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Ethan Hoang

Ms. OBrien

English III

*Insert Due Date*

Frailty in the elderly, explained.

As people retire and become older, they become frail and weak due to the natural aging

process. Recent studies have shown that the elderly tend to lose considerable amounts of weight

developing the condition known as, sarcopenia. Sarcopenia is defined as the loss of muscle

mass which is common in retired adults. As time passes, less and less time is spent exercising

and rebuilding muscle when compared to teenagers and young adults. Often times, this condition

is combined with obesity as retired adults gain and never spend energy to burn calories. This

issue, combined with poor nutritional intake, can lead to neural damage, spinal cord injuries, and

painful lifestyles. Retired adults are suffering from muscular atrophy and should be

engaging in low stress exercises such as water aerobics, and altering nutrition intake to

prevent obesity and slow aging.

In an experiment conducted by M. Halil et al, sarcopenia and sarcopenic obesity are also

prevalent in retired adults at a retirement home in Turkey; proving that this issue is present not

only in the United States, but also across the globe. Sarcopenic obesity is more common now

than it ever was before and is essentially sarcopenia combined with common obesity. Or in other

words, low muscle mass and high fat content in the bodys composition. Sarcopenic obesity is

defined as the combination of low lean body mass and high fat mass, and is also associated with
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higher dependency and metabolic complications (Halil et al 690). This type of condition,

sarcopenic obesity, is starting to appear more often in the retired community. According to their

estimations, the prevalence of Sarcopenic Obesity was 23.6% in 1990, 32% in 2000 and 37.4%

in 2010 (Halil et al 694), showing gradual increases over the decades. Following that trend, by

the year 2020 Sarcopenic Obesity will affect over 40% of the retired population. Especially with

new technologies being developed yearly, it will become easier and easier for an adult to develop

this condition. These new developments are enablers that aid in the development in these

conditions. According to an experiment performed by the authors, the increasing percentage of

sarcopenigenic elderly is causing deterioration in muscle and musculoskeletal strength as well as

nerve damage. Eventually, if left unchecked, this nerve damage can lead to severe pain

throughout nervous system due to the amount of stress put on joints and the spinal cord.

Losing weight is not as simple as changing diet and exercising more. Each body uses

energy, creates, and loses fat in different ways. While studying the physiology of the human

body, studies conducted found that the energy consumption was higher in individuals with

physical disability than those without physical disability (Tsan-Hon et al 321). Meaning, it would

be easier for those with disabilities to spend energy while exercising and hopefully lead to a

healthier body than a normal person. However, since majority of individuals are in a resting

state, none of the energy built up is spent which further increases the bodys fat percentage. This

high rate of inactivity is one of the primary enablers of obesity and other disabilities. As stated

by the authors,

Apart from physical inactivity and muscle atrophy, other factors associated with weight

gain among people with physical disabilities are secondary conditions associated with the
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primary disability, (5-9) unhealthy lifestyle, (24) and disparity of medical utilization.(25)

People with physical disabilities often have more than one secondary condition.

This statement tells me that though obesity is primarily caused by inactivity and overeating, there

are other, secondary conditions that either cause or are an effect of obesity. In fact, at later stages

of obesity, problems such as pressure sores, diabetes, and even depression may arise. Thus arises

the need for a healthy, regular diet with minimal deviance. It can be tempting for depressed

individuals to binge eat or to overindulge on sweets, but cravings can and should be carefully

managed.

Another experiment performed by Mechling, Heinz and Morat, Tobias, tested the effects

of different exercises on retired adults over a two month period. The experiment consisted of

different groups performing strength training, another performing cardio-like exercise, and a

control group that did not perform exercise. After the experiment was complete, the results

yielded that even something as light as a 10 minute warm up on a cycling ergometer (1 watt/kg

body weight) can drastically improve the physical state of the body. The common misconception

that one needs to do full body core workouts using 100% to be healthy is not true. The retirees

showed increases is balance, strength, power, and movement from these light exercises. Though

the group that performed strength training did show higher performance, the results were

marginally better than the cardio group. That being said, the control group had not exercised and

thus found regular tasks difficult compared to those who did exercise.

Though improvements in muscle strength, muscle power, and balance, older adults could

maintain a spectrum of movements of everyday life e.g., rising from a chair, climbing
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stairs, and walking.- As a consequence of effective training programs, older adults could

avoid, retard, and reduce decreases in physical performance. (Mechling, Morat 105)

This result would make retirement life much more positive and comfortable to live in. Over long

periods of time, the body will naturally start to lose muscle mass due to disuse, which in turn

leads to a difficult lifestyle in retirement since retirees no longer have the energy or strength

needed to finish light tasks. These light exercises can prevent this issue and maybe even end it

altogether.

