DOI: https://doi.org/10.21203/rs.3.rs-2194477/v1
Sarcopenia is a state of reduced muscle function that can lead to increased falls, fractures, and mortality in the elderly population. This study aims to identify the prevalence of sarcopenia and its related risk factors in the elderly in the community during the COVID-19 pandemic. This cross-sectional study investigates sarcopenia, muscle strength, physical performance, fear of COVID-19, distress, and depression in 103 community-dwelling elderly individuals over 65 years of age. The prevalence of sarcopenia among the elderly in the community was 4.8% and 29.1% in men and women, respectively. Age, gender, physical performance, and depression were risk factors for sarcopenia; however, COVID-19-related factors were not significant.
At the beginning of the coronavirus disease (COVID-19) outbreak, 15% of the first deaths were people over the age of 60, encouraging strict social isolation to prevent infection; this negatively affected mental health with increased fear, anxiety, and isolation1–3. According to a 2020 survey of the elderly in Korea that examined their mental health in the context of COVID-19, 71.1% of the participants had high levels of frustration, followed by worry, depression, anxiety, and fear of COVID-19 infection4. Globally, the level of physical activity has greatly decreased due to government policies such as social distancing because of COVID 195,6, resulting in the frailty of the elderly7. Changes in intake due to decreased physical activity were factors that aggravated sarcopenia, such as decreased muscle mass and increased body fat5.
Sarcopenia is defined as a condition in which muscle function is reduced due to a decrease in the amount of muscle mass8. The main characteristic of the diagnosis of sarcopenia in the elderly, revised in 2018, is that it is important to check the decrease in the quantity and quality of the muscle due to the decrease in muscle strength9. In the study, if there was no activity for 2 weeks, muscle atrophy of the lower extremities was about 3%, the lean mass of the lower extremities was changed, and at the same time, the strength of knee extension was decreased by 7%10. Sarcopenia is prevalent in the elderly and is a major risk factor for SARS-COV-2 and pneumonia by causing reduced immunity and lung capacity11. Sarcopenia in the elderly is also associated with falls, fractures 11,13, and mortality11,12,14. It is important to detect and manage in advance. As the importance of sarcopenia in the elderly has increased, WHO added sarcopenia to the 11th edition of the International Classification of Diseases in 201713, In Korea, the diagnosis code for sarcopenia was added in the 8th revision of the 2020 Korean standard cause of disease classification and recognized as a disease15.
In a study on sarcopenia, it was found that sarcopenia is greatly affected by psychological factors such as loneliness, isolation, anxiety, fear, and depression1,12,15. After the corona pandemic, the study of sarcopenia in the elderly has been expanded to studies on the correlation with physical activity according to the social distancing policy 5,16, The association between the incidence of COVID-19 and sarcopenia, malnutrition, and weakness in this study found that low physical activity was associated with a higher risk of developing COVID-1917. In particular, it was found that if there were depressive symptoms and low social support, the muscle mass and sarcopenia were also low18. However, no studies have identified risk factors after COVID-19, including psychological factors such as distress, depression, and fear of COVID-19. Therefore, it is necessary to pay attention to the elderly who are vulnerable to sarcopenia and to prepare appropriate preventive measures to alleviate sarcopenia by identifying its prevalence and risk factors. Therefore, in this study, we aim to provide basic data for nursing interventions for the screening, prevention, and management of sarcopenia by identifying the prevalence and risk factors of sarcopenia among the elderly living in the community during the COVID-19 pandemic.
This study was conducted to identify the prevalence of sarcopenia and related risk factors in the elderly over the age of 65 years, who are living in the community, to prepare preventive measures and determine the actual condition of sarcopenia in the elderly, a population group vulnerable to sarcopenia during the COVID-19 pandemic. The purposes of this study are as follows:
To determine the prevalence of sarcopenia in the elderly in the community.
Identify risk factors for sarcopenia in the elderly in the community.
This descriptive study aimed to confirm the prevalence of sarcopenia among the elderly living in the community and to identify related factors.
