The Comparison of Sarcopenia Prevalence between

Elderly in Community Dwelling and Nursing Home

Based on Indonesian Young Adult Cut-Off Point

Maria Regina Rachmawati

1,2,3

, Siti Annisa Nuhonni

, Tirza Z. Tamin

3,4

, Magdalena Wartono

, Dian

Mediana

, Debora Pranata

, Qraxina Chaidir

Faculty of Medicine, University of Trisakti, Jakarta Barat

Faculty of Medicine, University of Gunadarma, Depok

Research and Development of Indonesian Association of Physical Medicine and Rehabilitation (PERDOSRI)

Faculty of Medicine, University of Indonesia, Jakarta; Cipto Mangunkusumo National Hospital, Jakarta

Keywords: Sarcopenia, Elderly, Appendicular Skeletal Muscle Mass, Handgrip Strength, Gait Speed

Abstract: Sarcopenia is a progressive loss of skeletal muscle mass and strength that can decrease quality of life. This

study aimed to find a cut-off point of appendicular skeletas muscle mass (ASM), hand grip strength (HGS),

and gait speed (GS) from young adult, as a based value to defined the Sarcopenia in elderly; and to find the

differences values of sarcopenia between elderly in community dwelling and nursing home. Subjects

recruited by simple random sampling and convenience sampling. There were 369 young adults (44% male,

56% female), 183 elderly (47% male, 53% female) on community dwelling, and 62 elderly (40% male, 60%

female) on nursing home. Cut-off point from young adult for ASM, HGS, and GS for male and female were

8,1 and 5,6 Kg/m

, 32 and 20 Kg, and 1,2 and 1,17 m/sec. The value of ASM, HGS, and GS in male from

community dwelling were higher (8,8 vs 7,5 Kg/m

(p<0,001), 25,9 vs 17,7 Kg (p<0,001), and 1,5 vs 0,8

(p<0,001), while the value of GS in female from community dwelling were higher 1,3 vs 0,73 m/sec

(p=0,008), and similar on ASM and HGS. The percentage of lower ASM, HGS, and GS in male were all

higher on elderly from nursing home; 28% vs 60% (p<0,026), 82% vs 99% (p<0,001), and 28% vs 88%

(p<0,001), as well as in female 5% vs 5,4% (p<0,001), 70% vs 86,2% (p<0,001), and 34% vs 100%

(p<0,001). There were cut-off point based on Indonesian young adult to determination the sarcopenia in

elderly, and the elderly from nursing home have a lower muscle mass and performance, especially in male.

1 INTRODUCTION

Sarcopenia is a major clinical problem and a quite

commonly treatable geriatric condition (Moreira,

Perez and Lourenço, 2019;! Shafiee et al., 2017). It

defined as an age related loss muscle accompanied

by a reduction in muscle strength and function

(Rodríguez-Rejón et al., 2019; Abe et al., 2011;

Milanović et al., 2013). Progressive loss of skeletal

muscle mass and strength as the individual gets

older often contribute to numerous negative health

outcomes, such as disability, functional impairment,

increased risk of falls, hospitalisation, decreased

quality of life and increased risk of mortality

(Santilli et al., 2014,!Lees et al., 2019).

In addition, sarcopenia is a potentially modifiable

risk factor for health status, risk of falls, and

fractures in elderly. So, an early detection of

sarcopenia is important to prevent progressive

reduction in skeletal muscle mass and function

(Yeung et al., 2019;!Lees et al., 2019).

Based on International Working Group on

Sarcopenia (IWGS) and Asian Working Group for

Sarcopenia (AWGS), sarcopenia is defined as low

muscle mass and low muscle strength, and/or low

physical performance, that can be measured by

appendicular muscle mass divided by the height

squared, the handgrip strength, and/or gait

speed.(Chumlea et al., 2011,!Chen et al., 2014)

The definitions of sarcopenia provided by

EWGSOP, IWGS, and AWGS were based on

different methods and different cut-off points to

define loss of muscle mass, reduction in muscle

strength, and low gait speed (Chumlea et al., 2011;

Chen et al., 2014; Carvalho do Nascimento, Poitras

and Bilodeau, 2018). The measurement of muscle

Rachmawati, M., Nuhonni, S., Tamin, T., Wartono, M., Mediana, D., Pranata, D. and Chaidir, Q.

