Cartledge, Thomas J., Tan, Qian Yue, Jones, Liam, Becque, Taeko, Ibrahim, Kinda and Lim, Stephen Eu Ruen (2025) The effects of acute hospitalisation on the characteristics of acute sarcopenia in older adults: a systematic review and meta-analysis. JCSM Communications, 9 (1), [e70024]. (doi:10.1002/rco2.70024).
Abstract
Background: acute sarcopenia in hospitalised older adults is associated with poor outcomes, such as functional decline, increased risk of falls and prolonged hospital stays. Despite this, its development among older inpatients remains poorly understood. We aimed to quantify the effects of acute hospitalisation on sarcopenia outcomes in older adults.
Methods: MEDLINE, EMBASE, CINAHL, and Web of Science were searched from inception until January 2025. Studies that included acutely admitted patients aged 65 years or older and reported changes in at least one measure of sarcopenia during hospitalisation were included. Barthel Index was also included. A random-effects meta-analysis was undertaken.
Results: fifty five eligible studies were included, with a participant mean age of 82.2 years (n = 14,919 participants). Our meta-analysis showed grip strength and chair-to-stand performance to significantly increase during hospitalisation (standard mean difference [SMD] = 0.06, 95% confidence interval [CI]: 0.00; 0.13, I2 = 3%, p = 0.05 and SMD = 0.23, 95% CI: 0.13; 0.33, I2 = 0%, p <0.01, respectively). No physical performance measure showed a significant change. Muscle mass showed no change when measured by bioelectrical impedance analysis (SMD = 0.01, 95% CI: -0.09; 0.08, I2 = 0%, p = 0.86). There were insufficient studies using MRI (n = 2) or DEXA (n = 1) to perform a meta-analysis. Individual studies showed a significant decrease in mid-thigh muscle area (cm2) by MRI (mean difference [MD] = -3.9, p <0.01) and a significant decrease in leg lean mass (kg) by DEXA (MD = -0.16, p <0.05). Barthel Index score significantly increased from admission to discharge (SMD = 0.26, 95% CI: 0.06; 0.46, I2 = 98.0%, p = 0.01) but significantly decreased from pre-admission to discharge (SMD = -0.66, 95% CI: -0.92; -0.39, I2 = 97.5%, p <0.001). Both age and hospital length of stay had no effect on grip strength (p = 0.615 and p = 0.096) or Barthel Index (p = 0.835 and p = 0.279).
Conclusions: this review has shown that grip strength improves during hospitalisation and decreases in muscle mass are observed when measured using MRI or DEXA. Muscle strength and physical performance assessed on admission are poor indicators of baseline status, as they are often adversely affected during acute illness, making them unrepresentative of true baseline capacity. The lack of improvement in physical performance outcomes is an important finding as it represents failure to return to pre-hospital baseline abilities.
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