Healthy muscles is a critical enabler to ensure that the elderly can continue to retain their mobility, strength, energy levels and independence.

In a joint study by Changi General Hospital (CGH) and SingHealth Polyclinics (SHP), both members of the SingHealth group, with healthcare company Abbott, 20% of Singaporeans above 65 suffer from sarcopenia – also known as the loss of muscle mass and strength.

Muscle mass is an important indicator of health in the elderly as low muscle mass is associated with adverse health outcomes and slower recovery in older people.

According to the study, which consisted of 400 elderly over 65 years of age:

• Prevalence of low muscle mass was higher in females (24.9%) than in males (15.5%)
  
  
• Every one-year increase in age over the age of 65 was associated with 13% higher odds of having low muscle mass. On average, adults lose up to 8% of their muscle mass every 10 years starting from age 40. That rate might be doubled when one hits 70 years of age.
  
  
• Even adults with normal nutritional status were at risk for having lower muscle mass
  
  
• 52% of participants had vitamin D insufficiency

“Most studies suggest that muscle mass loss is limited to those who are malnourished. However, the findings of our study show the prevalence of low muscle mass in normally nourished elderly individuals is significant as well,” said Clinical Associate Professor Samuel Chew, Senior Consultant from the Department of Geriatric Medicine at Changi General Hospital (CGH). 

"However, the findings of our study show that the prevalence of low muscle mass in normally nourished seniors is significant as well," said Adj Asst Prof Chew, principal investigator of the study. Therefore, seniors do need to be mindful of their own muscle mass status in order to maintain muscle health.

1. Ageing

2. A sedentary lifestyle

3. Poor nutrition

4. Medical conditions like heart disease

• Decrease in muscle size

• Weakness

• Loss of stamina

• Loss of endurance

From a pool of 400 participants, the researchers studied various factors like body composition, nutritional biomarkers and associated factors with low muscle mass in physically able seniors with a normal nutritional status.

To best determine your muscle health, do talk to your healthcare provider to perform simple tests such as the Malnutrition Universal Screening Tool (MUST) and the Bioelectrical Impedance Analysis (BIA).

Clinical Associate Professor Tan Ngiap Chuan, Senior Consultant and Family Physician as well as Director of Research at SingHealth Polyclinics (SHP) said, "Healthcare professionals should take note of these results and encourage patients to consider early screening of their muscle mass and adopt a lifestyle that incorporates physical activity and the right diet, including optimal levels of protein."

Food rich in protein helps to make new cells, maintains bone health and keeps muscles healthy. They include chicken breast, fish, tofu, beans, nuts and eggs. Because of the increased risks of sarcopenia (low muscle mass), especially those above the age of 65 require more dietary protein to help maintain their muscles.

Because of decreased appetite or possibly dental issues which might hinder them from chewing meat, some seniors take less protein than is needed, so they have to be especially mindful of that fact.

Other nutrients that support muscle health or the immune system include zinc and vitamins A, C, D and E.

Vitamin D, in particular, plays an important role in the normal functioning and strength of muscles. Good sources of Vitamin D include:

• Salmon

• Mackerel

• Tuna

• Sardine

• Shiitake mushrooms

• Egg yolk

Clin Assoc Prof Chew said, "Oral nutritional supplements can be helpful for those who are unable to meet these requirements through their usual diet, as they are nutrient-dense and easy to consume, so people can get important nutrients, regardless of their appetite."

With physical activity and proper nutrition, seniors can maintain muscle mass.

The key to avoid losing muscle mass is to include resistance or weight exercises and sufficient protein. This not only improves one's muscle health, but also contributes positively to bone health and nutritional status,” quips Clin Assoc Prof Chew.

Strong muscles, he added, are associated with the regulation of the immune system. Citing studies, Clin Assoc Prof Chew said that muscles produce and release compounds which play an important role in the proliferation, activation and distribution of some immune cells.

"While additional research is needed, there is data that suggests loss of muscle mass is associated with compromised immunity and infections," he said.

"Muscles are a major storage site for amino acids used by the body during a trauma or infection. Hence, low muscle mass, coupled with inadequate protein intake, may affect the body's response to an injury or infection." Given the evidence linking muscle to the immune system, maintaining or improving muscle health should be a priority, said Clin Assoc Prof Chew.

He advised seniors to do resistance exercises such as lifting light weights, one-leg stands, squats, heel raises and lunges.

Simple household chores such as cooking, carrying groceries or watering the garden can also maintain muscle strength.

Clin Assoc Prof Chew added, "I advocate sit-to-stand exercises on a daily basis for geriatric patients. It is important to make these exercises a habit. Support from the carer and family is essential for this to be successful."

There will be a second phase of the study that is being carried out, and it involves 811 seniors aged 65 and above who are at risk of malnutrition.

The second phase will focus on the impact of oral nutritional supplement intakes on health outcomes and physical ability. The results from this study are expected to be ready by October, so stay tuned for more updates!

Ref: K21

Related articles:

5 Easy Ways Seniors Can Stay Healthy

Best Foods for the Elderly

Best Exercises for Seniors

7 Common Ageing Problems Faced by Seniors

Must-Know Nutrition and Diet Tips for Seniors

Why Seniors Need to Be Vaccinated

How to Prevent Falls in the Elderly

Beware of Depression in Seniors