This study was conducted with elderly (65 years or older) individuals who agreed to participate in the research among the elderly registered at the Center for the Elderly Living Alone and the Senior Industrial Innovation Center located in the metropolitan area of S city in Korea. The criteria for selection of participants were those who could communicate, had been informed of the purpose and method of the study, and had given written consent to participate in the study. Individuals over 90 years of age were excluded. In terms of the number of participants, 96 were required when the significance level was .05, effect size was .35, and power was .95, referring to the study of Savci et al.,2 with the G*power 3.1.9.7 program, but data were collected from 110 participants considering the dropout rate. After excluding seven incomplete response data copies, 103 data points were used for the final analysis. This study received ethical approval from the Institutional Review Board of Eulji University(No.EUIRB2021-80) and was performed in accordance with IRB regulations according to the Declaration of Helsinki.
The research questionnaire consisted of 10 general characteristics such as gender and age, two physical characteristics (body fat percentage and body mass index), four characteristics related to COVID-19 (infection, test, self-isolation, and vaccination), five questions from the sarcopenia questionnaire, and questions on COVID- 19 which consisted of 44 items, including seven items to measure fear, one item to measure distress, and 15 items to measure depression. Body fat percentage and Body Mass Index (BMI) were measured using a body fat meter (G Health CARD; QSCD-OA, Seoul, Korea).
1) Sarcopenia
Sarcopenia can be evaluated by three criteria: strength, muscle mass, and physical performance presented by EWGSOP (European Working Group on Sarcopenia in Older People) and AWGS (Asian Working Group for Sarcopenia)8. In this study, by applying the 2019 revised AWGS diagnostic criteria, the sarcopenia questionnaire tool SARC-F, muscle strength evaluation, and physical performance are evaluated in three ways. The prevalence of sarcopenia is a SARC-F score of 4 or higher, and the grip strength is less than 28 kg for men and less than 18 kg for women13.
① SARC-F
The simple sarcopenia self-diagnosis tool developed by Malmstrom and Morley19 was adapted for Koreans by Kim et al 20. On a 2-point Likert scale, check 0 if there is no difficulty in the activity and 2 if the difficulty is high. The total score ranges from 0 to 10, with a high score indicating more severe muscle loss, and a score of 4 or higher indicating suspected sarcopenia. The reliability of the tool was Cronbach α = .779 at the time of development and .877 in this study.
② Muscle strength
Muscle strength was measured using grip strength according to the AWGS evaluation criteria, and a digital dynamometer (PRO-SPECS®, PGF-1000, China) was used. After stretching the arms in a standing position, each hand was measured twice, the highest value was recorded, and the average value was used12.
A higher score indicates a stronger grip strength. The standard for lowering grip strength is less than 26 kg for men and 18 kg for women based on the AWGS8.
③ Physical performance
To measure physical performance, the Short Physical Performance Battery (SPPB) developed by the National Institute of Aging (NIA) of the National Institutes of Health was used as a tool21. It consists of three items: standing balance, gait speed, and repeated chair stands. Each item is rated on a scale of 0 points for inability to perform and 1– to 4 points depending on the degree of performance. If the total score was less than 9, it was judged that there was a problem with physical performance22. In this study, a score of 9 or less was classified as having limitations in physical performance23.
2) Fear of COVID-19
The tool developed by Ahorsu et al24. was translated into Korean by Hwang et al25. The tool consists of seven items with three physiological responses to COVID-19 and four emotional responses (1, 2, 4, and 5 items). The higher the score, the higher the level of fear of COVID-19. The reliability of the tool was Cronbach α = .82 at the time of development, .88 in Hwang's study, and .82 in this study.
3) Distress
Among the Distress Thermometer & Problem List (DT & PL) tools developed by the US National Comprehensive Cancer Network (NCCN) and translated by the National Cancer Center, DT, which measures emotional stress, was used in this study26. DT is an 11-point visual event scale ranging from 0 to 10, with the degree of emotional stress experienced over the past week being scored on a distress thermometer. A higher score indicates higher distress, a score of 4 or less reflects mild distress, and a score of 4 or more reflects severe distress.
