Abstract
BackgroundWe assessed the quantitative changes in muscle mass and strength during 2 weeks of hospitalization in immobile and mobile acutely ill hospitalized older adults.MethodsForty-one patients (82.4 ± 6.6 years, 73.0% females) participated in this prospective longitudinal observational study. Mobility status was defined according to walking ability as described in the Barthel-Index. Functional status, including handgrip strength and isometric knee-extension strength, and mid-thigh magnetic resonance imaging (MRI) measurements of cross-sectional area (CSA) were conducted on admission and at discharge.ResultsTwenty-two participants (54%) were immobile and 19 (46%) mobile. In all, 54.0 and 12.0% were at risk of malnutrition and malnourished, respectively. The median time between baseline and follow-up for MRI scans were 13 days in mobile and immobile participants (P = 0.072). Mid-thigh muscle and subcutaneous fat CSA significantly decreased by 3.9cm2 (5.0%, P = 0.002) and 5.3cm2 (5.7%, P = 0.036) during hospitalization whereas intermuscular fat remained unchanged in immobile subjects. No significant changes were observed in mobile patients. In a regression analysis, mobility was the major independent risk factor for changes in mid-thigh muscle CSA as a percentage of initial muscle area (P = 0.022) whereas other variables such as age (P = 0.584), BMI (P = 0.879), nutritional status (P = 0.835) and inflammation (P = 0.291) were not associated with muscle mass changes. There was a significant decrease in isometric knee extension strength (P = 0.002) and no change in handgrip strength (P = 0.167) in immobile patients whereas both parameters increased significantly over time in mobile patients (P = 0.048 and P = 0.012, respectively).ConclusionsTwo weeks of disease-related immobilization result in a significant loss of thigh muscle mass and muscle strength in older patients with impaired mobility. Concomitantly, there was a significant reduction of subcutaneous adipose tissue in immobile older hospitalized patients whereas no changes were observed in intermuscular fat among these patients. These data highlight the importance of mobility support in maintaining muscle mass and function in older hospitalized patients.
Highlights
We assessed the quantitative changes in muscle mass and strength during 2 weeks of hospitalization in immobile and mobile acutely ill hospitalized older adults
In our recent study [8] among 198 older hospitalized patients, after adjustment for potential confounders such as age and gender, sarcopenia was associated with increased 1-year mortality among patients with limited mobility prior to admission (n = 138, hazard ratio, HR: 2.52, 95% CI: 1.17–5.44) and at time of discharge (n = 162, HR: 1.93, 95% CI: 0.67–3.22). In another prospective cohort study in persons aged over 80 years living in the community, Landi et al [9] reported that patients with sarcopenia had a higher risk of death during the 10-year follow-up than those without sarcopenia (HR = 2.15; 95% CI: 1.02–4.54)
34.0 and 54.0% had normal nutritional status or a risk of malnutrition, respectively whereas 12.0% were malnourished according to Mini Nutritional Assessment Short Form (MNA-SF)
Summary
We assessed the quantitative changes in muscle mass and strength during 2 weeks of hospitalization in immobile and mobile acutely ill hospitalized older adults. In our recent study [8] among 198 older hospitalized patients (mean age 82.8 ± 5.9 years), after adjustment for potential confounders such as age and gender, sarcopenia was associated with increased 1-year mortality among patients with limited mobility prior to admission (n = 138, hazard ratio, HR: 2.52, 95% CI: 1.17–5.44) and at time of discharge (n = 162, HR: 1.93, 95% CI: 0.67–3.22). In another prospective cohort study in persons aged over 80 years living in the community, Landi et al [9] reported that patients with sarcopenia had a higher risk of death during the 10-year follow-up than those without sarcopenia (HR = 2.15; 95% CI: 1.02–4.54). The interplay between acute diseases and factors such as immobility and malnutrition, all prevalent among older adults, may superimpose and accelerate the process of muscle loss in this population [12, 13]
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