INTRODUCTION

Sarcopenia is a generalized and progressive musculoskeletal disorder characterized by the loss of mass, strength, and functioning of the muscular system of the elderly, related to multiple risk factors (nutritional, lifestyles, hormonal imbalance, and others)¹, it reduces mobility, decreases the quality of life and is a potential risk factor for falls².

According to the World Health Organization³, the adult population over 80 years of age increased to 125 million people in 2018. It is estimated that by 2050, those over 60 years of age will double their number³. In Colombia, data obtained from a national census carried out in 2018⁴determined that the population over 60 years of age was 13.3%, with an aging rate in the department of Risaralda of 60.6%, this being the third highest at the national level, surpassed only by Quindío (72.29%) and Caldas (67.07%)⁴. In Peru, the prevalence of this pathology is 15-17% in elderly people⁵.

This pathology increases the costs in the care of the elderly patient since it leads to other comorbidities such as serious traumas due to falls, pathological fractures, physical instability that increases the risk of injury with the environment, and the use of elements such as canes and treadmills⁶. In the same way, this condition is associated with an increase in all causes of morbidity, mortality, and disability, causing worse results mainly in the management of prevalent diseases in the frail elderly, such as renal and intestinal pathologies⁷; which generates high costs for the health system due to the persistent delivery of supplies, longer hospital stays, a greater number of complications, and extensive rehabilitation. Based on the previous, working on the prevention and early management of sarcopenia would abruptly reduce the costs of patients, family members, and the health system.

Currently, one of the sustainable development goals proposed by the United Nations Organization aims at the health and well-being of the general population, promoting and guaranteeing a healthy life at all ages⁸.

In this order of ideas, the main objective of this study was to determine the prevalence of sarcopenia and the degree of dependency in the elderly in two nursing homes, one private and one public, in Pereira, Risaralda. Since these regions do not have this type of characterization and its relationship with different factors such as skeletal muscle mass, muscle strength and physical functionality.

METHODS

RESULTS

A total of 57 people participated, 49 older adults in the rst home, which was private, and 8 in the second home, which was government (public). 68.4% (n=39) were women. The median age was 83 years with an interquartile range (IQR) of 76.0 - 87.5 years. 100% of individuals were of mestizo ethnicity.

The median BMI was 26.3 kg/m2 (IQR: 23.2 - 30.4 kg/m2), no participant had malnutrition, 38.6% (n=22) had normal weight, 31, 6% (n=18) overweight and 29.8% (n=17) obese. The median of the Barthel Index was 85 points (IQR: 75 - 100], with 68.5% of the participants having some degree of dependency.Table 1describes the other results of this scale.

The median of prehensile strength in Las women was 15.5 (IQR 8.6 - 30.9) and 22.0 for men (IQR 12.5 - 41.6). 83.33% of the men had decreased strength, the same for 56.41% of the women. Consequently, 64.91% percent of the total number of participants obtained a result below the cut-off point to dene decreased grip strength. The remaining 35.09% were above it, without representing a measure corresponding to sarcopenia suspicion. The median SMI index (skeletal muscle mass) was 6.9 kg/m2 (IQR: 6.4 - 7.6), with 50% of the participants presenting low SMI.

Table 2shows the percentage of people with sarcopenia, where the highest percentage corresponds to severe sarcopenia (61%), followed by sarcopenia conrmed by BIA (28%), covering the majority of the population studied. Regarding the distribution of sarcopenia, it was found that home 1 (private) had 92% of patients with sarcopenia, while home 2 (public) had 72% with this diagnosis

Table 3shows the results by household subclassied according to the degree of severity and/or the absence of sarcopenia. Regarding gender, only one woman was found without sarcopenia, while 11% had suspected sarcopenia (n= 4), 32% had conrmed sarcopenia (n= 12), and 57% had severe sarcopenia (n= 22). In the case of men, no men were found within the category without sarcopenia. With suspected sarcopenia, 6% (n=1), while 22% (n= 4) and 72% (n= 13) had conrmed sarcopenia and severe sarcopenia, respectively

DISCUSSION

This study aimed to characterize a population of older adults from two nursing homes and establish the prevalence of sarcopenia and the degree of dependency. It was found in the evaluated population that 89% had sarcopenia, a value well above that found in the literature, where on average it is 18%¹³.

