Reduced muscle power in elders following hospital admission
Risk factors for chronic diseases, acute infections and elective procedures increase as individuals age. As such, there is a relatively high rate of hospital admission for elders, and many elders have reduced functional capacity, ADL limitations and decreased mobility upon discharge. Many studies have been conducted, that quantify a loss of muscle mass and power following prolonged bed rest, and it has also observed that individuals in nursing homes and other environments where mobility is generally reduced, have lower muscle mass and power than age-matched controls. To date, no specific study has assessed the effects on muscle mass and power on the often medically diverse hospital population of elders.
A systematic review and meta-analysis published analysed data from over 1300 individuals, all aged above 65, admitted for an average stay of 14 days to assess the admissions effect on muscle mass and power. Muscle mass measurements were obtained via bioelectric impedance analysis, and muscle power was tested using hand grip power as a marker. 2 sub-groups, acute admission and elective admission, were distinguished within the analysis to make the data more population specific. Surprisingly, the results of the meta-analysis show no reduction in muscle power, and in some cases, improved muscle power in the acute admission group of patients. However, there was a statistically significant drop in muscle mass in the acute group. There was also a significant reduction in both muscle mass and power in the elective admission group which was far more severe than the acute group.
These data show that elders admitted to hospital whether acutely or electively will lose muscle mass and may also lose muscle power. The authors note that, while their data shows no loss of muscle power during an admission in acutely ill patients, this may be related to the improvement in medical condition on discharge and reflect increased muscle power resulting from this.
At time of writing, this is the only meta-analytical study we are aware of which quantifies loss of muscle mass and power in elders during hospital admission, specifically in elective admission. Although further study is required, encompassing larger and higher quality trials, this study highlights the importance of physiotherapy assessment and appropriate management during hospital stays to minimise or prevent a loss of muscle mass and power. Also, further studies following on from this may potentially highlight the need for ‘prehab’ before elective surgery where possible to optimise muscle mass and power in anticipation of a hospital stay.
> From: Van Ancum et al., Exp Geront 92 (2017) 34-41. All rights reserved to Elsevier Inc. Click here for the online summary.