In August last year I sent out a newsletter about how older patients I was seeing post lockdown after 3-4 months away from care, were looking positively fragile.
Well this week I had a study delivered to my inbox that discusses a key part of fragility, sarcopenia.
One of the key things about sarcopenia is the increased risk of falls and guess what the number one cause of fatal and none fatal injuries is in the elderly…..falling.
Just developing sarcopenia is linked with 430% increased risk of death in hospitalised geriatrics.
This stuff is serious.
The lockdowns have stopped their physical activity and isolated them in a way that we have never seen before.
Seems to me that they are now in a vicious cycle from a combination of lack physical exercise, lack social contact (zoom really isn’t the same as face to face), lack of sunlight making vitamin D, fear creating a stress response that is driving inflammation up and immunity down.
They have a nice graphic to explain their overall idea in how the lockdowns are affecting them:
Lets pick a few keys bits out and see how they could play out in the longer term and how we might help them.
More time at time at home has to mean less physical activity and that means less muscle and more sitting.
No doubt about it in my practice, older patients muscles have fallen away and the posture has gone forward.
More time at home means less sunshine and that means less vitamin D.
This is where we can start to develop a vicious cycle.
Vitamin D deficiency on it’s own can lead to sarcopenia.
And it leads to higher levels of inflammation and that is absolutely central to accelerated ageing.
They even have a nice graphic on the countermeasures they recommend.
4000 iu of vitamin D?
You know we got that covered:
Worries about digestive issues affecting absorption?
Fear not, it is sublingual, goes straight in the blood stream.
Remember by the time they are over 70 they lose the ability to synthesise adequate amounts of vitamin D compared to younger people when they get natural sun exposure, so supplementation becomes a must.
Fish oil for people under 70 ish I am not a massive fan of as there is mixed research on the potential dangers plus there is so much other stuff they need before we get to fish oil as a supplement. So I just tend to get them to eat oily fish and cut the ultra-processed foods down.
However for the elderly there is a consideration of maintenance of brain structure and function with DHA especially, plus digestion issues often so I can go with that.
The creatine reminded me of just how useful a nutrient is can be, especially in certain populations.
We talked it in depth here in June last year:
Short version, it recycles ATP, something you need as ATP actually takes a lot of ATP to make so we need to recycle what we have not make it from scratch.
Now we can make it ourselves by combining glycine, arginine and methionine.
But this requires B12, B6 and folate to run cycle called methylation and frankly so many people are low in those it is a bit scary.
So supplementing the elderly and vegetarian/vegans (it is high in meat, so they tend to be low) is a useful thing in some cases.
It might even help with their mood if the thought of yet another lockdown in the winter despite high antibodies rates, is weighing on their mind.
As far a movement is concerned, walking is a great start, but strictly no dawdling, I want fast walking, at the very least a strut.
But a sashay is not enough.
I also love a set of nordic walking pole (not sticks, never call them sticks it puts the elderly off).
A static bike for harder cardio than walking is also a good option and removes any risk for those unsteady on a bike.
Resistance bands are great but even a tin of beans in each had will be better than nothing.
Sadly our old friend, the ever popular statins for lowering cholesterol can lead to less muscle strength and higher risk of falls. This can be a delicate topic for the very elderly as they have faith in GP’s like a religion, so tread carefully.
If in doubt whip out the independent Number Needed to Treat review site
ACTIONS TO TAKE:
– Get them moving, at least one fast walk a day, keep a set of nordic poles in your clinic for them to try.
– Start recommending 4000 iu vitamin D with the two forms of K2 needed in a sublingual form www.inhealthsupplements.co.uk
– Try creatine 5g daily for older patients, it is cheap, safe and well tolerated