The Comparison of Sarcopenia Prevalence between Elderly in Community Dwelling and Nursing Home based on Indonesian Young Adult Cut-Off Point.

DOI: 10.5220/0009035500050011

In Proceedings of the 11th National Congress and the 18th Annual Scientiﬁc Meeting of Indonesian Physical Medicine and Rehabilitation Association (KONAS XI and PIT XVIII PERDOSRI

2019), pages 5-11

ISBN: 978-989-758-409-1

mass along with muscle performance were assessed

using hand grip strength and gait speed.Muscle mass

were measured using Body Impedance Analysis

calculated in (Kg)/body height (m

), hand grip

strength were evaluated using Jamar Hand Grip (kg),

and gait speed were calculated by measuring gait

speed (second) on four meter track of gait (m/sec)

(Cruz-Jentoft et al., 2010;!Bahat et al., 2016; Yeung

et al., 2019)

The elderly population in the world, as well as in

Indonesia, continues to grow throughout the

following years and decades. Based on the statistic

data, elderly population in Indonesia on 2010 took

up as much as 7.6% of the total population,

increasing up to 8.5% in 2015, and the population

were estimated to have expected increase up to a

total of 10% in 2020 (Depkes RI, 2016). However,

research on the prevalence of sarcopenia in

Indonesia is still limited, as well as the lack of

further research to determine the cut-off point for

skeletal muscle mass, muscle strength, and/or gait

speed in Indonesia. Since the cut-off point of muscle

mass, handgrip strength and gait speed varies among

countries and populations, the measurement on

young adult is necessary to be done as a standard in

every country. (Chen et al., 2014; Bahat et al., 2016;

Yeung et al., 2019)

Determination of sarcopenia in elderly were

based on – 2 standard deviation or lowest quartile of

normal value of muscle mass, hand grip strength,

and gait speed in young adult. Young subjects as the

standard value are required to be in perfect health,

without history or current chronic disease or chronic

drug usage as a reference population for assessing

muscle mass (Bahat et al., 2016).

Based on previous study on Asian working group

for sarcopenia in elderly population above 65 years,

diagnosis of sarcopenia in Taiwan were established

based on skeletal muscle index (SMI) 2 SD below

normal young adult were <8,87Kg/m

( 23,6%

male); <6,42 Kg/m

(18,6% female), while in Japan

it was established based on Appendicular skeletal

muscle (ASM) 2 SD below young adult values were

< 7,0 Kg/m

(11,3% male); <5,8 Kg/m

(10,7%

female); ≤ 6,42 Kg/m

(22,1% female), and in Korea

based on ASM were 6,75 Kg/m

(21,8% male);

<5,07 Kg/m

(22,1% female) (Chen et al., 2014).

The value of hand grip strength (HGS) based on

lowest quartile in young adult in Japan were 30,3 Kg

(male), and 19,3 kg (female), while HGS value

based on Asian Working Group of Sarcopenia in

<18 kg for females and <26 kg for males were

considered as cut-off points for the definition of

sarcopenia. In Taiwan, HGS value based on

European Working Group of Sarcopenia (EWGSOP)

recommendation and adjusted according to Asia data

were <22,4 Kg (male), and <14,3 Kg (female). (6,9)

The physical performance quality assessed by

measurement of gait speed (GS) in Japan, based on

the lowest quartile of study group were measured

within the standard of <1,27m/s (11,3% male);

<1,19 m/s (10,7% female); ≤ 1,22 m/s (22,1%

female). In Taiwan, the standard used are ≤ 1 m/s, be

it for male or female (Chen et al., 2014).

This study aimed to find the cut-off point of

skeletal muscle mass, handgrip strength, and gait

speed in Indonesian young adult, as a reference for

determining the prevalence of sarcopenia, and also

the differences between elderly who lived in

community dwelling and nursing home.

2 METHODS

The method design of this study was cross-sectional.

