As people age, their muscle mass inevitably starts to decline.
Everyone starts to lose muscle beginning at age 30, a natural process known as sarcopenia. The lean muscle mass in firm biceps and abs gradually becomes soft layers of fat. For some older people the muscle loss can be severe and debilitating, causing functional decline and loss of independence.
Severe muscle decline, doctors are finding, is one of the root causes of a host of other health problems that plague the elderly, including physical frailty, hip fractures and other injuries.
Health care providers believe the condition can make people so weak it puts them at more risk of falling and injuring themselves. People with severe sarcopenia may have trouble walking and end up in wheelchairs or using canes. It also can be more difficult to perform some surgeries on people with the condition.
Yet not all doctors, particularly those who don’t specialize in gerontology, or aging, are screening for or diagnosing severe sarcopenia. There is no drug approved by the U.S. Food and Drug Administration to treat it, though studies are underway to develop one.
“The condition in general is underappreciated and there are probably people not being diagnosed,” said Dr. Jeremy D. Walston, a professor of geriatric medicine and a practicing physician at the Johns Hopkins Asthma and Allergy Center.
A group of aging experts and medical organizations hopes to change that. They have formed The Aging in Motion Coalition and are trying to bring more awareness of the disease and are pushing for better treatments, which now focus mostly on diet and exercise.
Exercise can slow or even reverse the effects of sarcopenia and a diet with more protein and anti-inflammatory foods and rich in amino acids also helps.
An estimated 5 percent to 10 percent of people older than age 65 have severe sarcopenia. Around 25 to 35 percent of those older than 75 live with the condition. Many others with severe sarcopenia are probably being misdiagnosed with other conditions, such as osteoporosis, coalition members believe.
“It is really a condition that can rob adults of their independence and mobility,” said Ryne Carney, public policy associate for the Alliance for Aging Research in Washington, which started the coalition. “We are trying to push for greater levels of treatment for sarcopenia and overcome some of the impediments for getting treatment.”
The risk of disability is 1.5 to 4.6 times higher in older persons with severe sarcopenia than in older persons with normal muscle mass, researchers have found.
As baby boomers continue to age, the numbers of people with severe sarcopenia will likely grow. By 2030 the number of Americans over age 65 will have more than doubled in a 30-year period, according to the Administration on Aging, an agency of the U.S. Department of Health and Human Services.
The coalition has made slow and steady strides in gaining official recognition of severe sarcopenia. Last last year, the Centers for Disease Control and Prevention assigned sarcopenia a medical code and formally classified it as a disease. The designation will allow doctors to bill insurers for treating it. The next step is to get insurers to include treatment for it in their coverage plans.
“It still doesn’t guarantee that Medicare will pay for it yet, but it is a step in the right direction,” said Dr. Jack Guralnik, a professor at the University of Maryland School of Medicine who specializes in sarcopenia and is chair of the coalition.
The condition is also on the radar of the Food and Drug Administration. It was one of 24 conditions the agency has held hearings about since 2013 to better understand how it affects people. The hearings were part of an initiative to get patient feedback that the agency can use during the drug development process.
“If the drug companies have a pharmaceutical they are hoping to get approved, the FDA will understand not just what the drug is, but how it could affect people,” Guralnik said.
Walston and others said that part of the obstacle in getting severe sarcopenia recognized is that there is no clear definition of the disease, making it difficult to diagnose.
The National Institute on Aging, using research on the disease, recently recommended criteria for standardizing the diagnosis of severe sarcopenia, which includes walking less than 31.5 inches per second and having a weak grip. Those standards have not been widely adopted.
“These criteria, the first based on evidence from large population studies of older people, offer a way to better define and measure this problem so that we can eventually assess the effectiveness of drugs and other interventions for this disabling condition,” wrote Dr. Richard J. Hodes, the aging institute’s director, when the recommended standards were first announced.
The Aging in Motion Coalition said that one of its goals is to get consensus among clinicians and regulators on measures and outcomes. The group is working to mobilize doctors and insurers to support criteria for diagnosing the disease.
Carney said there are some patients that diet and exercise alone will not help.
”We want to get a greater interest from industry to develop pharmaceuticals or other treatments to improve function for those where diet and exercise is not enough,” he said.
Research is needed to figure out the biological mechanisms that cause sarcopenia, Walston said.
“What is it about getting older that causes the muscle cells to decline?” he asked.
Better treatments for sarcopenia will not only help improve the lives of some senior citizens, they could also reduce health care costs by allowing people to remain independent longer, Guralnik and others said.
A study in the Journal of the American Geriatrics Society estimated the direct healthcare costs attributable to sarcopenia in the United States in 2000 were $18.5 billion — $10.8 billion for men and $7.7 billion for women. A study published in 2016 in the European Journal of Clinical Nutrition found sarcopenia increased hospitalization costs by 58.5 percent for patients younger than age 65 and 34 percent for patients older than age 65.
Like many people her age, Dory Storms, 83, has not been officially diagnosed with sarcopenia, but she said she has experienced muscle loss. Sometimes, when she gets the flu and is inactive, her “muscles go to pieces,” Storms said. Her massage therapist has told her at times that she seems to have lost muscle mass.
Storms takes Tai Chi and gets physical therapy to help rebuild her muscle and improve her balance. She said elderly people need to be better educated about the effects of muscle decline because there are steps they can take to address it.
“Becoming older is like living in a different country,” she said. “You don’t know what is going to happen and you’re not prepared for it.”