Sarcopenia, the loss of skeletal muscle mass and function related to age,1 exponentially increases fall risk. Its cause is multifactorial but primarily associated with the natural aging process. It can begin as early as a person’s 30s or 40s and increases in intensity between ages 65 and 80, with some patients losing up to 8% of their total skeletal muscle mass each decade.2 While some muscle mass loss is expected during the aging process, Sarcopenia causes loss at a higher rate than normal.
Sarcopenia causes include1:
● Low activity levels
● Chronic diseases
● Inflammatory disorders
● Insulin resistance
● Altered Endocrine function
● Nutritional deficiencies
A diagnosis of Sarcopenia can be reached after a thorough physical exam and optional testing reveal a trend of decreasing muscle mass and strength, difficulty rising from a sitting position, and a slow gait speed.2 While more specific diagnostic criteria does not exist, it is generally accepted that a decline in these areas is indicative of Sarcopenia.
It must be noted that the condition differs from cachexia in both cause and presentation. Cachexia, also known as wasting syndrome, also causes muscle loss but is primarily caused by an inadequate intake of calories. The deficit may be due to anorexia or to the body’s misuse of its nutritional supply. Cachexia can be reversed by treating any underlying disease and increasing intake.3 Conversely, Sarcopenia requires an approach that focuses more heavily on rebuilding muscle through resistance training while eating a healthy diet.2
With its impact on strength, the ability to stand, and gait, it’s no wonder Sarcopenia increases fall risk. A study in 2012 found that patients diagnosed with Sarcopenia are three times more likely to fall than non-sarcopenic patients.4 The study accounted for other fall risk factors, such as cognitive impairment and medications, and still found a definitive link between the disorder and the prevalence of falls.4
Caregivers in every area, even if performing their duties within the patient’s home, must focus heavily on fall prevention. Once a patient has fallen, they are more likely to fall again, leaving them at an increased risk of serious injuries, including hip fractures, traumatic brain injuries, and subdural hematoma.6 Furthermore, serious injuries from falls are associated with increased mortality,6 with up to 30% of nursing home residents dying within one year of a fall-related hip fracture.7
Fall prevention begins with proper assessment. It’s crucial to understand the underlying factors driving the patient's risk and address each specifically. Our article Common Causes of Falls in Memory Care and How to Mitigate Risk outlines the CDC’s STEADI tool. Following the STEADI assessment method ensures proper screening and intervention for each patient.
Additionally, a fall prevention care plan for patients suffering from Sarcopenia must include proper treatment of the condition. This consists of a diverse nutritional plan as well as a customized exercise program that includes resistance training.
Resistance training, exercise utilizing external weights to build muscle strength, is highly beneficial for patients with Sarcopenia.5 This may include body weight resistance, resistance bands, weighted bars, or dumbbells.5 Development of an optimal exercise program must include physician clearance and consultation with a senior fitness specialist or physical therapist.
While resistance training has the most significant impact on Sarcopenia, proper nutrition is also necessary to assist the body in building and maintaining muscle mass. A registered dietitian should be consulted and maintained as part of the patient’s care team, but the entire team can take part in ensuring the patient receives adequate nutrition.
Protein intake is associated with increased muscle mass. Animal proteins provide a more adequate source of proteins, but plant proteins, such as soy, can also be beneficial. Regardless of the source chosen, caregivers must provide the patient with adequate protein sources.
High-protein meals and snacks include foods such as:
● Eggs
● Chicken
● Lean Beef
● Fish
● Turkey
● Cottage Cheese
● Lentils
● Quinoa
● Nuts
● Greek Yogurt
● Milk
● Beans
Vitamin D deficiencies lead to increased muscle protein breakdown and, therefore, muscle loss.8 Maintaining adequate levels of Vitamin D, combined with the recommended intake of protein and leucine, an amino acid found in many protein sources, increases muscle mass in patients’ extremities, even without resistance training.
While oral Vitamin D supplementation is possible, the sun is the most direct source. Regular and safe sun exposure should be encouraged for 10-30 minutes daily, depending on tolerance. Fatty fish and fortified foods such as milk provide additional sources of the vitamin.
Probiotics, prebiotics, and synbiotics, which consist of beneficial gut bacteria and the foods necessary to feed them, are essential for the health of our digestive systems. They contribute to a well-regulated immune system, help to prevent infections and improve digestion. In the aging population, these bacteria often diminish, and thus their benefits. Studies have actually found increased grip strength and gait speed in patients with properly managed microbiota.8 While easily overlooked, maintaining gut health can significantly impact a patient’s overall strength and mobility, decreasing fall risk.
Probiotics can be taken as a supplement or found in foods such as:
● Yogurt
● Sauerkraut
● Kefir
● Tempeh
● Miso
● Pickles
Prebiotics are necessary for probiotics to thrive. They are foods such as:
● Garlic
● Bananas
● Asparagus
● Onions
● Oats
● Leeks
● Flax Seeds
● Cocoa
● Wheat Bran
● Beans
● Almonds
● Soybeans
● Cabbage
● Apples
Synbiotics are a combination of pro and prebiotics and are taken as a supplement.
A beneficial nutritional plan should include protein, vitamin D, probiotics, prebiotics, synbiotics, and a wide variety of other vitamins and minerals. Leucine, Vitamins E and C, Magnesium, Selenium, Calcium, and Collagen intake should also be prioritized.
In patients whose Sarcopenia has advanced, the primary fall prevention strategy may be environmental. While an appropriate nutrition and exercise plan remains imperative, even in bed bound patients, environmental adaptations must be implemented to ensure patient safety.
Always ensure that the patient can call for help when needed, either with a call system or monitoring system or by posting a caregiver within earshot. Furthermore, the patient's area should be clear of clutter, well-lit, and consistent. Adaptive equipment such as hand rails and walkers may be of assistance if the patient is able to utilize them. Many patients will benefit from an ultra-low low bed, such as the Empresa FloorBed from Accora. Its ability to lower to the floor ensures patients won’t fall from great heights if they roll from the bed. However, caregivers can raise it to a safe height to assist the patient in safely exiting the bed.
Caregivers for older adults will encounter Sarcopenia regularly throughout their careers. Understanding how to recognize the symptoms and take steps to keep the patient safe and improve their overall strength is the first step in impacting their life.
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