Basis for Sarcopenia Screening With the SARC-CalF in Nursing Homes

doi:10.1016/j.jamda.2017.07.011

Journal of the American Medical Directors Association

Volume 18, Issue 11, 1 November 2017, Pages 991.e5-991.e10

https://doi.org/10.1016/j.jamda.2017.07.011 Get rights and content

Abstract

Background

Sarcopenia is a major health problem of the older population. The European Working Group on Sarcopenia in Older People (EWGSOP) developed diagnostic criteria for diagnosis of sarcopenia that require assessing muscle mass and strength or physical performance. Recently, however, a rapid screening method SARC-CalF was developed.

Objective

The aim of the present study was to validate the SARC-CalF test using EWGSOP sarcopenia diagnostic criteria in a sample of nursing home residents.

Methods

Cross-sectional study. A sample of 80 nursing home residents [30% of men; mean age 84.3 (7.9) years]. Sarcopenia was determined as proposed by the EWGSOP diagnostic criteria, whereby muscle mass was measured by bioelectrical impedance, muscle strength by handgrip strength, and physical performance by usual gait speed and a Short Physical Performance Battery score. Sarcopenia was also assessed by the SARC-CalF screening test.

Results

A total of 38.7% of sarcopenia was evaluated using EWGSOP diagnostic criteria and 36.2% using the SARC-CalF test. The SARC-CalF demonstrated a sensitivity level of 77.4% and specificity of 89.8%. The area under the receiver operating characteristic curves of SARC-CalF test was 0.84 (95% confidence interval 0.74, 0.94).

Conclusions

SARC-CalF could be a useful screening test for sarcopenia in nursing home residents. The incorporation of the test as a basis for sarcopenia screening will provide additional value to current nursing home preventive measures.

Section snippets

Participants

From January to February 2016, we invited 279 older adults (≥65 years of age) living in 2 nursing homes in the south of Slovenia to participate in our study. Written consent was obtained from 80 residents; we had to exclude 154 participants, some with immobility (n = 97), implantable cardiac peacemaker (n = 7), with terminal illness (n = 18), or with severe dementia (n = 32). The selection resulted in a final sample of 80 participants [30% of men; ages ranged from 65 to 97 years; average age

Results

The basic characteristics with calculated proportions of participants with sarcopenia, are presented in Table 1. In the 80 participants included in the study, the sex ratio was n = 56 (70%) women and n = 24 (30%) men. The participants in our sample were aged 84.3 (7.9) years. The classification of sarcopenia based on the EWGSOP-suggested algorithm showed a higher proportion of pooled women with sarcopenia (41.1%) than men (33.3%). The classification of sarcopenia using SARC-CalF in men and

Discussion

We investigated the validity of the SARC-CalF as a diagnostic test for screening sarcopenia, as defined by the EWGSOP diagnostic criteria.

This study shows that sarcopenia assessed, according to EWGSOP criteria, amounted to 38.7% of our sample of nursing home residents. The prevalence of sarcopenia according to the SARC-CalF test was 36.2%.

The SARC-CalF test in our sample demonstrates good diagnostic capacity, with a sensitivity of 77.4% and a specificity of 89.8%. In ROC analysis, the AUC for

Conclusions

Sarcopenia is an important health problem affecting the older population. An increasing population with sarcopenia will present challenges to ensuring adequate preventive systems in healthcare, which will need to include both the early detection of the disease as well as appropriate treatment.

SARC-CalF could be a useful screening test for sarcopenia in nursing home residents. Further validation of the SARC-CalF test for this sector of the population will provide additional value to current

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Cited by (33)

