Ümit KAN, Esra ATEŞ BULUT, Pınar SOYSAL, Ahmet Turan IŞIK

GERİATRİK OLGULARDA SARKOPENİNİN DENGE VE YÜRÜME FONKSİYONLARI ÜZERİNE ETKİSİ

Giriş: Yaşlanma ile ilişkili kas kütlesi kaybı sarkopeni, yaşlanma ile ilişkili kas gücü kaybı ise dinapeni olarak tanımlanmaktadır. Bu çalışmada, sarkopeni ve dinapeninin geriatrik olgularda denge ve yürüme fonksiyonları üzerine etkisi araştırılmak istenmiştir. Gereç ve Yöntem: Dokuz Eylül Üniversitesi Hastanesi geriatri kliniğine başvuran ve ayrıntılı geriatrik değerlendirme uygulanan 250 geriatrik olgu çalışmaya dahil edildi. Hastaların sosyodemografik özellikleri, kronik hastalık özgeçmişleri, kullandığı ilaçlar ve ilaç sayısı ile laboratuvar bulguları değerlendirildi. Hastalar presarkopenik, sarkopenik, dinapenik ve kas kütlesi ile gücü normal olan robust grubu olmak üzere 4 gruba ayrıldı. Denge ve yürüme fonksiyon testleri açısından gruplar arasında bir farklılık olup olmadığı irdelendi. Bulgular: Çalışmaya katılan 250 kişinin 65’inde (%26,0) sarkopeni, 83’ünde (%33,2) dinapeni saptandı. Sarkopeni ve dinapenisi olan olguların daha yaşlı olduğu ve Charlson Komorbidite İndeksi’nin daha yüksek olduğu görüldü (p0,05). Sarkopenisi ve dinapenisi olan olguların, Tinetti denge ve yürüme testinden daha düşük skor aldıkları, 4 metre yürüme hızlarının daha yavaş olduğu ve kalk-yürü testini daha uzun sürede tamamladıkları görüldü (p0,05). Sonuç: Bu çalışmada sarkopeni ve dinapeni ile denge-yürüme fonksiyonlarının ilişkisi değerlendirilmiş ve sarkopeni ile dinapeninin bu fonksiyonlarda bozulmayla ilişkili olduğu gösterilmiştir. Dinapeni ve sarkopeni gruplarının benzer oluşu, dinapeninin de en az sarkopeni kadar denge-yürüme fonksiyonları ve günlük yaşam aktiviteleri için belirleyici olduğunu ortaya koymaktadır. Bu nedenle sağlık merkezlerine başvuran geriatrik olgularda, kas gücünün rutin olarak değerlendirilmesi uygun olacaktır.

THE EFFECT OF SARCOPENIA ON BALANCE AND GAIT FUNCTIONS IN OLDER ADULTS

Introduction: Sarcopenia is defined as loss of muscle mass associated with aging. On the other hand, dynapenia means loss of muscle power associated with aging. In this study, it is aimed to investigate the effect of sarcopenia and dynapenia on balance and gait functions in geriatric cases. İzmir Eğitim ve Araştırma Hastanesi Tıp Dergisi (Medical Journal of İzmir Hospital) 24 (1): 1-8, 2020 2 İzmir Eğitim ve Araştırma Hastanesi Tıp Dergisi (Medical Journal of İzmir Hospital) Material and Method: A total of 250 geriatric cases who applied to geriatric clinic and underwent comprehensive geriatric evaluation were included in the prospective study. Patients’ sociodemographical characteristics, chronic disease backgrounds, medications used and total number of medications were recorded together with laboratory findings. The patients were divided into 4 groups: presarcopenic, sarcopenic, dynapenic and robust group. Robust group had normal muscle mass and power. In terms of balance and gait function tests, it was examined whether there was a difference between the groups. Results: Of the 250 participants, 65 (26.0%) had sarcopenia and 83 (33.2%) had dynapenia. Patients with sarcopenia and dynapenia were older and had a higher Charlson Comorbidity Index (p 0.05). It was observed that the subjects with sarcopenia and dynapenia had lower scores in Tinetti balance and gait test, slower walking speed and they completed the up and go test for a longer time(p 0.05). Conclusion:In this study, the relationship between sarcopeni, dynapenia and balance-gait functions was evaluated and it was shown that sarcopenia and dynapenia were associated with impairment in these functions. The similarity of the dynapenia and sarcopenia groups suggests that dynapenia is also a determinant of balancegait functions and activities of daily living as well as sarcopenia. Therefore, routine evaluation of muscle power is suggested in older adults.