The community dwelling elderly were recruited

from an outpatient setting in one of the private

hospital on South Tangerang, and elderly subjects

who lived in nursing home were recruited from a

social nursing home located in Cengkareng, West

Jakarta. All subjects were male and female above 60

years old who were able to walk without walking

aid, able to grip, and in good health. Subjects with

cardiac failure, chronic obstructive pulmonary

disease, acute asthma were excluded.

The young adult group were recruited from one

of the private university in West Jakarta. Inclusion

criteria for the subjects of the young adult group

includes: age range between 17-25 years old, with

good health condition, are able to walk without

walking aids, able to grip, no history of chronic

disease, and did not consume any drugs.

Ethical clearance were previously approved by the

ethics committee with 128/KER/FK/III/2018 ethical

clearance number. Data collection was conducted

between June 2018 and December 2018.

KONAS XI and PIT XVIII PERDOSRI 2019 - The 11th National Congress and The 18th Annual Scientiﬁc Meeting of Indonesian Physical

Medicine and Rehabilitation Association

Figure 1: Body Impedance Analysis data sampling.

Figure 2: HGS data sampling.

Figure 3: Gait speed data sampling.

All included subjects agreed to perform several

tests; the measurement of appendicular skeletal

muscle mass (ASM) in Kg/m

using “TANITA”

body impedance analysis, hand grip strength (HGS)

in Kg using Jamar Hand Grip, and gait speed (GS) in

m/sec evaluated by measuring the time on four

meter gait test using stopwatch.

3 RESULTS

There were 369 young adult subjects included in the

study. The subjects consisted of 163 male (44%) and

206 female (56%), and for the elderly subjects

group, there were 183 elderly subjects from

community dwellings with 86 male (47%) and 97

female (53%); and 62 elderly subjects from nursing

home consisted of 25 male (40%) and 37 female

(60%). The characteristic of the young adult and

elderly subjects are listed on the table 1.

The cut-off value of ASM, HGS, and GS based

on young male listed in table 2 were 8,1 Kg/m

; 32

Kg; and 1,2 m/sec, while cut-off value of ASM,

HGS, and GS based on young female were 5,6

Kg/m

; 20 Kg; and 1,17 m/sec.

Table 3 showed that the value of ASM, HGS,

and GS of elderly male subjects from nursing home

were significantly lower (p= <0,001, p<0,001,

p<0,001). The value of ASM and HGS were quite

similar between the elderly female subjects groups

(p=0,1 and p=0,9), while the GS value of the nursing

home elderly female subjects group were

significantly lower compared to the community

dwelling elderly subjects group (p=0,008).

The data listed in Table 4 have shown percentage

of lower values of ASM, HGS, and GS male and

female from nursing home were higher (p=0,026,

p<0,001, p<0,001), examined by Mc Nemar test.

The Comparison of Sarcopenia Prevalence between Elderly in Community Dwelling and Nursing Home based on Indonesian Young Adult

Cut-Off Point

Table 1: Characteristics of the young adult and elderly subjects.

Young adult

N=369

Elderly

Community dwellings

N=183

Nursing home

N= 62

Male

Female

Male

Female

Male

Female

Total

163 (44%)

206 (56%)

86 (47%)

97 (53%)

25 (40%)

37 (60%)

Age

(years)

(17-24)

(17-25)

68,5

(60-87)

62,6±

9,5

65±10

Body

weight

(Kg)

69,6 ± 12,6

55,6 ± 10,9

67±

12,2

60,6±

9,8

55±12

50±9

Body

height

(cm)

169,3±6

156±5,7

165 (142-183)

152 (141-

165)

153,6±9,2

141±

7,2

BMI

(Kg/m

)

24,3±4

22 (15,5-

37,6)

24,9 (16,7-40,9)

26,9 (17,6-

45,9)

22,2±

4,5

25±4.1

Table 2: The Cut-off Values of Appendicular Muscle Mass, Hand Grip Strength, and Gait Speed in young adult subjects.