Comparison of four screening methods for sarcopenia among community-dwelling older adults: A diagnostic accuracy study
2023, Geriatric Nursing
Citation Excerpt :
Similar results were obtained in the past when AWGS was used as the standard for diagnosing sarcopenia. For example, Yang et al.41 found a sensitivity of 60.7% and a specificity of 94.7%; Urzi et al.42 found a sensitivity of 77.4% and a specificity of 89.8%. However, as with SARC-F, sensitivity in men was lower than in women (69.9% vs. 83.6%), similar to the results from Yang et al.41 In contrast to our findings, Ishimoto et al.43 suggested that reducing the SARC-Calf cut-off score from 11 to 7 could improve sensitivity (76.3% vs. 94.7%) and specificity (100% vs. 92.3%).
This study aimed to compare the diagnostic values of SARC-F (strength, assistance with walking, rising from a chair, climbing stairs, and falls), SARC-Calf (SARC-F combined with calf circumference), CC (calf circumference), and the Yubi-wakka (finger-ring) test for screening for sarcopenia in community-dwelling older adults. The Asian Working Group for Sarcopenia (AWGS) 2019 criteria were used as a standard reference. A total of 209 participants were enrolled, and 40.7% were identified as sarcopenia. The sensitivity, specificity, and AUC were respectively 54.1%, 70.2%, and 0.687 for SARC-F; 76.5%, 73.4% and 0.832 for SARC-calf, 86.7%, 82.4%, and 0.906 for CC in men, and 85.5%, 63.3%, and 0.877 for CC in women. Relative to the “bigger,” a significant association between sarcopenia and the Yubi-wakka test (“just fits” OR: 4.1, 95% CI: 1.57–10.98; “small” OR: 27.5, 95% CI: 10.14–74.55) was observed. The overall accuracy of CC was better than SARC-Calf for sarcopenia screening.
Reliability and Concurrent Validity of the SARC-F and Its Modified Versions: A Systematic Review and Meta-Analysis
2021, Journal of the American Medical Directors Association
Sarcopenia, being prevalent in up to 40% of older adults, is associated with adverse health outcomes. The international sarcopenia guidelines recommend screening for sarcopenia using the SARC-F. A previous meta-analysis (2017) reported poor validity of the SARC-F among community-dwelling older adults. Since then, modified SARC-F versions were developed and new sarcopenia definitions were published, including the SARC-F for case-finding. This systematic review and meta-analysis aimed to assess the reliability of the SARC-F and its concurrent validity to identify sarcopenia.
Systematic review and meta-analyses.
Adults (all ages) from any study population.
A systematic search was conducted in MEDLINE, EMBASE, Cochrane, and CINAHL (January 1, 2013, to April 6, 2020). Articles were included if they reported on the reliability and/or concurrent validity of the (modified) SARC-F. No restrictions were applied for sex, age, study population, or sarcopenia definition. Reliability measures included inter-rater reliability, test-retest reliability, and internal consistency. Meta-analyses were performed for concurrent validity.
The 29 included articles included 21,855 individuals (mean age of 63.3±14.6 years, 61.3% females) among community-dwelling (n = 16), geriatric inpatient (n = 5), geriatric outpatient (n = 2), nursing home (n = 2), and long-term care (n = 1) populations. The SARC-F had good (2/4 articles) to excellent (2/4 articles) inter-rater reliability, moderate (1/6 articles) to good (5/6 articles) test-retest reliability, and low (4/8 articles) to high (4/8 articles) internal consistency. The SARC-F had low to moderate sensitivity (28.9%-55.3%) and moderate to high specificity (68.9%-88.9%) according to the European Working Group on Sarcopenia in Older People (EWGSOP; n = 13), revised EWGSOP definition (EWGSOP2; n = 6), Asian Working Group for Sarcopenia (AWGS; n = 13), Foundation for the National Institutes of Health (FNIH; n = 8), International Working Group on Sarcopenia (IWGS; n = 9), and Society on Sarcopenia, Cachexia and Wasting Disorders (n = 2). The SARC-CalF had low to moderate sensitivity (45.9%-57.2%) and high specificity (87.7%-91.3%) according to the EWGSOP (n = 5), AWGS (n = 4), FNIH (n = 3), and IWGS (n = 3).
Despite the good reliability of the SARC-F, its low to moderate sensitivity and moderate to high specificity make it nonoptimal to use for sarcopenia screening. It is recommended to apply the diagnostic criteria for sarcopenia without screening.
