Correlation between Muscle Mass and Fragility Parameters in the Elderly

Research Article

Austin J Musculoskelet Disord. 2022; 9(1): 1061.

Correlation between Muscle Mass and Fragility Parameters in the Elderly

de Oliveira JCM1, Gouveia CAM1, Moreira LDP2, Viscardi LGA1 and de Oliveira AS1,2*

¹Physiotherapy Course, Universidade Anhembi Morumbi’,São Paulo, SP, Brazil

²Postgraduate Program in Biomedical Engineering, Anhembi Morumbi University, São Paulo, SP, Brazil

*Corresponding author: Adriana Sarmento de Oliveira, Postgraduate Program in Biomedical Engineering, Anhembi Morumbi University, Rua Doutor Almeida Lima 1134, Mooca, São Paulo-SP, Brazil

Received: December 06, 2021; Accepted: January 20, 2022; Published: January 27, 2022

Abstract

Introduction: The frailty syndrome is an unstable condition related to the elderly’s functional decline and vulnerability to maintain homeostasis in the face of stressful factors. Grip strength is used as a predictor of general strength status, is closely related to mortality and disability and is related to several factors such as muscle mass.

Objective: To evaluate the correlation between muscle mass and frailty parameters in the elderly.

Methodology: An analytical, prospective, cross-sectional observational study was carried out. Elderly people aged 60 years or more, of both sexes, members of one of the elderly groups of the Integrated Health Center at Universidade Anhembi Morumbi were included in the research. The phenotype of Fried et al., [1]. was used to classify frailty, handgrip strength, gait speed (seconds at a distance of 4.6 meters), unintentional weight loss (greater than or equal to 4.5 kg), were evaluated. Exhaustion report (CES-D Depression Scale) and level of physical activity, measured through session 4 of the IPAQ long version. Bioelectrical impedance was performed using a tetrapolar device (Quantum II, RJL System, Clinton Twp, MI, USA).

Results: It was observed that the groups were similar to each other, except for height, as the non-frail ones were taller and had greater maximum handgrip strength. There was a statistical trend (p=0.05) in relation to BMI. In the group without frailty, there was a moderate and positive correlation between skeletal muscle and maximum grip strength (r=0.7; p<0.02). In the frail group there was no significant correlation (r=0.3; p<0.10). In assessing the correlation between skeletal muscle and age, no significant correlation was observed in the nonfrail group (r=0.2; p<0.57) or in the frail group (r=0.3; p<0.11). When evaluated between skeletal muscle and basal metabolism in the group without frailty, there is a strong and positive correlation (r=0.8; p<0.01), which did not occur in the frail group (r=-0, 1; p<0.79). Finally, the non-frail and frail groups did not present a significant correlation between skeletal muscle and gait speed (r=-0.3; p<0.39; r=-0.2; p<0.19, respectively).

Conclusion: The frail elderly have lower maximum handgrip strength compared to the non-frail elderly, but no correlations were observed between skeletal muscle and the variables maximum grip strength, age, basal metabolism and gait speed. In turn, the non-frail elderly showed a moderate and positive correlation between skeletal muscle and the variables maximum grip strength and basal metabolism, but there was no correlation between skeletal muscle and the variables age and gait speed.

Keywords: Aging; Skeletal muscle; Frailty

Introduction

It is notorious to observe that frailty syndrome in the elderly is tangible in the Brazilian and global scenario [2]. In addition, with the increase in the life expectancy of the population, the proportion of elderly aged 80 years or more has increased considerably in recent years and has gained 4.8 million elderly since 2012, surpassing the mark of 30.2 million in 2017, resulting in a phenomenon of great repercussion in Brazil, since longevity is reflected in all dimensions and sectors of society [3].

According to a census by the Ministry of Health it is estimated that 10 to 25% of people over 65 years old and 46% over 85 years old, living in the community, are frail. A recent U.S. Cardiovascular Health Study of 5,317 participants involving the prevalence of frailty showed that 6.7% of the elderly aged 65 years and older were frail. Moreover, 80 to 89 year olds accounted for 30% of the frail elderly [1].

Thus, all these clinical manifestations lead to an increased risk of unfavorable events: such as falls, urinary incontinence, decreased handgrip strength, hospitalization, and death [1]. According to the World Health Organization [4], a fall is determined as an involuntary eventuality that brings the body to the ground or on another surface. Still, it is estimated that one third of the elderly over 65 years of age experience a fall episode every year, and it is the second leading cause of death from unintentional injuries in the world. In Brazil, about 30% of the elderly fall once a year, and the most affected people are precisely the elderly, aged 80 years or more [5].

According to Santos et al., [6], frailty syndrome is considered a clinical syndrome, which can be characterized by progressive weight loss, decreased muscle strength, decreased lean body mass, altered gait resulting in decreased speed, imbalance, and decreased physical activity.

Furthermore, frailty is a clinical condition that has been widely studied in the last decades. Recently frailty has been proposed as a geriatric syndrome through the characterization of a “phenotype” and the description of a pathophysiology with a complex relationship between multisystem declines. However, despite the progress made in the last two decades, and although age is its main risk factor alone, the concept of frailty is far from an objective and consensual definition [7].

Thus, it is noteworthy to analyze that this disease is not exclusively subsequent to the aging process, since most elderly do not become frail compulsorily thus, according to Dias et al. [8] the loss of muscle strength generated by the absence of physical exercise can be assessed through handgrip strength, as a component of physical frailty, becoming an important tool for health professionals and researchers.

Grip strength is used as a predictor of general strength status and is closely related to mortality and disability, and is related to several factors such as muscle mass thus, it is essential to study the association between muscle mass and parameters of the frailty syndrome in the elderly.

General Objective

To evaluate the correlation between muscle mass and frailty parameters in the elderly.

Specific Objective

To evaluate the correlation between muscle mass and frailty parameters in the elderly in the following variables:

• Maximum grip strength;

• Age;

• Basal metabolism;

• Gait speed.

Materials and Methods

This was an analytical observational study, prospective in nature and cross-sectional in design. This research was approved by the Research Ethics Committee of Anhembi Morumbi University, linked to the Rectory of the University under protocol number 3.264.341 on 04/14/2019. All individuals who agreed to participate in the study were informed about its content and objectives, as well as the reliability of the information collected and their anonymity.

The study included elderly individuals aged 60 years or older, of both genders, members of one of the elderly groups of the Integrated Health Center at the Anhembi Morumbi University, who agreed to participate in the study and who signed the free consent form. Elderly people who did not agree to participate in the study, who did not sign the consent form, who were intolerant to the tests, or who dropped out were excluded from the study.

The instruments mentioned below were used to evaluate the elderly based on the five criteria for defining frailty according to Fried et al., [1]. The data were recorded in an individual evaluation form that was prepared based on the criteria of the cited author. The same instruments were used in all the evaluations to be performed.

To evaluate the handgrip strength in the dominant hand, we used a hand dynamometer, which was adjusted according to gender and Body Mass Index (BMI). A dynamometer is a device that is graduated in such a way as to indicate the intensity of the force applied to one of its extremes, where the answer is given in Kilogram (kg) values. Body mass index is recognized as the standard for assessing the degree of obesity and is calculated by dividing weight (in kg) by height (in m) squared. To calculate the BMI, we used a portable anthropometer with a 200 cm extension and a 0.1 cm scale to measure the height of the elderly (m), and a portable digital electronic scale to measure the body weight (kg) of the elderly. Thus, the cut-off for handgrip strength (kg) as a frailty criterion will be obtained through the individual’s Body Mass Index (BMI) according to (Table 1).