Format

Send to

Choose Destination
JPEN J Parenter Enteral Nutr. 2015 Mar;39(3):273-81. doi: 10.1177/0148607114567710. Epub 2015 Jan 15.

Sarcopenia and critical illness: a deadly combination in the elderly.

Author information

1
Department of Surgery, Division of Acute Care Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey joseph.hanna@rutgers.edu.

Abstract

Sarcopenia is the age-associated loss of lean skeletal muscle mass. It is the result of multiple physiologic derangements, ultimately resulting in an insidious functional decline. Frailty, the clinical manifestation of sarcopenia and physical infirmity, is associated with significant morbidity and mortality in the elderly population. The underlying pathology results in a disruption of the individual's ability to tolerate internal and external stressors such as injury or illness. This infirmity results in a markedly increased risk of falls and subsequent morbidity and mortality from the resulting traumatic injury, as well as an inability to recover from medical insults, resulting in critical illness. The increasing prevalence of sarcopenia and critical illness in the elderly has resulted in a deadly intersection of disease processes. The lethality of this combination appears to be the result of altered muscle metabolism, decreased mitochondrial energetics needed to survive critical illness, and a chronically activated catabolic state likely mediated by tumor necrosis factor-α. Furthermore, these underlying derangements are independently associated with an increased incidence of critical illness, resulting in a progressive downward spiral. Considerable evidence has been gathered supporting the role of aggressive nutrition support and physical therapy in improving outcomes. Critical care practitioners must consider sarcopenia and the resulting frailty phenotype a comorbid condition so that the targeted interventions can be instituted and research efforts focused.

KEYWORDS:

aging; critical illness; elderly; exercise; frailty; inflammation; malnutrition; sarcopenia

PMID:
25591973
DOI:
10.1177/0148607114567710
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Wiley
Loading ...
Support Center