Singapore multidisciplinary consensus recommendations on muscle health in older adults: assessment and multimodal targeted intervention across the continuum of care

BMC Geriatrics

Samuel T. H. Chew¹  Shuen-Loong Tham²  Geetha Kayambu³  Ngiap Chuan Tan⁴  Jonathan Tan⁵  Charles Chin Han Lew⁶  Fangyi Ong⁶  Tze Pin Ng⁷ 

[1] Department of Geriatric Medicine, Changi General Hospital, 2 Simei Street 3, 529889, Singapore, Singapore;Society for Geriatric Medicine Singapore, Singapore, Singapore;Department of Rehabilitation Medicine, Tan Tock Seng Hospital, Singapore, Singapore;Society of Rehabilitation Medicine, Singapore, Singapore;Department of Rehabilitation, National University Hospital, Singapore, Singapore;Department of Research, SingHealth Polyclinics, Singapore, Singapore;Mount Elizabeth Novena Hospital, Singapore, Singapore;Singapore Nutrition and Dietetics Association, Singapore, Singapore;Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore;

关键词: Muscle;    Sarcopenia;    Older adult;    Multidisciplinary;    Exercise;    Nutrition;    Consensus;   

DOI  :  10.1186/s12877-021-02240-8

来源: Springer

【 摘 要 】

BackgroundThe rapidly aging societies worldwide and in Singapore present a unique challenge, requiring an integrated multidisciplinary approach to address high-value targets such as muscle health. We propose pragmatic evidence-based multidisciplinary consensus recommendations for the assessment and multi-modal management of muscle health in older adults (≥65 years) across the continuum of care.MethodsThe recommendations are derived from an in-depth review of published literature by a multidisciplinary working group with clinical experience in the care of the older population in both acute and community settings.ResultsThe panel recommends screening for muscle impairment using the SARC-F questionnaire, followed by assessment for low muscle strength (handgrip strength or 5-times chair stand test ≥10 s as a surrogate for lower limb strength) to diagnose possible/probable sarcopenia. For uncomplicated cases, lifestyle modifications in exercise and diet can be initiated in the community setting without further assessment. Where indicated, individuals diagnosed with possible/probable sarcopenia should undergo further assessment.Diagnosis of sarcopenia should be based on low muscle strength and low muscle mass (bioimpedance analysis, dual-energy X-ray absorptiometry or calf circumference as a surrogate). The severity of sarcopenia should be determined by assessment of physical performance (gait speed or 5-times chair stand test ≥12 s as a surrogate for gait speed). To treat sarcopenia, we recommend a combination of progressive resistance-based exercise training and optimization of nutritional intake (energy, protein and functional ingredients). High quality protein in sufficient quantity, to overcome anabolic resistance in older adults, and distributed throughout the day to enable maximum muscle protein synthesis, is essential. The addition of resistance-based exercise training is synergistic in improving the sensitivity of muscle protein synthesis response to the provision of amino acids and reducing anabolic resistance. An expected dose-response relationship between the intensity of resistance-based training, lean mass and muscle strength is described.ConclusionsReviewed and endorsed by the Society of Rehabilitation Medicine Singapore and the Singapore Nutrition and Dietetics Association, these multidisciplinary consensus recommendations can provide guidance in the formulation of comprehensive and pragmatic management plans to improve muscle health in older adults in Singapore and Asia.

【 授权许可】

CC BY