A Golden Wave

Malaysia is expected to be an ageing nation by 2030. 15.3% of its population is estimated to be 60 years old and older.

Moreover, Malaysia is expected to claim its title as a ‘super-aged’ nation by 2056. This age group is expected to surpass 20% of the country’s population.

As we gear up to usher in a new era and season, are we as a nation ready to meet the needs of our elderly loved ones – healthwise, financially, socioeconomically and psychologically?

Ageing Gracefully

Phrases like ‘I must be getting old’ and ‘old liao lah!’ may be used jokingly, but often carry a negative connotation.

Growing old is often associated with apprehension, reluctance, uncertainty and a tinge of fear.

It is natural to fear losing a sense of independence, medical ailments and having a poor quality of life.

Ageing is inevitable, so the best thing we can do is to enjoy the process as much as possible.

After all, it is called the golden years for a reason. We aim to kick our shoes back, enjoy retirement, see our children marry well, hold our grandchildren in our arms, travel as much as possible, pick up new hobbies and enjoy life with our loved ones.

What is Sarcopenia?

Sarcopenia is a loss of muscle mass and muscle strength. It was initially assumed to be a natural cause of ageing. However, some elderly individuals do not develop sarcopenia as they age, leading medical professionals to believe that sarcopenia is a pathological process.

The word ‘sarcopenia’ is derived from the Greek words ‘sarx’ and ‘penia’, which mean muscle and loss respectively.

Fun fact: Did you know? 40,000 muscle fibres are lost from the quadriceps per year from 30.

It is estimated that a human can lose up to 50% of muscle mass by 80 years old.

It is no wonder that 28.5% to 33.6% of Malaysians have been diagnosed with sarcopenia.

Why is sarcopenia so bad?

One may think, ‘What can be so wrong about losing a bit of muscle? I will probably just not be able to lift heavy weights, that’s all.’

Mighty Muscles

When we think of muscles, the first thing that comes to mind is Popeye the sailor man.

Our body consists of three types of muscles which are

Cardiac muscles
Skeletal muscles
Smooth muscles

These 3 types of muscles make up the 600 muscles that work together to help our body carry out their necessary functions. Muscles aid in mobility, digestion, breathing, posture, blood circulation and more.

Fun Fact: Did you know? Muscles make up a total of 40% of our total body weight.

Unravelling Muscle Loss

Losing muscle mass can bring about adverse consequences for elderly individuals.

These include:

Loss of function
Frailty
Increased risk and rates of falls
Increased risk of hospitalisation
Increased insulin resistance (a condition that can cause type 2 diabetes mellitus)
Fatigue
Slower recovery from illnesses and surgeries
Overall reduced quality of life
Mortality

Sarcopenia is also associated with rheumatoid arthritis (an autoimmune condition that causes your small joints to become painfully inflamed, resulting in deformity and immobility).

What Causes Sarcopenia?

As mentioned above, although age is the main cause of sarcopenia, not every elderly individual will go on to develop this disease.

This has led scientists to believe that sarcopenia is not a cause of natural ageing.

The cause of sarcopenia can be classified into two categories: age-related and disease-related.

Age-Related Causes

This is also known as primary sarcopenia. Ageing is the main reason, but the following which are a result of ageing can potentially increase the risk of developing this disease:

A reduction in hormone levels like testosterone and growth hormone levels, including insulin-like growth factor (IGF-1)
Malnutrition is a rather common issue among the elderly.

As one age, one undergoes physiological changes which can affect one’s appetite and digestive system. As we age, our sense of taste and smell will change too. Poor dentition, constipation and swallowing issues also contribute to malnutrition.

The body cannot convert protein to energy as efficiently as before.
An inadequate intake of calories and protein will further accelerate the loss of muscle mass.
Physical inactivity and immobility.

Disease-Related Causes

Otherwise known as secondary sarcopenia, diseases that contribute to the development of sarcopenia include:

Obesity (otherwise known as sarcopenic obesity)

Obesity is classified as a BMI of >30 kg/m2 or a waist circumference of ≥ 90 cm for men and ≥80 cm for women, according to the Ministry of Health Guidelines.