4)Depression
Depression was measured using the Geriatric Depression Scale Short Form, developed by Sheikh and Yesavate 27. We used the Geriatric Depression Scale Short Form Korean Version (GDSSFK), a shortened Korean geriatric depression scale modified for the elderly in Korea28. The tool has fifteen items, and the degree of depression in the past week was calculated as 1 point for ‘yes’ and 0 points for ‘no’. A score of 0–4 indicates normal, a score of 5–8 indicates mild depression, a score of 9–11 indicates moderate depression, and a score of 12–15 indicates severe depression. The reliability of the tool was Cronbach's α = .88 at the time of development, 28 .88 in Kee's study, and .86 in this study.
The data collection period for this study was from August 24 to December 28, 2021. After obtaining permission from the senior center, the data were collected by visiting the home of the participant. After explaining the purpose of the study, written consent was obtained, and the degree of sarcopenia was measured by asking elderly people living in the community who participated in a health event. The data collection was conducted by trained investigators, who were 20 recruited nursing college students with 2 hours of prior training on the purpose and method of the study and survey method.
The collected data were analyzed using the statistical program SPSS 26.0. Participants’ demographic characteristics, the prevalence of sarcopenia, and the degree of fear, distress, and depression were analyzed using frequency, percentage, mean, and standard deviation. Factors related to the risk of sarcopenia according to health factors such as general characteristics of the participants, fear of COVID-19, distress, and depression were analyzed using univariate ordinal logistic regression analysis. As for the factors affecting sarcopenia, the factors related to sarcopenia were confirmed by multivariate ordinal logistic regression using variables that were significant in the univariate analysis as independent variables.
The demographic, health-related, and COVID-19-related characteristics of the participants are shown in Table 1. The demographic characteristics of the study participants were 65–74 years (43.7%), and the average age was 75.88 ± 7.00 years. As for the sex ratio, 34% of the elderly were male, and 66% of the elderly were female. Regarding the level of education, 48.5% had an education level below elementary school and 65% answered that they had a religion. With regard to the subjective economic status, 53.4% answered “moderate” and 61.2% corresponded to the elderly living alone. Regarding health-related characteristics, 90.3% had chronic diseases and 16.5% of the elderly had an involuntary weight loss of 5% or more within the last month. Regarding BMI, 60.2% belonged to the normal group, and the average body fat percentage was 24.59% in men and 34.40% in women. Regarding COVID-19, 35.9% had experienced COVID 19 PCR, 3.9% had experienced self-quarantine, and 97.1% had been vaccinated against COVID-19.
|
Characteristics |
Categories |
n(%) |
M ± SD |
|
|---|---|---|---|---|
|
Socio-demographic characteristics |
||||
|
Age(year) |
65–74 |
45(43.7) |
75.88 ± 7.00 |
|
|
75–84 |
43(41.7) |
|||
|
≥ 85 |
15(14.6) |
|||
|
Gender |
Male |
35(34.0) |
||
|
Female |
68(66.0) |
|||
|
Education |
≤Elementary |
50(48.5) |
||
|
middle-High |
23(22.3) |
|||
|
≥University |
30(29.1) |
|||
|
Religion |
Yes |
67(65.0) |
||
|
No |
36(35.0) |
|||
|
Subjective economic condition |
Satisfied |
29(28.2) |
||
|
Moderate |
55(53.4) |
|||
|
dissatisfied |
19(18.4) |
|||
|
Living condition |
Living alone |
63(61.2) |
||
|
Living with family |
40(38.8) |
|||
|
Health status |
||||
|
Chronic disease |
Yes |
93(90.3) |
||
|
No |
10( 9.7) |
|||
|
Involuntary weight loss(≥ 5%) |
Yes |
17(16.5) |
||
|
No |
86(83.5) |
|||
|
BMI(kg/m2) |
Underweight(< 18.5) |
5(4.9) |
23.91 ± 3.08 |
|
|
Normal(18.5–24.9) |
62(60.2) |
|||
|
Overweight (25.0-29.9) |
33(32.0) |
|||
|
Obesity(≥ 30.0) |
3(2.9) |
|||
|
Body fat(%) |
Male |
24.59 ± 4.37 |
||
|
Female |
34.40 ± 8.01 |
|||
|
Covid 19 testing experience |
Yes |
37(35.9) |
||
|
No |
64(64.1) |
|||
|
Covid 19 Self-isolation experience |
Yes |
4(3.9) |
||
|
No |
99(96.1) |
|||
|
Covid 19 Vaccination |
Yes |
100(97.1) |
||
|
No |
3(2.9) |
|||
| BMI: body mass index | ||||
Table 2 shows the participants’ sarcopenia, COVID 19 fear, distress, and depression. The average SARC-F score was 3.02 ± 3.08, 1.57 ± 2.22 for males and 3.77 ± 3.21 for females, and grip strength was 25.71 ± 7.53Kg for males and 15.41 ± 5.96Kg for females. SPPB, which measures physical performance, was 10.31 ± 1.90 points for the male elderly and 8.88 ± 3.02 points for the female elderly, and the cut-off score for females was less than 9 points, and the fear of COVID-19 showed an average of 16.21 ± 5.82 points. As for the distress score, the average of the group with a cut-off score of 4 or higher was 6.49 ± 1.99, the average of the depression score was 4.25 ± 3.87, and the average of the group with a cut-off score of less than 5 was 8.19 ± 3.07.