Screening Accuracy of SARC-F Combined With Calf Circumference for Sarcopenia in Older Adults: A Diagnostic Meta-Analysis
2020, Journal of the American Medical Directors Association
Effects of Elastic Resistance Training on Functional Performance and Myokines in Older Women—A Randomized Controlled Trial
2019, Journal of the American Medical Directors Association
To investigate the short- and long-term effects of elastic resistance training (ERT) on physical performance, inflammatory markers, and myokines in older women living in a nursing home.
A randomized controlled trial, with 12 weeks of ERT intervention.
Nursing home. Twenty female nursing home residents (mean age = 84 ± 8 years) were randomized into 2 groups: the training group (n = 11), and the control group (n = 9).
Muscle mass was estimated with bioelectrical impedance, and the functional test Short Physical Performance Battery (SPPB) was performed, whereas handgrip strength and plasma concentration of myokines and inflammatory markers were measured before and after the intervention period. Additional blood samples were also taken after the fourth ERT session. A mixed model (group × time) analysis of variance was applied to determine the effect on primary and secondary outcomes.
After 1 exercise session, the training group showed a significant increase in brain-derived neurotrophic factor (BDNF) (P = .04) and a decrease in interleukin (IL)-8 (P = .01) plasma concentration. After 12 weeks of intervention, the results showed a significant group × time effects for the SPPB total score (P < .01), as well as gait speed (P = .04), chair rise (P < .01), and BDNF concentration (P = .02). However, there were no significant interactions for grip strength, IL-15, IL-8, resistin, glucose, and C-reactive protein (P ≥ .06).
The present study emphasizes the clinical impact of moderate-intensity ERT on mobility and functional performance in older women. The results indicate that an increase in exercise-induced peripheral BDNF may have a protective role in the preservation of muscular function in older women. Incorporating ERT into nursing homes could be a feasible preventive strategy to counteract functional deterioration.
Prevalence and Associated Factors of Sarcopenia in Nursing Home Residents: A Systematic Review and Meta-analysis
2019, Journal of the American Medical Directors Association
Citation Excerpt :
However, the pooled prevalence of SMI-defined sarcopenia may be influenced by Rodondi's study38 (Supplementary Figure 3). The pooled prevalences of EWGSOP-defined sarcopenia in women and men were 46% (I2 = 96%, 95% CI 32%-59%, 8 studies,5,15–18,20,21,23 1332 cases) and 43% (I2 = 89%, 95% CI 31%-54%, 8 studies,5,15–18,20,21,23 739 cases), respectively (P = .190, Figure 3). Of the 12 included studies that reported EWGSOP-defined sarcopenia, 11 studies measured the muscle mass with BIA devices, whereas the other study applied calf circumference to estimate the muscle mass.
To review the prevalence and associated factors of sarcopenia in nursing homes.
A systematic review and meta-analysis of published studies in MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials.
Nursing homes.
Older adults aged ≥60 years.
Sarcopenia was defined according to various validated diagnostic criteria, such as the European Working Group on Sarcopenia in Older People (EWGSOP) criteria and skeletal muscle index (SMI). We performed meta-analyses with random effects models to calculate the pooled prevalence of sarcopenia. The risk of bias of the included studies was evaluated using a 10-item tool explicitly designed for prevalence studies.
We included 16 studies with a total of 3585 participants from 129 nursing homes. The included studies were of low to moderate risk of bias. The pooled prevalences of EWGSOP-defined sarcopenia and SMI-defined sarcopenia were 41% [95% confidence interval (CI) 32%-51%, 12 studies, 2685 cases] and 59% (95% CI 24%-93%, 3 studies, 643 cases), respectively. The pooled prevalences of EWGSOP-defined sarcopenia in women and men were 46% (8 studies, 1332 cases) and 43% (8 studies, 739 cases), respectively. The pooled data showed that malnutrition was an independent associated factor of EWGSOP-defined sarcopenia (odds ratio [OR] 1.74, 95% CI 1.36-2.24; 3 studies, 718 cases), but malnutrition risk (OR 1.01, 95% CI 0.53-1.94; 2 studies, 379 cases) and female gender were not (OR 1.14, 95% CI 0.11-11.66; 3 studies, 827 cases). The association between age and body mass index with sarcopenia was inconsistent across studies. Limited evidence indicated that smoking might be related to sarcopenia.
