Screening, Diagnosis and Management of Sarcopenia and Frailty in Hospitalized Older Adults: Recommendations from the Australian and New Zealand Society for Sarcopenia and Frailty Research (ANZSSFR) Expert Working Group

Abstract

Sarcopenia and frailty are highly prevalent conditions in older hospitalized patients, which are associated with a myriad of adverse clinical outcomes. This paper, prepared by a multidisciplinary expert working group from the Australian and New Zealand Society for Sarcopenia and Frailty Research (ANZSSFR), provides an up-to-date overview of current evidence and recommendations based on a narrative review of the literature for the screening, diagnosis, and management of sarcopenia and frailty in older patients within the hospital setting. It also includes suggestions on potential pathways to implement change to encourage widespread adoption of these evidence-informed recommendations within hospital settings. The expert working group concluded there was insufficient evidence to support any specific screening tool for sarcopenia and recommends an assessment of probable sarcopenia/sarcopenia using established criteria for all older (≥65 years) hospitalized patients or in younger patients with conditions (e.g., comorbidities) that may increase their risk of sarcopenia. Diagnosis of probable sarcopenia should be based on an assessment of low muscle strength (grip strength or five times sit-to-stand) with sarcopenia diagnosis including low muscle mass quantified from dual energy X-ray absorptiometry, bioelectrical impedance analysis or in the absence of diagnostic devices, calf circumference as a proxy measure. Severe sarcopenia is represented by the addition of impaired physical performance (slow gait speed). All patients with probable sarcopenia or sarcopenia should be investigated for causes (e.g., chronic/acute disease or malnutrition), and treated accordingly. For frailty, it is recommended that all hospitalized patients aged 70 years and older be screened using a validated tool [Clinical Frailty Scale (CFS), Hospital Frailty Risk Score, the FRAIL scale or the Frailty Index]. Patients screened as positive for frailty should undergo further clinical assessment using the Frailty Phenotype, Frailty Index or information collected from a Comprehensive Geriatric Assessment (CGA). All patients identified as frail should receive follow up by a health practitioner(s) for an individualized care plan. To treat older hospitalized patients with probable sarcopenia, sarcopenia, or frailty, it is recommended that a structured and supervised multi-component exercise program incorporating elements of resistance (muscle strengthening), challenging balance, and functional mobility training be prescribed as early as possible combined with nutritional support to optimize energy and protein intake and correct any deficiencies. There is insufficient evidence to recommend pharmacological agents for the treatment of sarcopenia or frailty. Finally, to facilitate integration of these recommendations into hospital settings organization-wide approaches are needed, with the Spread and Sustain framework recommended to facilitate organizational culture change, with the help of ‘champions’ to drive these changes. A multidisciplinary team approach incorporating awareness and education initiatives for healthcare professionals is recommended to ensure that screening, diagnosis and management approaches for sarcopenia and frailty are embedded and sustained within hospital settings. Finally, patients and caregivers’ education should be integrated into the care pathway to facilitate adherence to prescribed management approaches for sarcopenia and frailty.

Predictive value of frailty assessment tools in patients undergoing surgery for gastrointestinal cancer

“…There is one point for each item. The total score can range from 0-5, with 0 indicating robust, 1-2 indicating pre-frailty, and ≥ 3 indicating frailty [17]. Patients who scored ≥ 3 on the FRAIL scale were included in the frailty group and those who scored 0 to 2 were included in the non-frailty group [31].…”

“…However, because the FP assessment measures patients' physical activity, it can only be performed by medically stable and ambulatory patients. The FRAIL scale, proposed by the International Association for Nutrition, Health, and Aging, is recommended for frailty screening by the Australian and New Zealand Society for Sarcopenia and Frailty Research [17]. The FRAIL scale is based on patient self-reports and is simple and quick to complete, facilitating clinical implementation.…”

Fatigue and primary sarcopenia in geriatric patients

“…Sarcopenia can cause an increase in the risk of falls and fractures due to falls, deterioration in activities of daily living, movement disorders, increased hospitalization, decreased quality of life, and even death. As can be seen, sarcopenia is associated with many adverse conditions in the elderly and can be considered a marker of frailty 3 , 4 .…”

Sarcopenia is a serious disease and should be taken seriously

“…Sarcopenia diagnostics are not yet widely implemented in clinical practice despite clear clinical guidelines 12 . This is mainly due to a lack of knowledge, equipment, time and prioritization to diagnose sarcopenia and treat this disease 6,13,14 .…”

“…Sarcopenia diagnostics are not yet widely implemented in clinical practice despite clear clinical guidelines. 12 This is mainly due to a lack of knowledge, equipment, time and prioritization to diagnose sarcopenia and treat this disease. 6,13,14 Often, healthcare professionals wish to screen and diagnose sarcopenia in a simplified and fast way; therefore, the use of risk screening tools and blood biomarkers has been investigated, but their validity is limited.…”