老人ホームでのサルコペニアの有病割合と死亡率

老人ホームでのサルコペニアの有病割合と死亡率を調査した論文を紹介します。

Francesco Landi, et al: Sarcopenia and Mortality among Older Nursing Home Residents. Journal of the American Medical Directors Association doi:10.1016/j.jamda.2011.07.004

サルコペニアの診断基準はWorking Group on Sarcopenia in Older People (EWGSOP)を使用しています。筋肉量低下が必須で、これに加えて筋力低下もしくは身体機能低下がある場合に、サルコペニアと診断しています。

70歳以上で老人ホームに入所している122人のうち、40人（32.8％）がサルコペニアに該当しました。また、男性では68％、女性では21％と性別で有意差を認めています。

6か月のフォロー期間中に26人（21.3%）が死亡されました。年齢、性別、併存疾患、ADL、BMIで調整した後でも、サルコペニアは死亡のリスク因子でした(ハザード比2.34; 95%信頼区間1.04–5.24)。

結論として、サルコペニアは老人ホームの入所者に多く認め、死亡の独立した危険因子と言えます。ただ、日本の老人ホームでのサルコペニアの有病割合は、この程度ではすまないのではないかと個人的には感じています。サルコペニアを認めると生命予後が悪いという結論には異論はありませんが。

Abstract
Background and aims
Sarcopenia has been indicated as a reliable marker of frailty and poor prognosis among the oldest individuals. At present, no data are available on sarcopenia in the nursing home population. The aim of the current study was to explore the relationship between sarcopenia and all-cause mortality in a population of elderly persons aged 70 years and older living in a nursing home in Italy.

Methods
This study was conducted among all subjects (n = 122) aged 70 years and older who lived in the teaching nursing home of Catholic University of Rome between August 1, 2010, and September 30, 2010. According to the European Working Group on Sarcopenia in Older People (EWGSOP), sarcopenia was diagnosed in presence of low muscle mass plus either low muscle strength or low physical performance. The primary outcome measure was survival after 6 months.

Results
Forty residents (32.8%) were indentified as affected by sarcopenia. This condition was more common in men (68%) than in women (21%). During the follow-up period, 26 (21.3%) patients died. After adjusting for age, gender, cerebrovascular diseases, osteoarthritis, chronic obstructive pulmonary disease, activity of daily living impairment, and body mass index, residents with sarcopenia were more likely to die compared with those without sarcopenia (adjusted hazard ratio 2.34; 95% confidence interval 1.04–5.24).

Conclusions
The present study suggests that among subjects living in a nursing home, sarcopenia is highly prevalent and is associated with a significantly increased risk of all-cause death. The current findings support the possibility that sarcopenia has an independent effect on survival among nursing home residents.