Sarcopenia is highly prevalent in older nursing home residents. Malnutrition may be an associated factor of sarcopenia. More prospective studies are needed to clarify the association between age, gender, malnutrition, and smoking with sarcopenia.
Comparing Mini Sarcopenia Risk Assessment With SARC-F for Screening Sarcopenia in Community-Dwelling Older Adults
2019, Journal of the American Medical Directors Association
Citation Excerpt :
In their study, the sensitivity of the SARC-F ranged from 18.2% to 33.3%, and the specificity ranged from 78.7% to 81.1% when using the EWGSOP and the Foundation for the National Institutes of Health (FNIH) Sarcopenia Project criteria.25 Furthermore, Barbosa-Silva et al found that combining circumference (CC) with SARC-F (named SARC-CalF) could significantly improve the sensitivity of SARC-F.16 Another study has validated the diagnostic value of SARC-CalF for screening sarcopenia in nursing home residents.26 The SARC-CalF showed a sensitivity of 77.4% and a specificity of 89.8% in their study population.26
The Mini Sarcopenia Risk Assessment (MSRA), a new sarcopenia screening tool, has 2 versions: MSRA-7 (full version, 7 items) and MSRA-5 (short version, 5 items). We aimed to compare the diagnostic values of MSRA-7 and MSRA-5 to SARC-F for screening sarcopenia.
A diagnostic accuracy study.
A community in Chengdu, China.
Older adults.
Muscle mass, strength, and physical performance were tested using a bioimpedance analysis (BIA) device, handgrip strength, and walking speed, respectively. Using the Asian Working Group for Sarcopenia (AWGS) criteria as the gold standard, the sensitivity/specificity analyses of the 3 scales were assessed. Receiver operating characteristic (ROC) curves and area under the ROC curves (AUC) were used to compare the overall diagnostic accuracy of the 3 scales.
We recruited 384 participants. Against the AWGS criteria, SARC-F had a sensitivity of 29.5% and a specificity of 98.1%, and the MSRA-7 had a sensitivity of 86.9% and a specificity of 39.6%, whereas the MSRA-5 had a sensitivity of 90.2% and a specificity of 70.6%. The AUCs of SARC-F, MSRA-7, and MSRA-5 were 0.89 [95% confidence interval (CI), 0.86-0.92], 0.70 (95% CI, 0.65-0.74), and 0.85 (95% CI, 0.81-0.89), respectively. The differences in AUCs between SARC-F and MSRA-7 and in those between MSRA-7 and MSRA-5 were statistically significant (P <.001), but the difference between SARC-F and MSRA-5 was not statistically significant (P = .130).
MSRA-5 may serve as a novel screening tool for sarcopenia in Chinese community-dwelling older adults. SARC-F, a class screening tool, is also suitable for this population. MSRA-5 and SARC-F demonstrated a similar diagnostic accuracy in our study population. MSRA-5 has better sensitivity, whereas SARC-F has better specificity. However, the diagnostic value of MSRA needs to be further validated in different populations.

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: This work was supported by Norwegian Financial Mechanism 2009–2014 Program. (No. 4300-472/2014). The support of StarBios 2 “Structural Transformation to Attain Responsible BioSciences” is also acknowledged.

: The authors declare no conflicts of interest.

: This study was approved by the Republic of Slovenia National Medical Ethics Committee (No. 0120-313/2015-6 KME 105/06/16)

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JAMDA OnlineOriginal StudyBasis for Sarcopenia Screening With the SARC-CalF in Nursing Homes

Abstract

Background

Objective

Methods

Results

Conclusions

Section snippets

Participants

Results

Discussion

Conclusions

Maturitas

J Am Med Dir Assoc

J Nutr Health Aging

J Am Med Dir Assoc

J Am Med Dir Assoc

J Am Med Dir Assoc

Skeletal muscle function deficit: A new terminology to embrace the evolving concepts of sarcopenia and age-related muscle dysfunction

J Gerontol A Biol Sci Med Sci

Does admission grip strength predict length of stay in hospitalised older patients?

Age Ageing

JAMDA Online
Original Study
Basis for Sarcopenia Screening With the SARC-CalF in Nursing Homes