In the elderly, even in healthy people, there is a higher prevalence of limitations and functional dependence that are closely related to reduced muscle mass. Known as sarcopenia, it appears to arise from the complex interaction of innervation disorders, lowered hormones, increased inflammatory mediators and changes in diet that occur during aging. Loss of muscle mass and strength causes reduced mobility and increased functional limitations and dependence.
By Dr. Jaqueline Souza Lacerda
It is estimated that from 1996 to 2025 the percentage of older people in developing countries will increase by about 200%, and Brazil follows this trend worldwide. The estimate for 2025 is an increase of more than 33 million, which puts Brazil in sixth place of the largest percentage of the older population in the world.
Sarcopenia is used as a variable in fragility syndrome, which is common in the elderly, which results in an increased risk of falls, fractures, disability, dependence, recurrent hospitalization and mortality. This syndrome represents an age-related physiological vulnerability due to the decline in biological homeostasis and the body's ability to adapt to new stress situations. Other factors related to fragility syndrome include recent weight loss (especially lean body mass); self-report of fatigue; frequent falls; muscle weakness; reduced walking speed and reduced physical activity, all related to the performance of the musculoskeletal system.
It is estimated that at the age of 40, about 5% of the muscle mass is lost every decade, with a faster decline after 65 years. Currently the most commonly used method for the diagnosis of sarcopenia is the total body densitometry for the evaluation of body composition – bone mass, fat-free mass and total fat mass. The advantages of this technique are the usability, the achievement of objective measures in a short time of research, the relatively low costs compared to other methodologies, little ionizing radiation and good reproducibility.
Decreased food intake, the so-called "anorexia of aging", is an important factor in the development and progression of sarcopenia, especially in combination with other comorbidities. Reduced food intake in the elderly takes place as a result of the following factors: loss of appetite, reduction of taste and odor, reduced oral health, early satiety, psychosocial, economic and medication factors. Reduced protein intake leads to reduced fat-free mass and muscle strength. We discuss the need for protein supplementation in the elderly population.
Age-related sarcopenia also has a contributing factor to physical inactivity. Older people with lower physical activity also have lower muscle mass and a higher prevalence of functional limitations. Regular practice of lifelong exercise makes the aging of muscle loss slower. And the best form of prevention of sarcopenia and recovery of muscle mass are resistance exercises. It is therefore worth emphasizing that prevention is the most important and efficient strategy to prevent functional dependence.
* Dr. Jaqueline Souza Lacerda
Geriater and founder of the project Cuidar – Geriatria Goiânia (https://geriatriagoiania.com.br).