SINGAPORE - A 10-year study that tracked 300 people found that loss of muscle and strength in people as they age, a condition called sarcopenia, could become a challenge for the healthcare system.

Such muscle-wasting contributes to frailty, affecting balance, mobility and a senior person’s overall ability to perform daily tasks, and will be especially important as one in four Singaporeans is expected to be over the age of 65 by 2030.

The longitudinal study by Tan Tock Seng Hospital’s (TTSH) Institute of Geriatrics and Active Ageing (IGA) found the prevalence of sarcopenia here ranged from 13 per cent to 25 per cent, compared with 5.5 per cent to 25.7 per cent for Asia as a whole.

IGA director Lim Wee Shiong, who led the study beginning in 2013, said on Wednesday that sarcopenia is not as widely recognised a syndrome in older people as dementia, but it is still important to raise awareness of it, and the steps that can be taken to prevent or delay its onset.

In the longitudinal study, GeriLABS, doctors used screening and assessment tools to detect sarcopenia in its early stages and identify those at risk of adverse outcomes, such as frailty, so they could receive timely and effective interventions.

Associate Professor Lim said disorders of the muscle and bones are the leading cause of years that people in Singapore live with disability, as they increase the number of falls and result in low quality of life, low physical activity and loss of independence in daily living.

Frailty, an age-related decline that increases a person’s vulnerability to adverse health outcomes and falls, is expected to grow markedly among older people within the community, from 5 per cent to 6 per cent now to 27 per cent by 2030.

“Our research helped to validate screening and assessment tools to detect sarcopenia and unravel clinical and physiological markers of sarcopenia. This, in turn, helps predict an individual’s risk of frailty and functional decline. Doctors can now diagnose sarcopenia in the early stages more accurately and identify those who are at risk of adverse outcomes, and intervene in a timely manner,” Prof Lim said.

Scans used in the ongoing study include a bone density test called dual-energy X-ray absorptiometry, and bioelectrical impedance, which runs electric current flows through the body to calculate muscle mass.

At the same time, muscle strength is measured by the strength of the patient’s hand grip using a hand dynamometer. 

Loss of muscle mass could happen even in overweight people who do not appear to be losing bulk. An older person suffering from such obese sarcopenia, more commonly known as “fat-frail”, actually has very low muscle mass.

The issue here, said TTSH-IGA geriatrician Lim Jun Pei, is that many of those who suffer from obese sarcopenia often do not see the problem in themselves because “they remain large (and are) not shrinking or wasting away”.

“This person might not have enough functioning muscle to carry the weight of their own body around, so they depend on motorised PMDs (personal mobility devices) when they need to be exercising, which is one of the solutions for people over the age of 60 with sarcopenic obesity. This results in a vicious circle,” she added.

Prof Lim Wee Shiong said: “The solution for people over the age of 60 and who are fat-frail is to eat more protein, walk and do resistance exercise (strength training).”

He added that losing weight through dieting could simply mean losing more muscle mass.

The study also shed light on the non-obese form of sarcopenia. This could happen among people who neither exercise nor eat well, perhaps because of injury or dementia.

One such person who had her condition caught in time was retired businesswoman Susan Loong, 70.

“I felt I was getting small. I thought it was something more sinister, so I asked my daughter to take me to the doctor for a thorough check,” she said.

Blood tests and scans conducted earlier in 2023 led her doctor to conclude that Madam Loong had pre-sarcopenia, and she was asked to load up on her protein intake and to continue to exercise regularly.

“I never ate a lot of meat when I was young, but now I have two hard-boiled eggs for breakfast every morning, and I changed from drinking skimmed milk to (high-protein) powdered milk,” she said.

For the first time, Madam Loong got herself a trainer and works out in the gym.

“I must ensure that I build up my strength so I am not at risk of falling. It is very scary to fall and hurt myself at my age,” she added.