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1. Mitchell WK, Williams J, Atherton P, Larvin M, Lund J, Narici M. Sarcopenia, dynapenia, and the impact of advancing age on human skeletal muscle size and strength; a quantitative review. Front Physiol 2012; 3: 260.
2. Morley JE, Baumgartner RN, Roubenoff R, Mayer J, Nair KS. Sarcopenia. J Lab Clin Med 2001; 137(4): 231-43.
3. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F et al.Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing 2010; 39(4): 412-23.
4. Dhillon RJ, Hasni S. Pathogenesis and Management of Sarcopenia. Clin Geriatr Med 2017; 33(1): 17-26.
5. Cesari M, Pahor M, Lauretani F, Zamboni V, Bandinelli S, Bernabei R et al.Skeletal muscle and mortality results from the InCHIANTI Study. J Gerontol A Biol Sci Med Sci 2009; 64(3): 377-84.
6. Newman AB, Kupelian V, Visser M, Simonsick EM, Goodpaster BH, Kritchevsky SB et al. Strength, but not muscle mass, is associated with mortality in the health, aging and body composition study cohort. J Gerontol A Biol Sci Med Sci 2006; 61(1): 72-7.
7. Delmonico MJ, Harris TB, Visser M, Park SW, Conroy MB, Velasquez-Mieyer P et al. Longitudinal study of muscle strength, quality, and adipose tissue infiltration. Am J Clin Nutr 2009; 90(6): 1579-85.
8. Clark BC, Manini TM. What is dynapenia? Nutrition 2012; 28(5): 495-503.
9. Clark BC, Manini TM. Functional consequences of sarcopenia and dynapenia in the elderly. Curr Opin Clin Nutr Metab Care 2010; 13(3): 271-6.
10. Unutmaz GD, Soysal P, Tuven B, Isik AT. Costs of medication in older patients: before and after comprehensive geriatric assessment. Clin Interv Aging 2018; 13: 607-13.
11. Tinetti ME. Performance-oriented assessment of mobility problems in elderly patients. J Am Geriatr Soc 1986; 34(2): 119- 26.
12. Podsiadlo D, Richardson S. The timed "Up & Go": A test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991; 39(2): 142-8.
13. Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969; 9(3): 179-86.
14. Janssen I, Heymsfield SB, Baumgartner RN, Ross R. Estimation of skeletal muscle mass by bioelectrical impedance analysis. J Appl Physiol 2000; 89(2): 465-71.
15. Santilli V, Bernetti A, Mangone M, Paoloni M. Clinical definition of sarcopenia. Clin Cases Miner Bone Metab 2014; 11(3): 177-80.
16. Alexandre Tda S, Duarte YA, Santos JL, Wong R, Lebrao ML. Sarcopenia according to the European Working Group on Sarcopenia in Older People (EWGSOP) versus dynapenia as a risk factor for mortality in the elderly. J Nutr Health Aging 2014; 18(8): 751-6.
17. Patel HP, Syddall HE, Jameson K, Robinson S, Denison H, Roberts HC et al. Prevalence of sarcopenia in communitydwelling older people in the UK using the European Working Group on Sarcopenia in Older People (EWGSOP) definition: findings from the Hertfordshire Cohort Study (HCS). Age Ageing 2013; 42(3): 378-84.
18. Ates Bulut E, Soysal P, Isik AT. Frequency and coincidence of geriatric syndromes according to age groups: single-center experience in Turkey between 2013 and 2017. Clin Interv Aging 2018; 13: 1899-905.
19. Ates Bulut E, Soysal P, Aydin AE, Dokuzlar O, Kocyigit SE, Isik AT. Vitamin B12 deficiency might be related to sarcopenia in older adults. Exp Gerontol 2017; 95: 136-40.
20. Cruz-Jentoft AJ, Landi F, Topinkova E, Michel JP. Understanding sarcopenia as a geriatric syndrome. Curr Opin Clin Nutr Metab Care 2010; 13(1): 1-7.
21. Manini TM, Clark BC. Dynapenia and aging: an update. J Gerontol A Biol Sci Med Sci 2012; 67(1): 28-40.
22. Stewart JM, Medow MS, Montgomery LD, McLeod K. Decreased skeletal muscle pump activity in patients with postural tachycardia syndrome and low peripheral blood flow. Am J Physiol Heart Circ Physiol 2004; 286(3): H1216-22.
23. Joseph AM, Adhihetty PJ, Buford TW, Wohlgemuth SE, Lees HA, Nguyen LM et al. The impact of aging on mitochondrial function and biogenesis pathways in skeletal muscle of sedentary high- and low-functioning elderly individuals. Aging Cell 2012; 11(5): 801-9.
24. Yu S, Umapathysivam K, Visvanathan R. Sarcopenia in older people. Int J Evid Based Healthc 2014; 12(4): 227-43.
25. Soysal P, Stubbs B, Lucato P, Luchini C, Solmi M, Peluso R et al. Inflammation and frailty in the elderly: A systematic review and meta-analysis. Ageing Res Rev 2016; 31: 1-8.
26. Hairi NN, Cumming RG, Naganathan V, Handelsman DJ, Le Couteur DG, Creasey H et al. Loss of muscle strength, mass (sarcopenia), and quality (specific force) and its relationship with functional limitation and physical disability: the Concord Health and Ageing in Men Project. J Am Geriatr Soc 2010; 58(11): 2055-62.
27. Menant JC, Weber F, Lo J, Sturnieks DL, Close JC, Sachdev PS et al. Strength measures are better than muscle mass measures in predicting health-related outcomes in older people: time to abandon the term sarcopenia? Osteoporos Int 2017; 28(1): 59-70.
28. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyere O, Cederholm T et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 2019; 48(4): 601.