Male

Female

ASM (Kg/m

)

2SD: 8,1

25% percentile: 5,6

HGS (Kg)

25% percentile: 32

25% percentile: 20

GS (m/sec)

25% percentile: 1,2

25% percentile: 1,17

Table 3: Value difference of the Appendicular Skeletal Muscle Mass, Hand Grip Strength, and Gait Speed on elderly

subjects between community dwelling and nursing home settings.

Male

Female

Community Dwelling

N=86

Nursing home

N=25

Community Dwelling

N=97

Nursing home

N=37

ASM

(Kg/m

)

8,8

(5.6-14.9)

7,5 ± 1,4

<0,001*

6,8

(4,9-11)

6,6

(4,9-10)

0,1

HGS

(Kg)

25,9 ± 6,8

17,7± 5,6

<0,001**

18 (8-31)

11,8 ± 5,8

0,9

(m/sec)

1,5 ± 0,4

0,84± 0,24

<0,001**

1,3 ± 0,3

0,73 ± 0,2

0,008**

* Mann-Whitney Test

** T-test

Table 4: The percentage differences of lower ASM, HGS and GS between elderly in community dwelling and nursing

home.

Male

Female

Cut-off

Value

Community

Dwelling

Nursing

home

Cut-off

Value

Community

Dwelling

Nursing

home

ASM

(Kg/ m

)

2SD:

8,1

28%

60%

<0,026

25%

percentile:

5,6

5,4%

<0,001

HGS

(Kg)

25%

percentile :

82%

99%

<0,001

25%

percentile:

70%

86,2%

<0,001

(m/ sec)

25%

percentile:

1,2

28%

88%

<0,001

25%

percentile:

1,17

34%

100%

<0,001

KONAS XI and PIT XVIII PERDOSRI 2019 - The 11th National Congress and The 18th Annual Scientiﬁc Meeting of Indonesian Physical

Medicine and Rehabilitation Association

4 DISCUSSION

This study found that the value of – 2 SD of the

ASM from the young male were 8,1 Kg/m

, which

is a bit lower than the ASM of the young male in

Taiwan (8,82 Kg/m

), and higher than Japan (7,0

Kg/m

) and Korea (6,75 Kg/m

). While the lowest

quartile of the ASM from the young female were 5,6

Kg/m

, that was lower than Taiwan (<6,42 Kg/m

)

and Japan (< 5,8 Kg/m

), and higher than Korea (<

5,07 Kg/m

). The lowest quartile of HGS in young

male was 32 Kg, higher than Japan (30,3 Kg) and

EWGSOP to Asia data (22,4 Kg). Furthermore, the

lowest quartile of HGS in young female from this

study was 20 Kg, higher than Japan (19,3 Kg) and

EWGSOP recommendation (14,3 Kg). The study

result of the lowest quartile of the GS in young male

was 1,2 m/sec, is a bit lower than in Japan (1,27

m/sec), yet still higher than the Taiwan study (< 1

m/sec). The lowest quartile of the GS in young

female from this study was 1,17 m/sec, slightly

lower than Japan (1,19 m/sec) and a bit higher than

Taiwan (1 m/sec) (Chen et al., 2014).

The value of ASM, HGS, and GS of elderly male

subjects from community dwelling home were

significantly higher; 8,8 (5,6-14,9) vs 7,5 ± 1,4

Kg/M

(p<0,001); 25,9 ± 6,8 vs 17,7± 5,6 Kg (p<

0,001, and 1,5 ± 0,4 vs 0,84± 0,24 m/sec (p<0,001).

However, the ASM and the HGS in elderly female

subjects were shown slightly higher in female from

community dwelling home, but statistically no

difference between community dwelling and nursing

home subjects; 6,8 (4,9-11) vs 6,6 (4,9-10) Kg/m

(p=0,1); 18 (8-31) vs 11,8 ± 5,8 kg (p=0,9) , while

the GS of elderly female subjects in community

dwelling settings was higher; 1,3 ± 0,3 vs 0,73 ± 0,2

m/sec (p=0,008).

