Yesterday in the university of the elderly to talk about the prevention of sarcopenia, and everyone studied together with the "Prevention of Sarcopenia in the Elderly Core Information Chinese Expert Consensus (2021)", everyone listened very seriously, after class also took the initiative to join the discussion, share their own personal experience, here will be the courseware key content collation, shared with friends in need.
There are many words, a lot of information requires many efforts, self-prevention can look at the blue font.
Definition and Background
Sarcopenia is an age-related decrease in muscle mass with a simultaneous decrease in muscle strength and/or somatic function.
About 50 million people worldwide currently suffer from sarcopenia, and the number of sarcopenia is expected to reach as high as 500 million by 2050.
Sarcopenia can increase the incidence of falls, lead to fractures, etc., increase the risk of disability and loss of self-care ability in the elderly, early identification, intervention of sarcopenia, improve awareness of the adverse outcomes of sarcopenia, is conducive to maintaining the health and quality of life of the elderly.
According to the data of the seventh national census, the proportion of China's population over 65 years old will reach 13.5% in 2020.
Studies have shown that the prevalence of sarcopenia in the elderly aged 65 years and older is 14% to 33%, and the prevalence of elderly people aged 80 years and older is as high as 50% to 60%, which is an important senile syndrome affecting physical ability.
Core message for preventing sarcopenia
First, actively carry out health education and identify risk factors for sarcopenia in an early manner
Actively carrying out health education and science popularization activities related to sarcopenia can deepen the understanding of sarcopenia in the elderly and improve the importance of sarcopenia in the elderly. Strengthen the scientific understanding of sarcopenia in the elderly, encourage the cultivation of good living habits, thereby improving the health literacy and active health awareness of the elderly;
Advocate that family members, caregivers, medical staff and relevant policy makers of the elderly should pay attention to sarcopenia, and actively maintain the health status of the elderly and improve the quality of life while providing health services for the elderly;
Sarcopenia in the elderly should be prevented and treated early, and the prevention threshold should be moved forward to reduce the occurrence and development of sarcopenia from the source.
Risk factors for sarcopenia in the elderly include increasing age, femaleity, family history, restrictive diet, inadequate intake, less movement/immobilization/bed rest, multiple medications, and various acute and chronic diseases (e.g., diabetes, chronic kidney disease, chronic obstructive pulmonary disease, tumors, neurodegenerative lesions) and senile syndromes (e.g., depression, debilitation, cognitive dysfunction, etc.).
The core information recommends that the elderly should have regular physical examinations, early detection and intervention of high-risk acute and chronic diseases of sarcopenia, and then targeted management is very important;
Attention should be paid to the unintended weight loss of the elderly, and the recent weight loss of more than 5% should arouse the attention of the elderly, timely medical treatment, exclusion of disease factors, assessment, diagnosis and intervention of sarcopenia;
At the same time, if the elderly have falls, especially repeated falls, they should conduct sarcopenia and fall risk assessments, and actively intervene to avoid causing serious functional decline and physical damage.
Once sarcopenia causes weakness and disability, it will increase the difficulty of intervention and affect the quality of life and prognosis of the elderly, so under the guidance of a professional doctor, active intervention should be carried out as early as possible for risk factors that may improve.
2. Screening and diagnosis of people with sarcopenia
Clinical practice guidelines for sarcopenia published by the International Working Group on Sarcopenia and Debilitation (ICSFR) in November 2018 recommend that older adults aged 65 years and older should be screened for sarcopenia once a year, or after a health-related adverse event such as hospitalization after a fall. The Asian Sarcopenia Task Force (AWGS) recommends that older adults (60 years of age or older) with clinical conditions such as sarcopenia should be screened for sarcopenia, including unintended weight loss of more than 5% in the past 1 month, inadequate nutritional intake, functional impairment or decline, impaired cognitive function or anxiety and depression, chronic diseases such as chronic obstructive pulmonary disease, chronic heart failure, diabetes, chronic kidney disease, tumors and other wasting diseases.
Screening methods for sarcopenia in the elderly should be simple, fast, convenient and easy, ICSFR recommends screening using a simple five-point scoring questionnaire (SARC-F) or step rate, and those who screen positive should be further evaluated to confirm the diagnosis of sarcopenia;
The AWGS Consensus published in 2019 (AWGS2019) recommends screening using calf circumference (male <34 cm, female <33 cm) or SARC-F (out of ≥4) or SARC-CalF (out of ≥11) questionnaires in primary care settings in communities, and emphasizes that early management and intervention of sarcopenia is essential to reduce the risk of functional decline and death.