Type 2 Diabetes Mellitus
High Blood Pressure
Dyslipidemia (High Cholesterol Levels)
Osteoarthritis

A degenerative condition that causes a breakdown of tissues within joints. Weight-bearing joints like the knee and hip joints are commonly affected.

Inflammatory bowel disease

A chronic inflammation of the gastrointestinal tract.

Signs and Symptoms

Detecting early signs of sarcopenia is crucial in treatment and early intervention. If you or your loved one have the following, it would be beneficial to seek medical advice.

Easily fatigued
Reduced muscle strength
Difficulty climbing stairs
Poor balance
Difficulty standing up, walking up the stairs
Finding it hard to lift items
Unintentional weight loss
Frequent falls
Walking more slowly than usual

How is It Diagnosed?

Your doctor may ask questions about your symptoms and perform a physical exam.

You may be asked to perform special tests to help guide your doctor to an accurate diagnosis.

Some of these tests include:

Walking speed test: This test assesses the time it takes for you to walk 4 metres.
Handgrip test: This test compares strength in both hands.
Chair stand test: This test assesses how many times you can sit and stand from a chair without using your arms in 30 seconds.
Timed-up and go test (TUG): This test assesses how much time it takes you to rise from a chair, walk 3 metres away from the chair, walk 3 metres back to the chair and then sit back down in the same chair.

Your doctor may also do a dual-energy X-ray absorptiometry (DEXA) scan, which measures your bone density, fat mass and muscle mass.

Is Sarcopenia Curable?

Not only is sarcopenia treatable, but it is also reversible!

The mainstay treatment of sarcopenia is lifestyle modification, with the primary aim of treating and reversing the disease.

Resistance Training

Your doctor may advise you or your loved one to incorporate resistance training into your workout routine. Resistance training can improve your strength and build muscle mass by making your muscles work against a force.

Some types of resistance training include weight lifting with dumbbells, using resistance bands, or even using your body weight.

Your doctor may recommend approximately 2-4 sessions of resistance training per week.

Apart from resistance training, aerobic exercises and other forms of exercise are beneficial for overall physical and mental health.

Yoga, taichi, daily walks, hiking, swimming and cycling are other forms of exercise that can be incorporated into your weekly routine to make exercising more enjoyable.

Nutrition

Malnutrition and inadequate nutrition intake can speed up the loss of muscle mass and muscle strength.

Therefore, your doctor may ask you questions to identify the causes of malnutrition.

Malnutrition can be due to

Physiological changes to smell and taste as one grows older
Poor dentition
Chewing and swallowing problems
Digestive issues like delayed gastric emptying and constipation
Psychological issues like depression and delirium

An adequate amount of calories and protein is essential in preventing and/or treating sarcopenia.

Every individual aged 50 and above requires 1.2g of protein per kg in body weight daily.

For example, Mr Lee who weighs 70 kg requires 84g of protein a day.

Foods rich in protein include fish, eggs and lean meat like chicken.

Your doctor or dietitian may recommend some supplements to aid in the absorption of calcium which is essential in building strong bones and muscles.

Vitamin D helps to strengthen bones and muscles.

Whey protein helps to restore muscle mass.

Prevention is Better than Cure

Muscle loss is part and parcel of ageing, but sarcopenia is not. Take active steps to prevent sarcopenia today!

Here are some helpful tips:

Be Active

Adopt a physically active lifestyle. Pick up hobbies that keep you active. Not only will you reap physical benefits, but exercise also provides mental benefits. Include exercises like resistance training which build and maintain muscle mass.

A Healthy and Balanced Diet

Ensure your body is receiving adequate amounts of macronutrients and micronutrients.

Avoid highly processed foods and foods high in sugar and trans fat.

Scientists have found that a Mediterranean diet (filled with vegetables and fruits, whole grains, lean meat and healthy fats) aids in weight loss. It prevents heart attacks, stroke and type 2 diabetes mellitus.

Maintaining a healthy weight range is important too.

A Healthier You

Sarcopenia is treatable and reversible.

If you or your loved one has symptoms of sarcopenia, don’t be afraid to seek medical help and advice today.

Muscle Matters: Understanding, Treating and Preventing Sarcopenia