However, it should be noted that in this study the population was not institutionalized, and as mentioned¹⁴by Bravo et al patients residing in nursing homes have a higher prevalence of sarcopenia due to their poor nutritional status and decreased ability to function. Perform basic activities of daily living, triggering an involuntary loss of skeletal muscle mass and strength, which is linked to age¹⁴.

Studies indicate that muscle and body mass begins to decrease from the fourth decade of life and up to 50% in the eighth decade of life¹⁵.

In this study, only 2% (n=1) of the patients did not suffer from sarcopenia, a result associated with the age of the population studied. It is important to know that the severity o f sarcopenia is associated with unhealthy lifestyles^16,18. A sedentary lifestyle is one of the main factors responsible for muscle weakness that leads to loss of muscle mass and strength^16,18, generating greater dependence on the part of the elderly on their caregivers.

In the present study, it was observed that 45.6% of older >adults, according to the Barthel scale, were classied as patients with mild dependency. According to María et al¹⁹, dependency scales such as Barthel's help predict the development of sarcopenia and its severity, which makes it possible to prevent the compromise of functional status that will generate, in the short or long term, high costs for both the patient and the institutions, caregivers and their families, since it increases the risk of falls, fractures, and decreased independence, requiring the use of health services that could be distributed more profitably.

The increase in hospitalizations, specialized consultations, and rehabilitation, are events that carry one of the highest health costs. Pinedo et al. 20 carried out a study that determined that the costs were much higher for individuals with muscle weakness than those who did not suffer from this difficulty. The mean annual total costs for the participants with muscular weakness were 5,198.26 USD, being in Colombian pesos (COP) $23,162,211. In comparison, the patients without muscular weakness carried costs of 2,133.87 USD, COP $9,508,006, that is, more double the expenses²⁰. Dorosty et al. 21 carried out a study in Ethiopia using a population of 644 patients, where they found that economic income is associated with the development of sarcopenia²¹. The proportion of pre-sarcopenia and sarcopenia in low-income households was relatively higher (22.6% and 20.5%) compared to those with medium income (21.7 and 18.2%) and higher-income high (13.7 and 12.8%)²¹.

The magnitude of sarcopenia found in nursing home number 1, which was private, was greater (92%) compared to nursing home number 2, which was public (71%); a nding that allows us to demonstrate that private geriatric institutions do not always generate a better quality of life for older adults. It should also be taken into account that all patients with sarcopenia have a higher risk of in-hospital mortality, as reported by Ramos-Ramirez et al²²who conducted a study on sarcopenia in Peru in hospitalized patients, showing a statistically signicant association between this condition and mortality. (RR 4.69; 95% CI: 1.62-13.10; p=0.004).

Although the present study could not evaluate these variables, it can be estimated that almost the entire population evaluated has a high risk of dying from any type of disease, in case of suffering any complication and being hospitalized²². It should also be noted that some measures were not taken that could predict the risk of mortality, such as time up and go, lift test, and 6- meter walk.

In addition, the strength in the lower limbs was not evaluated. Although it was not necessary to make the diagnosis, it would have given more details about the functional status of the participants.

Similarly, other sociodemographic or pathological factors could inuence the correlation between the type of nursing home and the magnitude of sarcopenia. However, the data was limited to what was available due to the history of the households. It should be noted that sarcopenia is a pathology that has been increasing in recent years, given that the generational pyramid is greater in the elderly than young people, so this pathology is prevalent in the majority of the population.

This study also shows us two different realities: private nursing home and a public one, and how this can affect >or benet the outcome of this pathology. In the same way, it serves as the basis for the restructuring of the physical exercise and diet model that is carried out in nursing homes to reduce the prevalence of sarcopenia and improve the quality of life of older adults.

It is necessary to highlight that multicenter studies must be carried out to determine the national prevalence, burden of disease, and health costs that this condition entails in order to support the design of effective public policies that counteract the impact of sarcopenia on patients, caregivers, and health system in general.

CONCLUSION

The prevalence of sarcopenia in nursing homes in Pereira, is high, even higher than that reported in the literature. Specically, 89 out of 100 older adults in these nursing homes have sarcopenia. Similarly, being in a private nursing home does not guarantee a better physical condition and quality of life.