Not being able to walk to the mailbox or push a shopping cart because of muscle weakness and breathlessness is a commonly reported problem in older patients. The complaint of breathlessness often leads them to the lung doctor’s office with concerns about lung dysfunction. Often overlooked is the role played by two factors which are generally not part of the initial assessment.
The two conditions that often define the cause of breathlessness in an older population are frailty (an actual condition that can be measured) and something called sarcopenia which is a progressive and generalized loss of skeletal muscle mass.
Frailty is a clinical syndrome characterized by a decrease in physiologic reserve with the presence of three or more criteria which include unintentional weight loss, weakness, exhaustion, slow walking speed and low physical activity. Sarcopenia, on the other hand,
is based on the presence of low quantity or quality of muscle mass and when coupled with low muscle strength and low physical performance it is considered severe.
The presence of frailty and sarcopenia do not occur alone but are usually associated with chronic, long-standing diseases such as heart disease or lung disease. Frailty and sarcopenia reduce the quality of life and are difficulty to manage because they are really part of the aging process. The loss of muscle mass and weakness, obviously, plays into the problems associated with frailty. Putting frailty and sarcopenia into the general assessment of an older patient may better help us address the needs of an aging population.
