and strength fall below a critical level, it can cause difficulties with simple activities of daily life, like carrying laundry. At a more significant level, it can even cause difficulty with essential activities like getting off the toilet. People with sarcopenia are also more likely to fall. Due to the association with sarcopenia and osteoporosis, this can then lead to fractures. What can you do to improve sarcopenia? It is important to understand that muscle mass itself doesn’t just predict outcomes like falls and fractures. Even if there is a relative loss of muscle, you can still take steps to improve strength and function and lessen the risks of adverse outcomes: <ol> <li>Resistance exercise – We all know that muscles can get stronger with use. This is true at any age and stage of life. Resistance exercise is a form of exercise that makes your muscles work against a force. This can start as simple exercises like standing from a chair without using your arms five times. If you are new to resistance training, it is best to get the advice of an exercise physiologist who has experience working with older adults.</li> <li>Balance and stability training – While balance training won’t necessarily improve muscle strength, this can decrease the risk of falls. This can be undertaken simultaneously with resistance training.</li> <li>Protein intake – In a study that looked at the effect of resistance training for older adults with sarcopenia, those who also had supplementation with high quality protein <a href="https://www.ncbi.nlm.nih.gov/pubmed/26864356" target="_blank">gained more muscle and strength</a>. This can be achieved with supplements, but also with inclusion of high protein foods in the diet, like dairy.</li> <li>Vitamin D – For those who are deficient in vitamin D, taking a supplement <a href="https://www.ncbi.nlm.nih.gov/pubmed/25033068" target="_blank">can also improve muscle strength</a>. This will also help to strengthen bones and prevent osteoporosis. This should be taken as a low daily dose as intermittent high doses can increase the risk of falls.</li> </ol> Like so many aspects of ageing the risk for sarcopenia is cumulative, which means that it is never too late to take action. Studies have shown that even the frailest older adults can improve their strength with exercise. Maintaining independence throughout life is a huge priority for most people. Taking steps to optimise muscle health is a key step in healthy ageing. Please note, this article contains general education and should not be interpreted as specific medical advice. If this article raises any health or other concerns, please consult your own medical practitioner. For the latest research on ageing well, follow Kate on Instagram <a href="https://www.instagram.com/drkate_elderhealth/" target="_blank">@drkate_elderhealth</a>.

Caring

Do you need to see a geriatrician?

Dr Kate Gregorevic is a geriatrician with a research interest in health and lifestyle factors that are associated with healthy ageing and recovery from illness. A geriatrician is a doctor who has completed specialist training in the care of older adults. But why do older adults need their own specialist? And why do doctors choose this area of medicine? Older adults often have more complex health care needs than younger adults, and there are also some medical conditions that occur more commonly in older adults, like frailty, dementia and falls. In addition, many older adults have multiple medical conditions requiring multiple medications, and unlike many other specialties, which are organ specific, like cardiology (heart) or renal (kidney), geriatricians take a whole person approach. Frailty is a loss of physiological reserve leading an individual vulnerable to a significant decline in health status from a seemingly minor insult. Assessment of frailty requires comprehensive geriatric assessment. This means geriatricians look at the whole person across medical, functional, cognitive, nutritional and social domains. This holistic assessment allows development of a management plan based on that person’s values and goals. This is also important because no two 80 year olds have had identical life experiences – due to life events and some lifestyle choices, people can have a vastly different health status at the same age. What training do geriatricians undertake? Geriatricians in New Zealand are trained under the Royal Australasian College of Physicians. Following graduation from university, we undertake four years of basic physician training in hospitals, working in a variety of areas like general internal medicine, intensive care, emergency, perioperative medicine and cardiology. Following this we undertake three years of subspecialty training in geriatric medicine. During this time, trainees (registrars) are supervised and assessed, as well as undertaking a formal training program. After a minimum of seven years of postgraduate training, a doctor can call themselves a geriatrician. This process does differ slightly in different countries, but in most countries for someone to call themselves a geriatrician, they need to have undertaken specialist training. Where do geriatricians work? Geriatricians work across a variety of settings such as residential aged care, acute hospital, rehabilitation wards and outpatient clinics. Geriatricians are often responsible for looking after older adults who are admitted to hospital with an illness like pneumonia, or working with surgeons who repair broken bones. Studies have shown that having a geriatrician involved in care of frail older adults actually improves survival. Many geriatricians visit people in their own homes or in residential care. This is particularly important for people who are having some difficulty at home. For many people staying independent in their home is a major goal, so by visiting there, a geriatrician can get a valuable insight to help people develop evidence based strategies to maintain their independence. Geriatricians also operate specialised clinics to diagnose and manage specific conditions. Attending a specialist falls and balance, memory or continence clinic involves a multi-disciplinary assessment and evidence-based advice. As the population ages, we see increasing numbers of older adults interacting with the healthcare system. There are not enough geriatricians to see everybody. Geriatricians have an increasingly important role in educating other health care professionals and optimising hospital processes and environments. As clinician researchers, we are able to use our experience and perspective to do further research into ways we can help our patients. From a personal perspective, with the rapidly growing number of studies on healthy ageing, there has never been a more exciting time to be a geriatrician. I feel greatly privileged to meet people who have lived far longer than to learn from their unique perspective and great resilience. Have you ever seen a geriatrician? Let us know in the comments below. To find out more information about ageing well, visit <a href="http://elderhealthaustralia.com/" target="_blank">Elder Health Australia here.</a> Related links: <a href="/health/body/2016/08/myths-of-modern-health/">Debunking 5 myths of modern health</a> <a href="/health/body/2016/07/seniors-guide-to-healthcare/">Why we need a seniors guide to healthcare</a> <a href="/health/body/2016/07/the-long-term-problems-with-a-b12-deficiency/">The long-term problems with a B12 deficiency</a>

