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Sarcopenia

Sarcopenia is the decline in skeletal muscle mass associated with decreased strength and/or function which commonly occurs as a result of age, reduced muscle activity or certain comorbid conditions (for more info, click here). While there is not agreed upon diagnostic criteria for sarcopenia in the United States, a variety of different methods have been suggested and used to screen for muscle loss, strength, and function (for more info, click here).

During the planning phase, NUCOAT researched six conditions that commonly occur with sarcopenia. The original plan was to narrow down to three conditions associated with sarcopenia to further investigate during the research phase; however, the NUCOAT team and FDA agreed that understanding sarcopenia in older adults would be more valuable to understand physical function limitations rather than to narrow it into sarcopenia in specific diseases.

Candidate Conditions

Heart Failure

Overview

A chronic condition in which the heart doesn’t pump blood as well as it should. Heart failure can occur if the heart cannot pump (systolic) or fill (diastolic) adequately. Symptoms include shortness of breath, fatigue, swollen legs, and rapid heartbeat. Most commonly, diagnosis happens in patients age 65 years and older. More than half of those who develop heart failure die within 5 years of diagnosis.

Physical Function Impacts

  • Trouble walking
  • Difficulty climbing stairs
  • Difficulty picking up heavy items

Potential Cause of Physical Function Impacts

  • Fatigue
  • Sarcopenia
  • Edema
  • Dyspnea
  • Chest pain

Treatments

  • Dietary (e.g., less salt intake, limiting fluid intake)
  • Prescription medication
  • Defibrillator or implanted pacemaker
  • Physical activity

Parkinson's Disease

Overview

A disorder of the central nervous system that affects movement, often including tremors. Nerve cell damage in the brain causes dopamine levels to drop, leading to the symptoms of Parkinson’s. Parkinson’s often starts with a tremor in one hand. Other symptoms are slow movement, stiffness, and loss of balance. Parkinson’s patients typically develop symptoms at 50 years of age or older. Patients with Parkinson’s have an average life expectancy.

Physical Function Impacts

  • Loss of fine motor skill
  • Slow movement
  • Loss of balance

Potential Cause of Physical Function Impacts

  • Sarcopenia
  • Tremors
  • Rigid muscles
  • Fatigue
  • Pain

Treatments

  • Medications
  • Physical exercise
  • Deep brain stimulation

Chronic Obstructive Pulmonary Disease (COPD)

Overview

A group of lung diseases that block airflow and make it difficult to breathe. Emphysema and chronic bronchitis are the most common conditions that make up COPD. Damage to the lungs from COPD cannot be reversed. Symptoms include shortness of breath, wheezing, or a chronic cough. Most patients are 40 or older when COPD symptoms present. Life expectancy of COPD varies with disease severity.

Physical Function Impacts

  • List of possible physical function side effects that have been seen in patients
  • Loss of fine motor skill
  • Loss of balance

Potential Cause of Physical Function Impacts

  • Sarcopenia
  • Dyspnea
  • Fatigue
  • Chest pain

Treatments

  • Oral Steroids, e.g., inhalers
  • Medications
  • Regular physical activity

Hip Fracture

Overview

A break in the upper quarter of the thighbone, near the hip joint. A hip fracture can cause life-threatening complications. People over age 65 are most at risk because bones weaken and the risk of falling increases with age. Symptoms include the inability to move after a fall and severe hip or groin pain. A hip fracture almost always requires surgery and physical therapy. Overall life expectancy is slightly shorter for those with hip fracture, but there is a significant risk of mortality in the first year after the hip fracture.

Physical Function Impacts

  • Inability to get up after fall
  • Slow walking speed
  • Difficulty maintaining balance

Potential Cause of Physical Function Impacts

  • Sarcopenia
  • Fatigue
  • Bone and joint pain
  • Stiffness
  • Decreased range of motion

Treatments

  • Avoiding falls
  • Dietary steps to maintain bone density
  • Surgery
  • Physical therapy

Osteoarthritis

Overview

A type of arthritis that occurs when flexible tissue at the ends of bones wears down. The wearing down of the protective tissue at the ends of bones (cartilage) occurs gradually and worsens over time. Joint pain in the hands, neck, lower back, knees, or hips is the most common symptom. Typical onset is age 60 with no significant decrease in life expectancy.

Physical Function Impacts

  • Loss of fine motor skill
  • Difficulty bending joints
  • Slow walk speed

Potential Cause of Physical Function Impacts

  • Sarcopenia
  • Joint pain
  • Stiff joints

Treatments

  • Medications
  • Physical Therapy
  • Surgery

Advanced Cancer

Overview

Advanced cancer is any cancer that has advanced to either stage III (locally advanced cancer/primary) or stage IV (metastatic/secondary). When a cancer has developed to stage III and beyond, the cancer tumor has either grown to a specific size, multiple tumors have formed, or cancer has spread to adjacent lymph nodes or other organs and is unlikely to be cured. Primary cancer refers to cancer that is confined to one origin and/or region. The tumor is confined to its original site, such as the bowel. Secondary cancer, also known as metastatic cancer, is where cancer has spread beyond its organ of origin (such as lung cancer that has spread to the brain).

Physical Function Impacts

  • Loss of balance
  • Difficulty walking
  • Difficulty carrying things

Potential Cause of Physical Function Impacts

  • Sarcopenia
  • Fatigue
  • Joint pain
  • Neuropathy
  • Difficulty breathing
  • Cachexia
  • Loss of bone mass

Treatments

  • Medications
  • Chemotherapy
  • Radiation
  • Partial/complete resection