Table 3 shows the prevalence of sarcopenia among the participants. In the group with a SARC-F score of 4 or higher, 8 elderly males (7.8%) and 33 elderly females (32.0%) were included. Among them, 5 men (4.8%) and 30 women (29.1%) weighed less than 28 kg and 18 kg respectively, according to the grip strength criteria.
|
Variables |
Categories |
n(%) |
Cut off score |
M ± SD |
|---|---|---|---|---|
|
SARC-F |
Total |
103 |
3.02 ± 3.08 |
|
|
Male |
35(34.0) |
< 4 < 4 |
1.57 ± 2.22 |
|
|
Female |
68(66.0) |
3.77 ± 3.21 |
||
|
Hand grip strength(kg) |
Male |
35(34.0) |
< 28 |
25.71 ± 7.53 |
|
Female |
68(66.0) |
< 16 |
15.41 ± 5.96 |
|
|
SPPB |
Total |
103 |
9.34 ± 2.76 |
|
|
Male |
35(34.0) |
≤ 9 ≤ 9 |
10.31 ± 1.90 |
|
|
Female |
68(66.0) |
8.88 ± 3.02 |
||
|
Fear of Covid19 |
Total |
103 |
16.21 ± 5.82 |
|
|
Distress |
Total |
103 |
3.63 ± 2.89 |
|
|
Yes |
43(41.7) |
≥ 4 |
6.49 ± 1.99 |
|
|
None |
60(58.3) |
< 4 |
1.58 ± 1.18 |
|
|
Depression |
Total |
103 |
4.25 ± 3.87 |
|
|
Yes |
62(60.2) |
≥ 5 |
8.19 ± 3.07 |
|
|
None |
41( 39.8) |
< 5 |
1.64 ± 1.26 |
|
SARC F ≥ 4 |
SARC F ≥ 4 AND Handgrip strength (M < 28kg, F < 18kg) |
|
|---|---|---|
|
N (%) |
N (%) |
|
|
Male |
8 ( 7.8) |
5 ( 4.8) |
|
Female |
33 (32.0) |
30 (29.1) |
|
Total, n(%) |
41 (39.8) |
35 (33.9) |
Prior to identifying the risk factors affecting sarcopenia, age, gender, education level, subjective economic status, residence type, physical performance ability (SPPB), and depression were found to be significant in the univariate analysis (Table 4). Table 5 shows the results of the multiple logistic regression analysis by inputting the significant variables as the independent variables. In the Hosmer-Lemeshow test, which is a test of suitability for logistic regression, the p-value was .408, indicating that the null hypothesis was adopted and that the regression model was suitable. The explanatory power of the regression model for the dependent variable was 70.1% and the classification accuracy was 88.3%. Among the independent variables used in the regression model, age, gender, physical performance ability (SPPB), and depression were found to be significant factors.
