Change in muscle strength and muscle mass in older hospitalized patients: A systematic review and meta-analysis
Introduction
Aging is associated with multiple chronic health conditions and functional impairment, which are related to hospitalization and subsequent readmissions (Dall et al., 2013, Miljkovic et al., 2015). In 2013 approximately 35% of all hospital discharges in the US concerned patients of 65 years or older who had a mean length of stay of 5.2 days (Data from Healthcare Cost and Utilization Project database, 2013). One of the most prominent hazards of hospitalization is physical inactivity. Older patients spend > 80% of their hospital stay lying in bed (Brown et al., 2009). Physical inactivity during hospitalization is associated with a decline in Activities of Daily Living (ADL), higher rate of first institutionalization and mortality (Brown et al., 2004). Moreover, physical inactivity has a substantial impact on muscle strength and muscle mass (Coker and Wolfe, 2012).
Bed rest studies have shown a loss of 2% of total lean leg mass during 24 days of inactivity in healthy young participants (Paddon-Jones et al., 2004), and a more rapid decline of over 10% of total lean leg mass in healthy older participants in seven to ten days of inactivity (Coker et al., 2015, Drummond et al., 2012, Ferrando et al., 2010, Kortebein et al., 2007). Moreover, space flight studies have shown that total absence of muscle activity during a prolonged period can lead to a decline as high as 42% of muscle strength and 15% of muscle mass (English et al., 2015, Hackney and English, 2014). These findings are in line with the high prevalence of low muscle strength and muscle mass observed in older people living in nursing homes with an inherent lack of mobility (Bauer et al., 2008, Landi et al., 2012). During hospitalization, other factors besides inactivity influence muscle strength and muscle mass, e.g. the metabolic effects of the disease itself (Bautmans et al., 2009) and malnutrition (Vanderwee et al., 2010). In addition, the aging process causes increased protein degradation and lower protein synthesis, making older patients even more vulnerable to a negative impact of hospitalization on muscle strength and muscle mass (Cruz-Jentoft et al., 2010).
It is important to determine the effect of hospitalization on muscle strength and muscle mass, as determinants of health outcome, in older patients. Therefore we aimed to systematically review and synthesize the existing literature on change in muscle strength and muscle mass during hospital stay.
Section snippets
Methods
The protocol of the systematic review was registered at PROSPERO International prospective register of systematic reviews, registration number: CRD42015020448. A systematic search was performed in Pubmed, Embase, Cinahl and Cochrane from inception to March 2016. The search included the keywords “muscle strength”, “muscle mass”, “hospitalization”, “older age” and synonyms. The complete search strategy is presented in Supplementary Appendix A.
Results
Fig. 1 shows the selection process of the studies. A total of 5757 studies including 2734 duplicates were found. After title, abstract and full text screening 2998 studies were excluded resulting in 25 studies (n = 1789 patients) being included in this review and 17 studies (n = 1229 patients) in the meta-analysis. Seventeen studies, describing 19 patient subgroups (n = 1387), reported on change in HGS. Five studies, describing six patient subgroups (n = 239), reported on change in muscle mass. Three
Discussion
This systematic review and meta-analysis showed that HGS and muscle mass decreased significantly in electively admitted older patients and did not change in acutely admitted patients, although a trend for an increase in HGS was observed in this group.
Electively admitted patients predominantly underwent major surgery (Anderson et al., 2003, Barry et al., 1999, Gatt et al., 2005, Henriksen et al., 2002a, Henriksen et al., 2002b, Houborg et al., 2005, Houborg et al., 2006, Mathur et al., 2010,
Conclusion
This systematic review and meta-analyses showed a decrease in muscle strength and muscle mass in electively admitted patients during hospitalization. More research is required to further refine phenotypes of patients at risk of muscle detoriation and determine the long term effects of hospitalization on muscle, to eventually define specific interventions and prevent physical detoriation.
Conflict of interest
None.
Funding
This study was supported by the seventh framework program MYOAGE (HEALTH-2007-2.4.5-10) and European Union's Horizon 2020 Research and Innovation Programme (No 689238 and No 675003).
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These authors equally contributed to this research.