Utility of four sarcopenia criteria for the prediction of falls-related hospitalization in older Australian women
Numerous sarcopenia definitions are not associated with increased falls-related hospitalization risk over 5 years to 9.5 years in older community-dwelling Australian women. Measures of muscle strength and physical function, but not appendicular lean mass (measured by dual-energy X-ray absorptiometry) may help discriminate the risk of falls-related hospitalization.
The aim of this prospective, population-based cohort study of 903 Caucasian-Australian women (mean age 79.9 ± 2.6 years) was to compare the clinical utility of four sarcopenia definitions for the prediction of falls-related hospitalization over 9.5 years.
The four definitions were the United States Foundation for the National Institutes of Health (FNIH), the European Working Group on Sarcopenia in Older People (EWGSOP), and modified FNIH (AUS-POPF) and EWGSOP (AUS-POPE) definitions using Australian population-specific cut points (< 2 SD below the mean of young healthy Australian women). Components of sarcopenia including muscle strength, physical function, and appendicular lean mass (ALM) were quantified using hand grip strength, timed-up-and-go (TUG), and dual-energy X-ray absorptiometry (DXA), respectively. Incident 9.5-year falls-related hospitalization were captured by linked data.
Baseline prevalence of sarcopenia according to FNIH (9.4%), EWGSOP (24.1%), AUS-POPF (12.0%), and AUS-POPE (10.7%) differed substantially. Sarcopenia did not increase the relative hazard ratio (HR) for falls-related hospitalization before or after adjustment for age (aHR): FNIH aHR 1.00 95%CI (0.69–1.47), EWGSOP aHR 1.20 95%CI (0.93–1.54), AUS-POPF aHR 0.96 95%CI (0.68–1.35), and AUS-POPE aHR 1.33 95%CI (0.94–1.88). When examining individual components of sarcopenia, only muscle strength and physical function but not ALM (adjusted for height2 or BMI) were associated with falls-related hospitalization.
Current definitions of sarcopenia were not associated with falls-related hospitalization risk in this cohort of community-dwelling older Australian women. Finally, measures of muscle strength and physical function, but not ALM (measured by DXA) may help discriminate the risk of falls-related hospitalization.
KeywordsFalls-related hospitalization Geriatrics Muscle mass Muscle strength Physical function
The authors wish to thank the staff at the Western Australia Data Linkage Branch, Hospital Morbidity Data Collection and Registry of Births, Deaths, and Marriages for their work on providing the data for this study.
M. S., R. L. P., D. S., R. M. D., G. D., C. A. I, K. Z., R. J. W., J. M. H., and J. R. L. conceived and designed the study. J. R. L, K. Z., and R. L. P. collected the data. M. S., J. M. H, J. R. L., and R. L. P. prepared the manuscript; all authors reviewed the manuscript; M. S. had the primary responsibility for the final content. All authors read and approved the final manuscript.
The Perth Longitudinal Study of Aging in Women (PLSAW) was funded by Healthway, the Western Australian Health Promotion Foundation, and by project grants 254627, 303169, and 572604 from the National Health and Medical Research Council (NHMRC) of Australia. The salary of J. M. H. is supported by a NHMRC of the Australia Senior Research Fellowship and a Royal Perth Hospital Medical Research Foundation Fellowship. The salaries of J. R. L. and D. S. are supported by a NHMRC of Australia Career Development Fellowship. None of these funding agencies had any input into any aspect of the design and management of this study.
Compliance with ethical standards
Conflict of interest
All participants provided written informed consent. Ethics approval was granted by the Human Ethics Committee of the University of Western Australia. Both studies were retrospectively registered on the Australian New Zealand Clinical Trials Registry (CAIFOS trial registration number ACTRN12615000750583 and PLSAW trial registration number ACTRN12617000640303) and complied with the Declaration of Helsinki. Human ethics approval for the use of linked data was provided by the Human Research Ethics Committee of the Western Australian Department of Health (project number 2009/24).
- 2.Goodpaster BH, Park SW, Harris TB, Kritchevsky SB, Nevitt M, Schwartz AV, Simonsick EM, Tylavsky FA, Visser M, Newman AB (2006) The loss of skeletal muscle strength, mass, and quality in older adults: the health, aging and body composition study. J Gerentol A Boil Sci Med Sci 61(10):1059–1064CrossRefGoogle Scholar
- 5.Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, Scherr PA, Wallace RB (1994) A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerentol 49(2):M85–M94CrossRefGoogle Scholar
- 7.Bischoff-Ferrari HA, Orav JE, Kanis JA, Rizzoli R, Schloegl M, Staehelin HB, Willett WC, Dawson-Hughes B (2015) Comparative performance of current definitions of sarcopenia against the prospective incidence of falls among community-dwelling seniors age 65 and older. Osteoporos Int 26(12):2793–2802CrossRefGoogle Scholar
- 11.Tanimoto Y, Watanabe M, Sun W, Sugiura Y, Hayashida I, Kusabiraki T, Tamaki J (2014) Sarcopenia and falls in community-dwelling elderly subjects in Japan: defining sarcopenia according to criteria of the European working group on sarcopenia in older people. Arch Gerontol Geriatr 59(2):295–299CrossRefGoogle Scholar
- 12.Scott D, Seibel M, Cumming R, Naganathan V, Blyth F, Le Couteur DG, Handelsman DJ, Waite LM, Hirani V (2017) Sarcopenic obesity and its temporal associations with changes in bone mineral density, incident falls, and fractures in older men: the concord health and ageing in men project. J Bone Min Res 32(3):575–583CrossRefGoogle Scholar
- 14.Scott VJ, Gallagher EM (1999) Mortality and morbidity related to injuries from falls in British Columbia. Can J Public Health 90(5):343Google Scholar
- 23.Bischoff HA, Stähelin HB, Monsch AU, Iversen MD, Weyh A, Von Dechend M, Akos R, Conzelmann M, Dick W, Theiler R (2003) Identifying a cut-off point for normal mobility: a comparison of the timed ‘up and go’ test in community-dwelling and institutionalised elderly women. Age Ageing 32(3):315–320CrossRefGoogle Scholar
- 26.Delmonico MJHT, Visser M, Park SW, Conroy MB, Velasquez-Mieyer P, Boudreau R, Manini TM, Nevitt M, Newman AB, Goodpaster BH, for the Health, Aging, and Body Composition Study (2009) Longitudinal study of muscle strength, quality, and adipose tissue infiltration. Am J Clin Nutr 90(6):1579–1585CrossRefGoogle Scholar
- 27.Visser M, Schaap LA (2011) Consequences of sarcopenia. J Am Geriatr Soc 52(7):1121–1129Google Scholar