What is muscle loss in the elderly?
Muscle loss in the elderly, medically known as sarcopenia, is the involuntary loss of muscle mass and function due to aging. As age advances, various degrees of decline occur in body functions. Muscle loss in the elderly is one of the most significant of these natural processes.

One of the elements of a quality life is living independently without needing help from others. Due to muscle loss, difficulties may arise in performing some routine daily activities such as sitting down and standing up, walking, carrying or lifting objects. Loss of balance and fractures caused by falls can confine individuals to bed and lead to further progression of muscle loss.

What causes muscle loss in the elderly?
Sarcopenia, generally known as a condition affecting people over 65 years old, is a normal process we must go through. About one-third of the total body weight of an adolescent is made up of striated muscles. After the age of 30, approximately 1% of muscle tissue is lost annually. By the seventies, about half of the muscle tissue and mass has been lost. As aging continues, these losses accelerate and sarcopenia progresses more rapidly. The most common causes of muscle loss in the elderly include:

• Aging; starting around 65 and accelerating after 80 years,
• Nutrition; reduced taste sensation in the mouth or insufficient protein intake due to poor nutrition,
• Decreased physical activity and sedentary lifestyle,
• Decreased secretion of hormones that increase protein synthesis in muscle tissue such as testosterone and growth hormone,
• Impaired blood flow (perfusion) in muscle tissue caused by atherosclerosis (vascular calcification) associated with aging,
• Age-related deficiencies in neural stimulation of muscle cells.

Why is muscle loss important in the elderly?
To live physically independently, healthy muscle tissue and muscle functions are essential. Muscle loss in the elderly can cause various health problems resulting in physical disability, low quality of life, trauma, and even death.

Sarcopenia is more common in men and is one of the main causes of disability and hospitalization in the elderly. Balance disorders and falls occurring after 65-70 years of age often result in traumatic bone fractures, brain injuries, and bleeding due to muscle loss in elderly individuals.

Confinement to bed can lead to other diseases, increasing healthcare costs. Considering the increase in life expectancy, this situation may cause serious social security challenges in the coming years.

Besides all this, feeling physically inadequate, weakness, fatigue, and difficulty performing daily activities are among the most challenging problems of life. As a result, the individual gradually withdraws from life and becomes dependent on others. Among people over 85, this dependency rate approaches almost half.

Being able to perform daily tasks without needing anyone’s help is a very important privilege.

What are the symptoms of muscle loss in the elderly?
Muscle loss in the elderly is a progressive condition and usually does not cause pain. In the initial stage called presarcopenia, physical performance is not yet affected, but muscle mass has decreased. In the sarcopenia stage, muscle strength and performance also decline along with muscle mass. In severe sarcopenia, all three key criteria—muscle mass, muscle strength, and physical performance—are reduced. Common symptoms include:

• Weakness and loss of strength in muscles,
• Difficulty climbing stairs,
• Balance problems and falls,
• Difficulty performing daily physical activities,
• Decrease in muscle mass,
• Difficulty standing up from a seated position and starting to walk.

How is muscle loss in the elderly diagnosed?
Many symptoms may be dismissed as normal aging and underestimated. However, when the condition progresses, signs such as fatigue, weakness, and thinning of the hips and legs become noticeable. Consulting a physical therapy and rehabilitation specialist is the first step to diagnosis. With a thorough history, detailed physical examination, and some supportive tests, diagnosis can be made confidently. Sarcopenia tests and measurements can determine the severity of the condition.

To diagnose muscle loss in the elderly, it is essential to analyze muscle mass, muscle strength, and physical performance.

• Muscle strength is assessed with tests like the handgrip strength test,
• Muscle mass is measured using imaging techniques such as CT, MRI, DEXA, or bioimpedance analysis (BIA),
• Physical performance is evaluated with tests like the Short Physical Performance Battery, which measures strength, balance, and endurance.

Can muscle loss in the elderly be treated?
Currently, there is no approved medication specifically for preventing muscle loss in the elderly. Hormonal therapies like growth hormone, testosterone, or drugs stimulating ACTH secretion from the pituitary gland (such as urocortin) have been tried but are not recommended due to their side effects.

Preventive measures take priority here. With physical therapy and rehabilitation strategies implemented before the condition progresses (e.g., before fractures occur), individuals can maintain their independence.

What can be done to prevent muscle loss in the elderly?
The most reasonable preventive measures are those focused on rehabilitation and exercise. Applying these methods increases physical capacity and helps prevent muscle loss.

Resistance (strength) exercises and training can prevent and reduce muscle loss in the elderly. Exercises to strengthen muscles (aerobic) targeting all muscle groups (legs, lower back, chest, shoulders, abdomen, and back) should be done at least twice a week. Aerobic exercises play a very important role in slowing down and preventing muscle loss.

In addition to exercise, dietary measures supervised by a dietitian should be implemented to increase muscle mass, including a high-quality protein diet and supplements like vitamin D. Exercise and nutrition stimulate muscle protein synthesis.

Studies have shown that appropriate exercise programs can lead to about a 20-30% increase in muscle strength and endurance.

At our center, under the supervision of physical therapy and rehabilitation specialists and with the help of professional physiotherapists, exercises are applied to slow down and stop muscle loss in the elderly.