Sarcopenia: What Every NP Needs to Know
The onset and progression of sarcopenia are insidious and often not recognized until significant limitations occur. It is important that nurse practitioners (NPs) remain vigilant because accurate assessment, early diagnosis, and intervention may decrease premature morbidity and mortality. From a clinical perspective, sarcopenia can be categorized as either primary (ie, aging related) or secondary (ie, numerous causal factors such as endocrine disorders, neurodegenerative diseases, cachexia, inadequate nutrition/malabsorption, and disuse). Assessment is warranted when patients describe a noticeable decline in function, strength, or overall health status; mobility-related difficulty; recurrent falls; unintentional weight loss; and challenges with activities of daily living. An NP should have a high index of suspicion with patients who have a slow gait or are nonambulatory, cannot rise from a chair unassisted, and have difficulty with balance or stair climbing. Additionally, patients with chronic diseases such as diabetes, congestive heart failure, chronic obstructive pulmonary disease, rheumatoid arthritis, or cancer should raise a "red flag" because these individuals are more often affected with sarcopenia.
Although a visual assessment of a person's physique may allow one to observe muscle loss and make a presumptive diagnosis of sarcopenia, it is not a sensitive method. Therefore, numerous assessment techniques are available to better quantify muscle mass, strength, and performance. Clinical manifestations of sarcopenia have both physical and performance attributes. Physical manifestations are the observed loss of muscle mass and strength, whereas a decline in physical performance is determined by tests that evaluate lower body performance such as balance, gait speed, and stair climbing. Although sarcopenia is associated with frailty and general thinness, people can also be sarcopenic and obese, which masks the underlying muscle loss by preservation of fat mass.
Assessment
The onset and progression of sarcopenia are insidious and often not recognized until significant limitations occur. It is important that nurse practitioners (NPs) remain vigilant because accurate assessment, early diagnosis, and intervention may decrease premature morbidity and mortality. From a clinical perspective, sarcopenia can be categorized as either primary (ie, aging related) or secondary (ie, numerous causal factors such as endocrine disorders, neurodegenerative diseases, cachexia, inadequate nutrition/malabsorption, and disuse). Assessment is warranted when patients describe a noticeable decline in function, strength, or overall health status; mobility-related difficulty; recurrent falls; unintentional weight loss; and challenges with activities of daily living. An NP should have a high index of suspicion with patients who have a slow gait or are nonambulatory, cannot rise from a chair unassisted, and have difficulty with balance or stair climbing. Additionally, patients with chronic diseases such as diabetes, congestive heart failure, chronic obstructive pulmonary disease, rheumatoid arthritis, or cancer should raise a "red flag" because these individuals are more often affected with sarcopenia.
Although a visual assessment of a person's physique may allow one to observe muscle loss and make a presumptive diagnosis of sarcopenia, it is not a sensitive method. Therefore, numerous assessment techniques are available to better quantify muscle mass, strength, and performance. Clinical manifestations of sarcopenia have both physical and performance attributes. Physical manifestations are the observed loss of muscle mass and strength, whereas a decline in physical performance is determined by tests that evaluate lower body performance such as balance, gait speed, and stair climbing. Although sarcopenia is associated with frailty and general thinness, people can also be sarcopenic and obese, which masks the underlying muscle loss by preservation of fat mass.