|
Characteristics |
Categories |
Sarcopenia risk |
|||
|---|---|---|---|---|---|
|
OR(95% CI) |
p value |
||||
|
Age(year) |
65–74(ref) |
1 |
|||
|
75–84 |
5.76(1.89,17.47) |
.002 |
|||
|
≥ 85 |
32.00(6.65,153.81) |
< .001 |
|||
|
Gender |
Male(ref) |
1 |
|||
|
Female |
4.737(1.64,13.68) |
.004 |
|||
|
Education |
≤Elementary(ref) |
1 |
|||
|
middle-High |
40.04(5.04,317.70) |
.002 |
|||
|
≥University |
8.05(.87,74.62) |
.066 |
|||
|
Religion |
Yes(ref) |
1 |
|||
|
No |
2.36(.937,5.95) |
.069 |
|||
|
Subjective economic condition |
Satisfied(ref) |
1 |
|||
|
Moderate |
1.406(.050,3.91) |
.515 |
|||
|
dissatisfied |
4.32(1.24,15.02) |
.021 |
|||
|
Living condition |
Living alone(ref) Living with family |
1 |
|||
|
.050(5.22,106.35) |
< .001 |
||||
|
Chronic disease, n% |
No(ref) |
1 |
|||
|
Yes |
.171(.02,1.39) |
.099 |
|||
|
Involuntary weight loss (≥ 5%) |
No(ref) |
1 |
|||
|
Yes |
6.57(2.08,20.70) |
.001 |
|||
|
BMI (kg/m2) |
Normal(ref) |
1 |
|||
|
underweight |
2.05(.26,15.56) |
.489 |
|||
|
Overweight |
.93(.37,2.31) |
.877 |
|||
|
Obesity |
4.09(.351,47.76) |
.261 |
|||
|
Body fat (%) |
1.036(.98, 1.09) |
.172 |
|||
|
Covid 19 testing experience |
Yes(ref) |
1 |
|||
|
No |
2.51(.99, 6.32) |
.051 |
|||
|
Covid 19 Self-isolation experience |
Yes(ref) |
1 |
|||
|
No |
.500(.27,14.83) |
.201 |
|||
|
Covid 19 Vaccination |
Yes(ref) |
1 |
|||
|
No |
.24(.02,2.81) |
.571 |
|||
|
SPPB |
No Limitation |
1 |
|||
|
Limitation |
16.92(6.07, 47.18) |
< .001 |
|||
|
Fear of COVID19 |
.99(.92, 1.06) |
.902 |
|||
|
Distress |
Normal |
1 |
|||
|
Distress Risk |
1.821(.797,4.16) |
.155 |
|||
|
Depression |
Normal |
1 |
|||
|
Depression risk |
5.32(2.20,12.85) |
< .001 |
|||
|
Characteristics |
Categories |
Sarcopenia risk |
|
|---|---|---|---|
|
OR(95% CI) |
p value |
||
|
Age(year) |
65–74(ref) |
1 |
|
|
75–84 |
1.78(.32, 9.75) |
.506 |
|
|
≥ 85 |
14.48(1.48, 141.40) |
.021* |
|
|
Gender |
Male(ref) |
1 |
|
|
Female |
4.58(.70, 29.64) |
.037* |
|
|
Education |
≤Elementary(ref) |
1 |
|
|
middle-High |
3.61(.21, 60.64) |
.348 |
|
|
≥University |
1.01(.04, 22.67) |
.991 |
|
|
Subjective economic condition |
Satisfied(ref) |
1 |
|
|
Moderate |
.42(.07, 2.41) |
.334 |
|
|
dissatisfied |
5.31(.71, 39.78) |
.104 |
|
|
Living condition |
Living alone(ref) |
1 |
|
|
Living with family |
2.36(.22, 23.31) |
.479 |
|
|
SPPB |
No Limitation |
1 |
|
|
Limitation |
7.41(1.55, 35.21) |
.012* |
|
|
Depression |
Normal |
1 |
|
|
Depression risk |
5.29(1.16, 24.06) |
.031* |
|
| Hosmer-Lemeshow test χ2 = 8.267, p = .408 | |||
| Model summary: Nagelkerke R2 = .701, χ 2= 72.75 p = < .001 | |||
This study aimed to identify the prevalence of sarcopenia among the elderly in the community during the COVID-19 pandemic and to identify relevant risk factors, including COVID-19-related factors and psychological and physical factors. First, based on the study results, the prevalence of sarcopenia was 7.8% in elderly men and 32.0% in elderly women based on the SARC-F diagnostic criteria. Compared to the 4.2% in men and 15.3% in women given in a cohort study of 1,222 Korean elderly people aged 70 years and older in 2016, before the COVID-19 period, this study showed a higher prevalence of sarcopenia However, the difference in prevalence according to gender was approximately four times higher in women than in men20, which was similar to the results of this study. According to the AWGS diagnostic criteria revised in 2018, among those with a SARC-F score of 4 or higher, if a person with a grip strength of less than 28 kg for men and less than 18 kg for women is diagnosed with sarcopenia8, the prevalence of sarcopenia that satisfies both conditions at the same time was 4.8% for the male elderly and 29.1% for the female elderly, and the risk of sarcopenia was about six times higher in the female elderly than in the male elderly. This was a high result compared to 1.7% for men and 4.6% for women when the prevalence of sarcopenia was diagnosed with SARC-F and grip strength in 2,123 elderly people 70 years of age or older in Korea in 201630, As a result of the prevalence of sarcopenia measured by walking speed and muscle strength, the result was lower than that of 38.0% for men and 62.0% for women29.