The percentage of the lower ASM, HGS, and GS

in elderly male from community dwellings were

lower; 28% and 60% (p<0,026); 82% and 99%

(p<0,001); 28% and 88% (<0,001). As well as in

elderly female subjects, the percentage of the lower

ASM, HGS, and GS from community dwellings

were lower than in nursing home; 5% and 5,4%

(<0,001); 70% and 86,2% (p<0,002); 34% and 100%

(p<0,002).

The prevalence of sarcopenia increases in a

nursing home setting. The results of this study are

consistent with previous studies, showing that there

is a close association between the degree of

sarcopenia and the degree of dependence among

residents (Buckinx et al, 2017). This results also

consistent with one of the multi-center study from

Spanish, stating that sarcopenia is a frequent

condition in elderly population who lived in a

nursing home, especially among female. (Salvà et

al., 2016). Although, in this study, elderly male in

nursing home have lower value of ASM, HGS and

GS, while elderly female in nursing home only have

lower value in GS.

Elderly skeletal muscle performance is regulated

by some factors, such as nervous, muscular, and

skeletal systems. These factors are influenced by

lifestyle, biological, and psychosocial factors.

Lifestyle factors including physical activity and

nutritional intake; biological factors including

genetics, hormones, and low-grade inflammation;

psychosocial factors including fear of falling,

psychological resiliency, self-efficacy, and

loneliness (Tieland, Trouwborst and Clark, 2017).!

Based on systemic review and meta-analysis study

conducted by Shen Y, et al, the review also said that

malnutrition was quite common in nursing home

setting, and it appeared to be an independently

associated factor of sarcopenia (Shen et al., 2019).

This study found that the prevalence of sarcopenia

was higher in nursing home than in the community

dwelling. It can be caused by low physical activity

in nursing home, low nutrition intake, and some

other psychological problem, because nursing home

usually don’t have any family that can support them,

so they usually lacking motivation to be active.

The percentage of the lower ASM in elderly

male subjects from community dwellings (28%) and

nursing home (60%) were significantly higher than

previous study in Taiwan (23,6%), Japan (11,3%),

and Korea (21,8%). While the lower ASM in elderly

female subjects from community dwellings (5%)

and nursing home (5,4%) were lower than earlier

study in Taiwan (18,6%), Japan (10,7% and 22,1%),

and Korea (22,1%) (Chen et al., 2014).

The prevalence of the lower physical

performance by measuremalet of gait speed in this

study of elderly male subjects from community

dwellings (28%) and in nursing home setting (88%)

were higher than the Japanesestudy (11,3%). As well

as the lower gait speed in elderly female subjects

from community dwellings (34%) and nursing home

(100%) were higher than elderly female subjects in

the Japanese study (22,1%) (Chen et al., 2014).

The limitations of this study were each group of

the adult and elderly subjects were recruited only

from one location.

The Comparison of Sarcopenia Prevalence between Elderly in Community Dwelling and Nursing Home based on Indonesian Young Adult

Cut-Off Point

5 CONCLUSIONS

Based on this study, Sarcopenia in Indonesia can be

determined by cut-off point from young adult values

for the ASM; <8,1 Kg/M

(male) and <5,6 Kg/M

(female), the HGS; < 32 Kg (male) and <20 Kg

(female), and the GS; < 1,2 M/sec (male) and < 1,17

(female).

The values of the ASM, HGS, and GS in elderly

male subjects from community dwelling were higher

than values obtained from subjects in nursing home

setting. While the ASM and HGS results in elderly

female subjects were quite similar between both

location, however, elderly female subjects from

community dwelling group have higher GS

compared to the elderly female subjects in the

nursing home. The percentage of the lower ASM in

elderly male and female subjects were significantly

higher in nursing home setting than community

dwelling home.

The physical performance in this study presented

by gait speed was better in elderly who lived in

community dwelling home in both gender.

ACKNOWLEDGEMENT

This study was support by Research Institution of

Trisakti University. The authors subsequently

present their sincere gratitude to the Director of Sari

Asih Hospital Ciputat Tangerang, The Head of

Budhi Mulya 2 Social Care Institution Cengkareng

for facilitating this study, and also the highest

appreciation to all of the students from the

university, the elderly subjects from the community

dwelling group and the elderly subjects from the

nursing home who participated in this study.

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