Like all things, there are exceptions to the claims made above. Further studies conducted

by Clark, Brian and Manini, Todd have shown that sarcopenia may not be to blame. Though

sarcopenia is a popular scape goat, the culprit very well may just be another condition called

dynapenia. Very similar to sarcopenia, dynapenia is a condition that affects the muscular groups

of individuals. However, the difference being that dynapenia is the loss of muscle force, rather

than muscle mass. In studies conducted by the authors, results yielded that strength training did

lead to a development in muscle mass, but a marginal improvement in overall muscle

performance. These findings indicate that loss of muscle strength is weakly associated with

sarcopenia if at all. The loss of muscle strength could be due to the reduced excitability in alpha

motor neurons due to aging. There was also some evidence that carotenoids and selenium, which

increase inflammation, were also present in volunteers during experiments. With these findings,

the authors conclude that dynapenia may not only be affected by inactivity and bed rest. There

may also be genetic factors caused by physiological and neurological issues out of anyones

control such as genetics.

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Dynapenia can be developed in one of two ways. Clark and Manini state that, the

contributors to dynapenia can be compartmentalized into two factos, i.e., 1) neurologic and 2)

skeletal muscle properties (Clark, Manini 496). The neurological reasoning comes with ageing

and development. In later stages of life, human motor neurons naturally start to degrade often

along with the rest of the neurological system and other bodily processes. This process of

degrading motor neurons will either weaken or entirely kill off neurons so to speak which can

lead to two major issues. The first being that the neuron does not fire off strong enough signals

and only a portion of a muscle group can be flexed, or the entire muscle group is useless. The

second scenario can also be diagnosed as Lou Gehrigs disease if the conditions worsen at an

alarmingly fast rate. This also leads to slowed improvements in motor skills and balance. The

second factor that contributes to dynapenia would be the skeletal muscle properties. The

musculoskeletal system is often directly affected by nutrition. After retirement, adults tend not to

worry about eating healthy and often consume over the daily required calories or they consume

too much of the wrong type of nutrient. With malnourished bone and muscle health, the body

cannot properly develop the correct muscle groups and instead focus on growing only muscles

used daily such as quadriceps to stand up, calves to walk, among many others. However, though

muscles are being developed, they do not include every other muscle group required to acquire a

comfortable body to move around in. They are simply developing the bare minimum in order to

get around and even that task is completed with difficulty at times.

Another idea proposed by Connie Wales and Christine Ritchie, claims that malnutrition

can lead to weight loss and sarcopenia. This idea is different because sarcopenia is thought to

have been primarily caused by lack of exercise. However, according to the authors, ageing can

lead to reduction or deterioration in homeostatic reserve over time. Homeostatic reserve is the
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bodys ability to fight off disease and/or changes in metabolism. The loss or deterioration of

homeostatic reserve can lead to frailty if left unchecked over long periods of time. Factors for

preventing the loss of homeostatic reserve are physical activity, nutritional status, and cognitive

and social stimulation. The idea of modifying these factors to foster the process of successful

aging has been discussed in detail, and continues to be the focus of research. (Factora 1)

Providing more food and energy does not always correct the issues of sarcopenia or dynapenia.

As mentioned above, alterations of physical activity, nutrition, social support, etc. are the main

factors in maintaining proper health and aging successfully as stated by Ronin Factora, MD.

The exercises mentioned before can be anything from strength training to water aerobics as long

as the body is continually using and circulating energy. It is also important to balance exercise

with a proper diet so that the body is only taking in what it needs. This can be difficult because

every human body is different and requires different levels of every nutrient. Similarly,

overeating due to depression or other conditions leads to an imbalance of nutrition, leading to

obesity. The development of obesity, poor mental health, and sometimes even disease

development can lead to accelerated development of sarcopenia or dynapenia in later stages of

life. In conclusion, Bales and Ritchie say that sarcopenia is heavily affected by malnutrition and

leads to weight loss. It can be retarded through proper nutrition intake and light exercises

combined.

Responses Age Hours spent Idle

<50 yrs. All Day
Female
51-60 yrs. 1-2 Hours
Male
61-70 yrs. 3-4 Hours
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Do you find small tasks Exercise

difficult? Not at all

Yes 0-1 Hours

No 2-3 Hours

Sometimes 4-5 Hours

Calories Consumed
0-1000
1001-2000
2001-3000

This primary source shows the results of a survey conducted online through a Google

forms document. Any genetic diseases such as Lou Gehrigs were intended to be left out to keep

the results as clear as possible and root out any factors that were uncontrollable. Out of the total

12 volunteers, 9 were female, and 3 were male. The goal of the questions asked, were to identify

any changes or signs of early sarcopenia or obesity in the community. Of the 12 responses, 7

volunteers were under the age of 50, 3 volunteers were between the ages of 51 and 60, and that

last two were between the ages 61 and 70. As you can tell, just under half of the volunteers were

at retiring age and the other half were approaching retirement age. The first question asked was,

