Sarcopenia; a key driver of physical frailty

Miles Witham is a Clinical Reader in Ageing and Health, University of Dundee, and is Deputy Editor for Age and Ageing.

The BGS Autumn Meeting 2016 saw the launch of the newest BGS Special Interest Group – the Frailty and Sarcopenia Research SIG. The inaugural session, held in the main auditorium in Glasgow’s SECC was attended by several hundred delegates, and so far, over 100 members have signed up on-line to be part of the new SIG. So why do we need this SIG, and what do we hope it will achieve?

Frailty is of course core business for all geriatricians. There are already lots of initiatives underway to develop new services for people living with frailty, both in the community and in hospitals. But if we are to make progress in developing better ways of finding and treating frailty, two things are needed. Firstly, we need high-quality translational research that turns fundamental discoveries into improvements in health and wellbeing. Secondly, we need effective dissemination and knowledge transfer to ensure that research findings are shared across the wider geriatric medicine community, and with older people themselves, to enable rapid implementation into clinical practice.

On a related topic, it is now clear that sarcopenia (the age-related loss of muscle mass and function that affects so many of our patients) is a key driver of physical frailty. So finding ways to diagnose and treat sarcopenia is also crucial. The overlap between sarcopenia and frailty is such that it makes sense to have a single SIG to address both of these conditions.

We have set up the Frailty and Sarcopenia Research SIG with the following aims:

  • To promote research in sarcopenia and frailty with the aim of improving identification, understanding, prevention and treatment of these conditions
  • To disseminate best practice and improve care for patients with sarcopenia and frailty

So how are we going to achieve those aims? Are we, as one delegate in Glasgow wanted to know, going to simply do more research that isn’t useful to clinicians? The answer to this is no! It’s vital that we promote and facilitate research on sarcopenia and frailty, but that research needs to be informed by the needs of clinicians, and the results need to be of direct usefulness to clinicians. The SIG is an ideal platform for you all to shape the research agenda. By joining together in multicentre studies (whether surveys, audits, observational studies or trials), we will be well placed to deliver the evidence that our practice needs, but that we so often lack in geriatric medicine.

What do we have planned? In terms of knowledge dissemination, we are planning a session for the Autumn 2017 BGS conference, which we hope will be highly multidisciplinary in nature. We are working with physiotherapy colleagues on ways to standardise and disseminate resistance training for frailty and sarcopenia. Resistance training is proven to work for patients with sarcopenia, yet we don’t apply this valuable intervention at scale – a clear gap that the SIG is working to fill.

A show of hands at the BGS conference indicated a lot of enthusiasm for UK-wide surveys on who screens for frailty and sarcopenia, what tools people use for this, and what they do with the results. Understanding this would greatly clarify current practice, setting a baseline for future work, and we are now considering how best to undertake this work.

In terms of trials, the NIHR-funded LACE trial (of perindopril and leucine) for sarcopenia is now underway, and several colleagues expressed interest in recruiting to this at the BGS Autumn meeting. Additionally, the NIHR-funded HERO (Home-based Extended Rehabilitation for Older People) multicentre trial for older people with frailty after admission to hospital with acute illness or injury is due to start in March 2017. There will almost certainly be further multicentre trials in this area – another way that the SIG will support turning research into practice.

The final, and most important way that the SIG will work is by coordinating all of us in a community of practice and research, allowing knowledge and experience to be shared, and voices to be heard. And this relies on you getting involved! So please sign up for the SIG via the BGS Portal.

Register for British Geriatrics Society Spring Meeting 2017, 26 – 28 April 2017 SAGE Gateshead/ Newcastle.

See Miles Witham’s PowerPoint Presentation: Treatment of sarcopenia: latest developments

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