Body

Expert tips to survive (and thrive) when you’re admitted to hospital

Dr Kate Gregorevic is a geriatrician with a research interest in health and lifestyle factors that are associated with healthy ageing and recovery from illness. Hospitalisation is a sentinel event for older adults. Being admitted to hospital, especially if it unplanned for an illness like pneumonia, is very scary. Sometimes the illness can even be life threatening. The majority of people will leave hospital, but for those aged 75 and older around 30-40 per cent will experience functional decline. This is a particular risk for those who are already frail. As a doctor working in the hospital setting, it is heartbreaking to explain this loss of independence to patients and their loved ones. Appropriate medical, nursing and allied health care are critical, but it is not just up to the staff. There are things that you and your family can do to not only survive but make a full recovery following your illness. Frail older adults are at higher risk for adverse outcomes than others. Frailty is a loss of physiological reserve leading to an individual being at risk of new disability. As people become frailer, they often need more help doing day to day tasks, may experience falls and may even begin losing weight. People who have cognitive impairment or dementia are also at increased risk. If you think that this applies to you or your loved one, it is important you let hospital staff know. Eat It is surprisingly easy to become malnourished in hospital. When people are sick, they often don’t have much appetite. Although some hospitals have invested in improving food quality, many hospitals still serve food, which is unfamiliar and unappetising. If you are having surgery or another test you may have to fast. Even in this short time period, inadequate food intake can increase loss of muscle. Protein intake is particularly important. If you are finding that you don't have much of an appetite, it is important to focus on high protein, high kilojoule foods, like full fat yoghurt and milk with sustagen. Ask your family to bring in some favourite meals. There will be a dietician available to help guide these choices, particularly if you have a medical condition like diabetes. If you have been asked to fast, always ask why and find out when you will be able to eat again. By taking these steps to maintain nutrition, you are more likely to recover faster and leave hospital sooner. Move When you are unwell, it is hard to contemplate getting out of bed and walking, but this is critical for recovery. There are often restrictions on walking in hospital to minimise the risks of falls. The physiotherapist is the best person on the team to discuss safe mobility. With some guidance from the physiotherapist, it is important that you mobilise as much as you can. Even just sitting out of bed will enable you to breathe more deeply and ward off the dreaded pneumonia. Basically the more you walk in hospital, the faster you will walk out! Ask questions Doctors and nurses are very bad at recognising when they are using medical jargon. They spend so much time working and socialising with other medical people that they just don't realise they are using technical language. Many people are intimidated by the hospital environment and fear that asking for explanations will make them look silly, but it is actually the responsibility of the healthcare professionals to explain things in terms everyone can understand. If you don’t understand your illness or your treatments, keep asking questions until you do. The better you understand what’s happening to you, the better you can take an active role in managing your recovery. Have the difficult conversations No one likes to think about the worst things happening when they become unwell and are admitted for hospital. An illness is often a time of great reflection. There is increasing awareness of advanced care planning in the community. This means recording your wishes and values regarding healthcare and quality of life so that if you are not able to make decisions regarding your medical treatment, other people can still act according to what you would want. If you feel that for quality of life, there are certain things that are important to you, like not being kept alive in a vegetative state or completely dependent for all care, make sure those you love know this, to give you peace of mind. Advice for friends and family What if it’s not you, but your loved one who is admitted to hospital? There are key things that only family can do to aid recovery. Watch out for delirium Frail older adults are particularly vulnerable in the hospital environment. Around 30-40 per cent of older adults will experience delirium. Delirium is a sudden onset of confusion and a change in alertness. The confusion can fluctuate throughout the day. This can happen before or during the hospital stay. Some people will be more agitated some will be sleepier. The biggest risk factor for delirium is pre-existing impaired cognition, particularly dementia. Delirium can be difficult to identify and diagnose. Patients may describe odd stories, like policemen coming into the room in the middle of the night, little children running around or insects. They may seem to pluck at the air, or drift off in the middle of a conversation. The type of delirium most likely to go unnoticed is hypoactive delirium, where someone becomes very sleepy. Medical staff need to be on high alert for any of these symptoms, but often it is the patient’s family and friends who are first to notice that the person they love is not their usual self. Advocate It is very hard to see someone you love struggling with an illness. Admission to hospital is incredibly stressful for the patient and their loved ones. For a frail older person who is feeling sick and stressed, it can be very difficult to speak up if they have concerns. The friends and relatives will often be the first to notice something is not right. If your loved one seems weaker than prior to hospital, more confused or you’re just not sure they are getting better, speak up. It is impossible to overstate how important friends and family are to recovery. With so much focus on the physical aspects of illness, it is easy to forget the importance of emotional support – just visiting, bringing some favourite foods and sharing some time with your loved one, may be enough to help them walk back out of hospital. We as health professionals have a long way to go to make hospitals a better environment for older adults. The good news is that there is increasing recognition within hospitals of the importance of providing specialised care to older adults, and steps are being taken to improve processes and environment. It is quite disempowering to be dressed in a hospital gown, feeling unwell in a hospital bed and not really understanding what is going on, but you are not a passive agent in your recovery. By taking to steps to maintain nutrition, mobility and asking lots of questions, you can take back some control and take an active part in your recovery. To find out more information about ageing well, visit <a href="http://elderhealthaustralia.com/" target="_blank">Elder Health Australia</a>. Related links: <a href="/health/caring/2016/06/dementia-malnutrition-risk/">Dementia patients at risk of malnutrition</a> <a href="/health/caring/2016/05/this-mobile-game-is-helping-fight-dementia/">This mobile game is helping fight dementia</a> <a href="/health/caring/2016/05/animals-changing-lives-in-aged-care/">How animals are changing lives in aged care</a>