How many hours of your day are spent idle? Adults become very busy with either work or

tending to their children and do not often find the time to exercise. However, the results stated

that 10 volunteers spend between 1-5 hours idle and only 2 volunteers spent 5+ hours idle during

the day. This shows an increased rate of activity overall and is a good indicator that these adults

are active at the very minimum of 10 hours a day which is ample time to burn calories through

minute tasks. The next important question that ties into the previous was to determine how many
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calories were consumed on average per day. The amount of calories consumed will affect how

much fat is gained when combined with hours and types of exercises completed. For example, if

somebody consumes over 4000 calories and only burns about 500, about 1500 calories are

converted to fat by the body. The survey results showed that 2 participants consume about 0-

1000 calories, 5 consume about 1001-2000 calories and the other 5 consume between 2001-3000

calories. This is a very healthy range because the average body requires a recommended 2000

calories in order to perform basic life support processes and the rest can be burned off through

tasks such as walking or lifting objects throughout the day. However, this calorie burning is

accelerated by the participants because 7 participants exercise between 0-5 hours, 3 exercise for

over 6 hours and only 2 participants do not exercise at all. As stated earlier, the amount of hours

spent exercising directly influences the amount of fat gained by the body and the type of exercise

does not matter as studied by Morat and Heinz. Lastly, we asked the participants if they found

small tasks such as lifting small objects or climbing stairs difficult. With ageing, joints and

muscles tend to degrade leading to an increase in frailty; which in turn can cause discomfort and

potential nerve damage in later stages of life. As discovered by the survey, 10 participants did

not find small tasks difficult, 1 person did, and 1 person occasionally found those tasks difficult.

Retired adults tend to suffer from sarcopenia, frailty, and other conditions mainly due to

inactivity. They should be exercising to keep their muscles from degrading and prevent obesity

and uncomfortable retirements. However, as we discovered, exercising does not always prevent

frailty from being developed or stopped all together. The only surefire way to ensure that

retirement will be comfortable is to start early and to continue testing the bodys limits

throughout all stages of life and to maintain healthy lifestyles in general. Though it is an

extremely long work in progress, I believe that the results will be well worth the wait.
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Works Cited

Bales, Connie W., and Christine S. Ritchie. "Sarcopenia, Weight Loss, and Nutritional Frailty in

the Elderly." Annual Review of Nutrition, vol. 22, 2002, pp. 309-23, ProQuest

Central,

http://ezproxy.cpcc.edu/login?url=https://search.proquest.com/docview/20414750

8?accountid=10008.

Clark, Brian C., and Todd M. Manini. "What is Dynapenia?" Nutrition, vol. 28, no. 5, 2012, pp.

495-503, ProQuest Central; ProQuest Environmental Science Collection,

http://ezproxy.cpcc.edu/login?url=https://search.proquest.com/docview/10369632

34?accountid=10008, doi:http://dx.doi.org/10.1016/j.nut.2011.12.002. +

Factora, Ronan. Aging and Preventive Health. Cleveland Clinic Med Ed, Cleveland Clinic

Center for Continuing Education, May 2013,

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www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/preventive-

medicine/aging-preventive-health/. Accessed 20 Sept. 2017.

Halil, M., et al. "Sarcopenia Assessment Project in the Nursing Homes in Turkey."European

Journal of Clinical Nutrition, vol. 68, no. 6, 2014, pp. 690-4, ProQuest Central,

http://ezproxy.cpcc.edu/login?url=https://search.proquest.com/docview/15319843

20?accountid=10008, doi:http://dx.doi.org/10.1038/ejcn.2014.15. +

Morat, Tobias, and Heinz Mechling. "Training in the Functional Movement Circle to Promote

Strength and Mobility-Related Activities in Older Adults: A Randomized

Controlled Trial." European Journal of Ageing, vol. 12, no. 2, 2015, pp. 105-118,

ProQuest Central,

http://ezproxy.cpcc.edu/login?url=https://search.proquest.com/docview/16764532

30?accountid=10008, doi:http://dx.doi.org/10.1007/s10433-014-0325-9.

Tsan-Hon Liou, F. Pi-Sunyer, and Blandine Laferrre. "Physical Disability and

Obesity." Nutrition Reviews, vol. 63, no. 10, 2005, pp. 321-31, Research Library,

http://ezproxy.cpcc.edu/login?url=https://search.proquest.com/docview/21233302

5?accountid=10008. +

Vincent, Heather K., et al. "Functional Impairment in Obesity: A Focus on Knee and Back

Pain." Pain Management, vol. 1, no. 5, 2011, pp. 427-439, ProQuest Central,

http://ezproxy.cpcc.edu/login?url=https://search.proquest.com/docview/88813969

8?accountid=10008, doi:http://dx.doi.org/10.2217/pmt.11.39.
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