Elsevier

Archives of Gerontology and Geriatrics

Volume 55, Issue 2, September–October 2012, Pages e9-e13
Archives of Gerontology and Geriatrics

Association between sarcopenia and higher-level functional capacity in daily living in community-dwelling elderly subjects in Japan

https://doi.org/10.1016/j.archger.2012.06.015Get rights and content

Abstract

This study aimed to determine the association between sarcopenia, defined by muscle mass, muscle strength, and physical performance, and higher-level functional capacity in community-dwelling Japanese elderly people. Subjects were 1158 elderly, community-dwelling Japanese people aged 65 or older. We used bioelectrical impedance analysis to measure muscle mass, grip strength to measure muscle strength, and usual walking speed to measure physical performance. Sarcopenia was characterized by low muscle mass, plus low muscle strength or low physical performance. Subjects without low muscle mass, low muscle strength, and low physical performance were classified as “normal.” Examination of higher-level functional capacity was performed using the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC). The TMIG-IC is a 13-item questionnaire completed by the subject; it contains five questions on self-maintenance and four questions each on intellectual activity and social role. Sarcopenia was identified in 11.3% and 10.7% of men and women, respectively. The percentage of disability for instrumental activities of daily living (IADL) was 39.0% in men with sarcopenia and 30.6% in women with sarcopenia. After adjustment for age, in men, sarcopenia was significantly associated with IADL disability compared with intermediate and normal subjects. In women, sarcopenia was significantly associated with every subscale of the TMIG-IC disability compared with intermediate and normal subjects. This study revealed that sarcopenia, defined by muscle mass, muscle strength, and physical performance, had a significant association with disability in higher-level functional capacity in elderly Japanese subjects. Interventions to prevent sarcopenia may prevent higher-level functional disability among elderly people.

Introduction

Age-related loss of muscle mass and function, muscle strength, and performance was termed sarcopenia by Irwin Rosenberg, 1989, Rosenberg, 1997. However, there is no widely accepted definition of sarcopenia, and in many reports, sarcopenia has been evaluated only via assessments of muscle mass (Baumgartner et al., 1998, Iannuzzi-Sucich et al., 2002, Tanimoto et al., 2011). Recently, the European Working Group on Sarcopenia in Older People (EWGSOP) recommended using the presence of both low muscle mass and low muscle function (strength or performance) to define sarcopenia, as defining sarcopenia based only on muscle mass may provide too narrow a definition (Cruz-Jentoft et al., 2010) because of the non-linear relationship between muscle mass and muscle strength (Janssen et al., 2004, Newman et al., 2006).

The Japanese population has the highest life expectancy worldwide (79 years in men and 86 years in women in 2009) and the highest proportion of people older than 65 years (22.7% in 2009) (Bartok et al., 2003, Large et al., 2010). It is important for older people to maintain their ability to live independently and participate in social activities, as these factors contribute to quality of life.

Lawton defined seven stages of competence for older people, from the lowest and most basic function to the highest. The stages were, in ascending order of complexity, life maintenance, functional health, perception and cognition, physical self-maintenance, IADL, effectance, and social role (Lawton, 1970). The TMIG-IC was designed to measure three higher-level functional capacities, that is IADL, intellectual activity (effectance in Lawton), and social role in community-dwelling elderly Japanese (Koyano, Hashimoto, Fukawa, Shibata, & Gunji, 1993a). Several publications have addressed the relationship between sarcopenia and disabilities in IADL (Baumgartner et al., 1998, Gallagher et al., 1997, Iannuzzi-Sucich et al., 2002, Janssen et al., 2002). However, there is no report about the impact of sarcopenia on higher-level functional capacity, above IADL.

The purpose of this study was to determine the association between sarcopenia, defined by muscle mass, muscle strength, and physical performance, and higher-level functional capacity in daily living in community-dwelling elderly people in Japan.

Section snippets

Subjects

Takatsuki City is home to 80 695 individuals aged 65 or older; the proportion of the elderly population in this city is 22.5%. Takatsuki City is a metropolitan suburb in the north of Osaka Prefecture, where welfare centers for the aged and community centers are the main organizations that provide social support to community-dwelling elderly people. All participants were recruited through local newspapers and by the local welfare commissioner. A total of 1164 elderly subjects aged 65 years or

Results

Subject characteristics by sex and sarcopenia classification are shown in Table 1. Men had significantly higher values than women for all anthropometric measurements except age and body mass index (BMI). In this study, 11.3% of men and 10.7% of women were classified as having sarcopenia. In both men and women, age was significantly higher in subjects with sarcopenia than in normal subjects. Table 2 shows the percentage of disability on the TMIG-IC. The percentage of disability for IADL was

Discussion

Our study defined sarcopenia based on the EWGSOP guidelines (Cruz-Jentoft et al., 2010). First, we measured muscle mass by BIA analysis. BIA can be used to determine body composition and has been shown to be safe, convenient, reliable, and valid (Janssen et al., 2000, Kyle et al., 2003, Kyle et al., 2004a, Kyle et al., 2004b, Pietrobelli et al., 2004). In addition, BIA equipment is portable, and the test is inexpensive. Thus, measuring muscle mass using BIA is suitable for community-dwelling

Conflict of interest

The authors have no conflict of interest to declare.

Funding source

This work was supported by KAKENHI (22790576) Grant-in-Aid for Young Scientists (B), funded by The Ministry of Education, Culture, Sports, Science and Technology (MEXT) of Japan. The funding source had no role in the study design; in the collection, analysis or interpretation of data; in the writing of the manuscript; or in the decision to submit the manuscript for publication.

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