The reason for this difference was that the average age of this study was 75.8 years, in Kamo's study 29, which targeted older adults with an average age of 86.4 years old, the proportion of elderly women was also high (82.4%), indicating a high prevalence of sarcopenia. Kim et al30., it is thought that the prevalence of sarcopenia was low because only elderly individuals who were able to walk were investigated. Previous studies have shown that the decrease in the level of physical activity, such as a long time at home due to social policies such as social distancing due to low social interaction and social distancing due to COVID-19, is greatly affected by the elderly living alone5,6 In Kim's study 20, the average number of family members living with the elderly with a SARC-F score of 20 SARC-F 4 or higher was 2.9. In future studies, it will be necessary to confirm the degree of influence of the number of family members on sarcopenia. The prevalence of sarcopenia differs according to evaluation criteria. As a result of a study of the prevalence of sarcopenia among hospitalized elderly over 70 years of age in the Netherlands, the prevalence of sarcopenia was higher when men used muscle mass as a diagnostic criterion and women used muscle strength31. In this study, muscle strength was used as the standard, and previous studies in Korea showed that the muscle strength of elderly women was about 50% higher than that of men32. It is inferred that the prevalence of sarcopenia in women is higher than in men. Accordingly, additional research that applies certain diagnostic standards and methods should be conducted after the COVID-19 pandemic.
Sarcopenia is not an irreversible condition but changes according to external factors5,6,10 Logistic regression analysis was performed to identify factors related to sarcopenia prevention and management during the COVID-19 pandemic. As a result, age, sex, physical performance, and depression were identified as sarcopenia-related factors. The most relevant factor was age, and the risk of sarcopenia was high in those aged 85 years or older. Sarcopenia occurs during aging and occurs with advancing age13 According to a study of elderly aged 85 years16, a study of the elderly living alone in a Chinese community33, a study of elderly patients with osteoarthritis of the knee34, a study of the elderly over 70 years of age and a study of the elderly living in residence18, the prevalence of sarcopenia increased with age, supporting the results of this study. In terms of gender, the risk of sarcopenia was higher among elderly women than among men16. In particular, as a result of analyzing factors affecting muscle strength according to gender, older women were more stressed than men, perceived that they had a more obese body image, and had a lower quality of life32. In addition, this study found that obesity and physical activity had an effect on the sarcopenia in the elderly in China33. In order to prepare a plan for preventing sarcopenia in the elderly, nursing education and interventions should be devised to identify the exact physical condition of the elderly and to have a positive body image.
