Changes in muscle mass during acute short-term hospitalization of elderly patients: A mini-review

Abstract

It has long been a presumption that hospitalization is associated with a loss of muscle mass in elderly patients. However, only a handful of studies have directly measured whether such a loss actually occurs. This mini-review highlights some of the most recent research related to changes in muscle mass during acute shortterm hospitalization of elderly patients. Despite a high prevalence of physical inactivity during hospitalization, there is a lack of research measuring changes for habitual levels. The effect of inflammation on muscle mass in elderly patients is still uncertain. Nutritional supplementation beyond what is currently being prescribed in hospitals may have additional benefits on muscle mass. Dehydration prior to hospital admission may obscure true changes in muscle mass when using current state-of-the-art measures due to in-hospital rehydration. The current literature does not support the notion of in-hospital loss of muscle mass in acutely admitted elderly patients; however, there is a need for more precise measures of muscle mass that are able to account for fluctuations in hydration status. Moreover, future studies assessing changes in muscle mass should also measure changes in physical activity levels, inflammation status, and nutritional intake during acute hospitalization. K E Y W O R D Satrophy, disuse, elderly, hydration status, inflammation, protein intake | INTRODUCTIONThere are several physiological changes related to increasing age in humans, one of which is the progressive loss of skeletal muscle mass. 1 This loss, which has been termed sarcopenia, is multifactorial in nature and its exact etiology is yet to be established. A large body of research has been put into understanding this phenomenon, mostly focusing on factors such as physical inactivity, poor nutrition, inflammatory processes, and endocrine changes. Interestingly, some researchers have suggested that repeated hospitalizations in elderly may accelerate sarcopenia. 2 It has long been a presumption that hospitalization is associated with a loss of muscle mass in elderly patients. However, only a handful of studies have directly measured whether such a loss actually occurs during acute hospitalization. A recent meta-analysis investigated changes in muscle mass in older patients during either elective or acute admission. 3 The electively admitted patients showed a decrease in muscle mass [standardized mean difference (95% confidence interval): À0.44 (À0.61, À0.27)], whereas the acutely admitted showed no change [À0.25 (À0.58, 0.09)]. Although only two studies were used in the analysis of acutely admitted patients, other studies that were not included show similar results. 4,5 Several factors may explain these findings. This mini-review highlights some of the most recent studies in the field of geriatrics with a focus on changes in muscle mass during acute short-term hospitalization of elderly patients. The main putative mechanisms explaining these findings are discussed, and a hypothetical model illustrating changes in muscle m...

The association of biological sex and long-term outcomes in older patients with physical restraint at the emergency department

“…They were older [12,18], with poorer autonomy or health. [12,18,22] This could explain why they had been more hospitalized and had larger functional decline, with a longer LOS, and higher mortality rate [17][18][19] after PR use. This fact must be quali ed because the ED visit is described to be by itself a cause of excess of mortality and readmission for older people.…”

Avaliação do estado nutricional e presença de desnutrição em pacientes hospitalizados

“…Por outro lado, a avaliação CP demonstrou que a maioria dos pacientes apresentou diminuição da massa muscular. Desta forma, a CP foi uma boa medida para avaliar a redução da massa muscular, sendo este dado semelhante ao descrito por Norheim 23 , que a considera uma boa medida indicadora de sarcopenia.…”