Third, cultivate good living habits and attach importance to dietary nutrition
The management and treatment of sarcopenia include diet, exercise guidance and drug therapy, drug therapy because of its safety and efficacy is still lacking in the clinical large-sample trial demonstration results, the current intervention and treatment of sarcopenia is still based on exercise intervention and nutritional intervention.
Aerobic exercise, resistance and endurance exercise can increase muscle strength and mass in the elderly, effectively reducing the risk of sarcopenia.
The core information suggests that in addition to adhering to aerobic exercise, the elderly should also carry out resistance exercise according to their own conditions, including static squat against the wall, sit in a position to raise the leg or stretch the elastic band, etc., to effectively improve muscle mass, strength and body function.
For people at risk of sarcopenia, it is recommended to accumulate 20 to 30 minutes of high-intensity exercise (such as brisk walking, jogging) per day, and ≥ 3d per week is beneficial;
The elderly should avoid absolute rest, advocate that the elderly adhere to appropriate physical activities according to physical and health conditions, and avoid causing or aggravating sarcopenia due to long-term bed rest, injury and postoperative absolute rest.
Adequate protein intake is the basis for maintaining the health of skeletal muscle, and the core information recommends that attention should be paid to dietary nutrition, reasonable diet and appropriate increase in protein intake, and protein intake and total caloric intake should be guaranteed.
Eating fish, shrimp, meat, eggs, and milk beans is a food source of high-quality protein
The basic recommended protein intake of the European Society of Clinical Nutrition and Metabolism for the elderly aged 65 years and older is 1.0 to 1.5g·kg/day, while the protein intake of the elderly with serious diseases or trauma needs to be >1.5g· kg/day, preferably high-quality protein (such as milk, fish, eggs, etc.), evenly ingested in 3 meals;
At the same time, it is necessary to increase the intake ratio of foods rich in polyunsaturated fatty acids such as deep-sea fish oil and seafood, and recommend that the intake of docosahexaenoic acid (DHA) be 0.25 to 2.00g/d, and it is recommended that the elderly should achieve a variety of food types and balanced nutrition as much as possible;
Vitamin D deficiency is also closely related to sarcopenia, when the serum serum 25 hydroxyvitamin D [25(OH)D] in the elderly is lower than normal, vitamin D supplementation should be given vitamin D supplementation, the recommended supplement of vitamin D is at least 15 to 20 μg/day (600 ~ 800 U / d), it is best to supplement vitamin D3, if necessary, the dose should be increased under the guidance of a doctor;
At the same time, the elderly participate in outdoor activities, avoid sedentary, increase sun exposure, increase skeletal muscle mass, and reduce the risk of mental illness and vitamin D deficiency;
The intake of dark vegetables and fruits and legumes is also essential for maintaining the health of the elderly, and the elderly should be encouraged to increase the intake of such foods, and it is recommended that dietary supplements such as vitamin C, vitamin E, carotenoids, selenium and other dietary supplements can be appropriately supplemented;
At the same time, the elderly should avoid blind weight loss, limit protein intake, or only control diet, do not carry out reasonable exercise, which increase the risk of sarcopenia in the elderly;
The elderly should pay attention to maintaining a stable weight, recommending an energy supply of 25 to 35 kcal ·kg ·d, and avoiding overweight or too low weight.
The core information also indicates that the nutritional status and risk assessment of the elderly need to be routinely and regularly screened and risk-assessed to understand the changes in the dietary habits, appetite, chewing function, food intake and weight of the elderly and the presence of other diseases affecting eating and nutritional intake, so as to intervene early in the existing nutritional or health problems and reduce the risk of a poor prognosis.
The combination of exercise and nutritional interventions can be more conducive to the improvement of muscle strength and function in the elderly than exercise or nutritional interventions alone. Yamada et al. implemented a 12-week program of resistance exercise combined with protein and vitamin D supplementation in older adults, and the results showed that this program was the most effective measure to improve sarcopenia in the elderly compared with exercise alone or nutritional supplementation;
Anton et al. analyzed the effects of diet or exercise interventions on muscle or somatic function in patients with sarcopenia or debilitation by including 19 clinical trials, and the results showed that exercise interventions or combinations of exercise and dietary interventions could continuously improve muscle strength in the lower body, but the effect on walking speed and grip strength was not obvious.
Everyone will grow old, and society needs to provide more facilities and benefits to help the elderly and love the elderly, and the elderly should learn more and become the first responsible person for their own health.
I wish you all good health and old age.
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