In this study, the risk of sarcopenia was 5.2 times higher in the group with depression than that in the group without depression. With prolonged COVID-19, the incidence of depression among the elderly also increased, and even among the elderly without a history of depression, the risk of developing depression increased by 2.4 times compared to before COVID-1935, and the mental health of the elderly was also very vulnerable. In a study of factors affecting sarcopenia in the elderly with knee arthritis, the lower the depression score, the lower the sarcopenia by 0.5 times34, supporting the findings of this study. In a previous study, social and religious activities decreased due to COVID-19 but did not affect the risk of developing depression35. In this study, 61% of the elderly living alone without family members had an average depression score of 4.25 ± 3.87, and about 60% of the elderly with mild depression corresponding to a score of 5 or higher. This is about twice as high as the average depression score of 2.76 ± 2.43 for the elderly aged 60 years or older with osteoarthritis, and the depression rate was also 14.4%34, which is the depression rate for the elderly with knee osteoarthritis and the elderly aged 65 years or older living in Turkey in 2015. The rate of depression is about 3 to 4 times higher than the target depression rate of 25.2%, hence an intervention plan through continuous psychological support for depression in the elderly after COVID-19 is needed. As an influencing factor on depression in the elderly, the lower the physical activity, the higher the sarcopenia; it was reported to be 7.63 times higher34. In a study on the American elderly over 70 years of age living in the geriatric residence, those with depressive symptoms and low social support had lower muscle strength18 and this may be a factor that can exacerbate sarcopenia5,8. Nursing education and interventions for the elderly in the community should be devised so that health behaviors and perceptions related to reduced physical activity can change during the COVID-19 period.
Sarcopenia has been known to predict a poor prognosis, such as falls and death, when muscle function is reduced, such as a decrease in walking speed13. In this study, the physical performance-restricted group with a cut-off score of 9 or less in the SPPB score measured for muscle function was 7.4 times more likely to have sarcopenia than the normal group. Among the independent variables input to the regression model of the Bathel ADL index, which evaluates the level of daily activities for the elderly in nursing homes in Japan, SPPB, grip strength, and age were significantly higher29 In order to prevent and maintain daily life, it is necessary to prepare an intervention plan to detect and prevent the degree of sarcopenia in advance.
This study is significant because it provides basic data for developing a community-level nursing prevention and intervention program to exacerbate or prevent the occurrence of sarcopenia in the elderly in the community during the COVID-19 pandemic. When applying sarcopenia prevention and intervention programs to the elderly in the community in the future, it is thought that the important risk factors identified in this study, such as age, sex, depression, and physical performance, should be considered first. The present study has several limitations. Firstly, since this was a cross-sectional study, caution is needed when interpreting the factors related to sarcopenia in the elderly in the community as a causal relationship between cause and effect. Secondly, since only the elderly in one community were targeted, there is a limit to extending the interpretation to the entire community. Thirdly, variables on food intake and diet, which are the major causes of sarcopenia, were not included. Therefore, we suggest the following for future research: Primarily, a study that expands the subject to represent the elderly in Korea and a study of sarcopenia targeting the elderly living alone or a study that includes the number of family members as a variable. Since the prevalence of sarcopenia in the elderly differs according to the diagnostic criteria and methods for sarcopenia, we suggest further research using various diagnostic criteria and methods is needed. Finally, follow-up studies including variables on protein intake, dietary form, and physical activity level, which are important causes of sarcopenia, are needed based on the literature.
This study aimed to identify the risk factors and prevalence of sarcopenia among the elderly aged 65 years and older living in the community during the COVID-19 pandemic. This study aimed to comprehensively identify practically important factors by applying diagnostic criteria suitable for Asians. The results of this study showed that the prevalence of sarcopenia was 4.8% for men and 29.1% for women; age, gender, depression, and physical performance were found to be significant, and COVID-19-related factors were not significant. In conclusion, among the elderly living in the community, the prevalence of sarcopenia among elderly females was six times higher than that among elderly men. The risk of sarcopenia, physical performance limitations, and depression is approximately five times higher in the elderly aged ≥ 85 years. Therefore, measures to prevent sarcopenia in elderly women are urgently required. Since depression and physical performance are the main influencing factors, we suggest the development of interventions to prevent sarcopenia in the elderly.
Data availability
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
Acknowledgements
The authors would like to thank the study participants for their time and dedication. We also want to express our gratitude to members of Silver Sound club for their contributions to the data collection.
Author contributions
H.Y. wrote the manuscript; H.Y. and J.W. conceived and designed the study; J.W. recruited the subjects; H.Y. analyzed the data. H.Y. and J.W. discussed the results. All authors reviewed the manuscript.
Competing interests
The authors declare no competing interests.