Appetite loss, malnutrition, and mortality: a significant association in need of urgent recognition?
Despite its high prevalence among older adults, appetite loss is underrecognized in clinical practice. Explanations for this underrecognition include the lack of uniform terminology for the condition paired with an absence of defined, standardised approaches to assessing it. Moreover, appetite loss is commonly misconstrued as a normal and irreversible part of the ageing process. Together, these reasons create heterogeneity across anorexia of ageing studies, thereby hindering the recognition and management of appetite loss among older adults. To overcome this gap, a better understanding of appetite loss’ effects on morbidity and mortality in older adults is needed.
This systematic literature review aimed to investigate the relationship between appetite loss and negative outcomes in older adults aged ≥ 65 years.
Metabolic dysfunction and candidate biomarkers: an overview of anorexia of ageing
Anorexia of ageing is characterised by an age-associated reduction in appetite and food intake. With a prevalence of 20% in older adults, this syndrome may engender malnutrition and metabolic impairments, both of which are associated with increased negative health outcomes. Indeed, elderly individuals with anorexia of ageing possess higher risks of sarcopenia, disability, hospitalisation, and mortality. Importantly, malnutrition has also been identified as a major risk factor for frailty.
This article aims to summarise the state of research on anorexia of ageing in the context of age-related metabolic changes, with a focus on its candidate biomarkers.
Sarcopenia, unpreparedness, and the developing world: an urgent concern?
Muscle strength has recently been defined as sarcopenia’s main component by the revised European Working Group in Sarcopenia for Older People (EWGSOP2). This shift from muscle mass to strength has had transformative implications within clinical practice and has greatly facilitated sarcopenia’s diagnostic process. Despite this trailblazing consensus, sarcopenia remains an issue of growing concern throughout high-income countries (HICs). Although low- and middle-income countries (LMICs) are disproportionately affected by the threat of sarcopenia, their care providers and healthcare systems seem to be the least prepared to tackle it.
The aim of this article is to expose the state of sarcopenia awareness and management in LMICs. It further proposes solutions to prepare the developing world for this growing concern.
Explaining and combatting the knowledge gaps surrounding sarcopenia
Sarcopenia is characterised by an age-related decline in muscle mass and strength combined with impairments in physical function. The risk of falls, fractures, and death is doubled in individuals with sarcopenia compared to those without. This patient population also frequently possesses comorbid diseases, including diabetes, cardiovascular disease, dementia, and chronic obstructive pulmonary disease. This may significantly increase their risk of suffering adverse outcomes post-surgery.
The aim of this editorial was to expose the serious nature of sarcopenia and underscore associated knowledge gaps in clinical practice.
Sarcopenia and frailty assessments’ predictive value in elderly patients with COVID-19
Dynapenia is characterised by an age-related loss of muscle strength. When coupled with low muscle mass, it is instead diagnosed as sarcopenia according to the European Working Group on Sarcopenia in Older People revised guidelines (EWGSOP2).
The SARS-CoV-2 infection is accompanied by severe inflammation and increased catabolism, which may significantly impact infected patients’ skeletal muscle structure and function. These impacts may be detrimental to elderly patients, who are disproportionately affected and already highly burdened by the disease. Recent studies have suggested that sarcopenia at the time of hospital admission may shape older patients’ length of stay and increase mortality in those with moderate to severe COVID-19.
The aim of this study was to examine the association between simple clinical biomarkers, including those for the assessment of muscle function and frailty, and the risk of poor survival as well as increased length of hospital stay in older patients with COVID-19. Sarcopenia was screened using SARC-F, while frailty was assessed in accordance with the Rockwood Clinical Frailty Scale.
Sarcopenia and its metabolic basis in CKD: the key to treating physical frailty?
Patients with chronic kidney disease (CKD) possess an increased risk of developing physical or phenotypic frailty. The skeletal muscle dysfunction underpinning physical frailty has been associated with increased mortality. CKD-related phenotypic frailty shares features with ageing-related frailty, and CKD has thus been touted as a clinically relevant model of premature ageing.
The aim of this review was to examine the metabolic basis and pathogenesis of the skeletal muscle dysfunction responsible for phenotypic frailty in patients with CKD.
Sarcopenic obesity: prevalence and related outcomes
Ageing is associated with increased fat accumulation and weight gain due to altered energy metabolism. Sarcopenia, defined as a loss of muscle mass and function associated with increased mortality risk, is also linked to ageing.
Sarcopenia obesity (SO) refers to the combination of age-related sarcopenia and obesity, and stems from the negative correlation between intermuscular adipose tissue accumulation and muscle performance.
While elderly patients with obesity possess lower death rates than those with lower body mass indexes, patients with SO have higher mortality rates than these same peers. This, as well as obesity’s protective role against sarcopenia in the elderly, is the basis of the commonly known ‘obesity paradox’.
The aim of this review was to assess the current clinical evidence relating to SO.
Predicting and acknowledging the role of resilience in elderly patients
Resilience is characterised by the ability to bounce back after exposure to a stressor or a form of adversity. It is frequently separated into physical and psychological components, with the former being defined as the ability to recover following age-related losses or disease. A decline in resilience is both a marker and a risk factor for accelerated ageing and frailty, respectively.
The aim of this editorial was to showcase the importance of resilience in the recovery of frail patients. It also exposes the mechanisms behind resilience, as well as the gaps in its clinical assessment.
Frailty: a growing concern in the UK
Frailty is characterised by increased vulnerability to acute stressors associated with an age-related decline in function across multiple physiological systems. Since it is an age-dependent clinical syndrome, countries with ageing populations, like the United Kingdom (UK), are predicted to become increasingly exposed to worsening frailty-associated patient outcomes and burdened healthcare systems.
This article aimed to emphasise the importance of frailty-related education for healthcare professionals in the UK.