Caring

Aged care still needs a lot of work, says geriatrician

Eminent geriatrician Michael Woodward’s contribution into aged care was celebrated on Tuesday when he was named a Member of the Order of Australia, but says there’s still a lot more work to be done in the sector. <img width="166" height="270" src="http://www.australianageingagenda.com.au/wp-content/uploads/2016/01/MIchaelWoodward1-215x350.jpg" alt="Associate Professor Michael Woodward" class=" wp-image-37710" style="float: left;"/> As the Australian Ageing Agenda reports, Associate Professor Michael Woodward was recognised for his service to geriatric medical research, aged care and Alzheimer’s disease, among the 830 Australians who received the honour as part of 2016 Australia Day Honours List. Woodward is currently the head of aged care research, the wound management clinic and the memory clinic at Austin Health. In his 30 plus years in geriatric medicine, Woodward says he’s seen big changes and improvement in the sector, but stresses there’s still plenty of room for improvement. “There’s still a lot of work to be done. We still haven’t cured dementia. We have many people walking around Australia with chronic wounds that are often poorly managed. We have problems with the overuse and the under use of appropriate medications in older people,” he told Australian Ageing Agenda. Woodward also noted that while there is much more awareness of the need for better aged care in the country, there was still a tendency to view the aged care ward as the “poor country cousin.” “We’ll know that geriatric medicine in Australia has come of age when we build a new hospital and we have the same facilities and same new wards for the geriatric medicine unit as we do for cardiology or for gastroenterology,” he said. “We need more advocacy for the elderly by doctors, health professionals and administrators. We also need more demand from older people themselves; older people should not accept being treated as second-rate patients – they need to be advocates.” Source: <a href="http://www.australianageingagenda.com.au/2016/01/27/still-a-lot-of-work-to-be-done-in-care-for-seniors/" target="_blank">Australian Ageing Agenda</a> Related links: <a href="/health/caring/2015/12/carers-provide-billions-in-unpaid-care/">Labour of love: Australian carers provide $60.3 billion of care each year</a> <a href="/health/caring/2015/08/person-first-dementia-care/">Putting the “Person First” in dementia care</a> <a href="/news/news/2015/06/seniors-open-doors-needy/">Seniors open doors to needy in exchange for housework</a>

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