Elsevier

Clinical Nutrition

Volume 31, Issue 5, October 2012, Pages 652-658
Clinical Nutrition

Original article
Sarcopenia as a risk factor for falls in elderly individuals: Results from the ilSIRENTE study

https://doi.org/10.1016/j.clnu.2012.02.007Get rights and content

Summary

Background & aims

Sarcopenia has been indicated as a reliable marker of frailty and poor prognosis among the oldest individuals. We evaluated the relationship between sarcopenia and 2-year risk of falls in a population of persons aged 80 years or older.

Methods

Data are from the baseline and follow-up evaluations of the Aging and Longevity Study in the Sirente Geographic Area (ilSIRENTE Study) (n = 260). According to the European Working Group on Sarcopenia in Older People (EWGSOP), sarcopenia was diagnosed in presence of low muscle mass (mid-arm muscle circumference) plus either low muscle strength (hand grip) or low physical performance (4-m walking speed). The primary outcome measure was the incident falls during the follow-up period of 2 years. The relationship between sarcopenia and incident falls was estimated by deriving hazard ratios (HRs) from multiple logistic regression models considering the dependent variable of interest at least one fall during the follow-up period.

Results

Sixty-six participants (25.4%) were identified as affected by sarcopenia. Eighteen out of 66 (27.3%) participants with sarcopenia and 19 out of 194 (9.8%) without sarcopenia reported incident falls during the two-year follow-up of the study (p < 0.001). After adjusting for age, gender, cognitive impairment, ADL impairment, sensory impairments, BMI, depression, physical activity, cholesterol, stroke, diabetes, number of medications, and C-reactive protein, participants with sarcopenia had a higher risk of incident falls compared with non sarcopenic subjects (adjusted hazard ratio [HR], 3.23; 95% confidence interval [CI], 1.25–8.29).

Conclusions

The present study suggests that sarcopenia – assessed using the EWGSOP algorithm – is highly prevalent among elderly persons without gender differences (25%). Sarcopenic participants were over three times more likely to fall during a follow-up period of 2 years relative to non sarcopenic individuals, regardless of age, gender and other confounding factors.

Introduction

Falls and their related injuries represent one major health care issue in the elderly population. Falls are a common event among older adults and are associated with increased morbidity and disability.1 The prevalence of falls in older community-dwelling elderly individuals is approximately 30%2 and such estimate increases to 40% among the “oldest-old”.3 Moreover, older individuals have a high susceptibility to fall-related injuries.4 It has been estimated that, in such population, two-thirds of the death from unintentional injuries are related to a fall event.5 Due to their high frequency and to their serious consequences on health and functional status, falls contribute substantially to the health care expenditure for elderly individuals. According to recent studies, about 6% of all medical expenditures for elderly persons in the United States are due to fall-related injuries.5 Hospitalization is needed in 5% of elderly people who fall.5, 6

Falls have many different causes. Several risk factors that predispose elderly individuals to falls have been identified. Risk factors can be classified as either intrinsic or extrinsic.7 The first category includes factors related to functional and health status (e.g., functional impairment, balance disorders); the second category includes adverse drug reactions, prostheses, use of restraints and environmental factors (e.g., poor lighting or lack of bathroom safety equipment).

Sarcopenia is a condition characterized by loss of muscle mass and strength and decreased physical performance. It may represent an important risk factor for falls. In fact, sarcopenia has been associated with poor endurance, physical inactivity, slow gait speed and decreased mobility. These factors represent common features of the frailty syndrome and may contribute to an increased risk of falling.8, 9

To date, information on the association between sarcopenia and falls is limited. Also the underlying mechanisms of such association have yet to be clarified. In the present study, we estimated the effect of sarcopenia on increasing the 2-years risk of falls in a population of community-dwelling individuals aged 80 years or older enrolled in the “Invecchiamento e Longevità nel Sirente” (Aging and longevity in the Sirente geographic area, ilSIRENTE Study) study.

Section snippets

Methods

We used data from the ilSIRENTE, a prospective cohort study conducted in the mountain community living in the Sirente geographic area (L'Aquila, Italy) and developed by the teaching nursing home Opera Santa Maria della Pace (Fontecchio, L'Aquila, Italy) in a partnership with local administrators and primary care physicians. The Catholic University of Sacred Heart ethical committee ratified the entire study protocol. All the participants signed an informed consent at the baseline visit. The il

Results

Mean age of study participants was 86.7 (standard deviation 5.4) years, and 177 (68.0%) were women. Using the EWGSOP-suggested algorithm,14 sixty-six participants (25.4%) were identified as affected by sarcopenia (Fig. 1). No difference between men (21/83) and women (45/177) was observed.

The socio-demographic, functional, cognitive and clinical characteristics of study participants according to the presence of sarcopenia are summarized in Table 1. Compared with participants without sarcopenia,

Discussion

In the present study, we estimated the effect of sarcopenia on the risk of falling during a period of 2 years in a population of elderly persons aged 80 years and older living in community. According to our findings, sarcopenia – assessed using the EWGSOP algorithm16 – is highly prevalent among elderly persons. Also, the frequency of such condition does not change across gender. Individuals with sarcopenia are at increased risk of falling regardless of age, gender and other confounding factors.

Statement of authorship

All authors have made substantial contributions to all of the following: (1) the conception and design of the study, or acquisition of data, or analysis and interpretation of data, (2) drafting the article or revising it critically for important intellectual content, (3) final approval of the version to be submitted.

Conflict of interest

None.

Acknowledgments

The “Invecchiamento e Longevità nel Sirente” (ilSIRENTE) study was supported by the “Comunità Montana Sirentina” (Secinaro, L'Aquila, Italy). We thank all the participants for their enthusiasm in participating to the project and their patience during the assessments. We are grateful to all the persons working as volunteers in the “Protezione Civile” and in the Italian Red Cross of Abruzzo Region for their support. We sincerely thank the “Comunità Montana Sirentina”, and in particular its

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