Sarcopenia: age-related muscle loss, symptoms, causes and what helps

Sarcopenia is the term for progressive loss of skeletal muscle quantity, strength and function, most often linked to older age. A British Geriatrics Society conference abstract describes it as a major modifiable risk factor for falls, and notes that acute illness and hospitalisation can accelerate muscle loss, further raising the risk. Falls in older adults are described there as a leading cause of injury, hospitalisation and loss of independence.

Doctors often start with muscle strength, because it is practical to measure. In the Newcastle SarcScreen study, a short questionnaire (SARC-F) was used to flag probable sarcopenia, and objective measurement of muscle strength and quantity was then recommended to confirm it. Weakness was defined by grip strength.

The SARC-F questionnaire, used as a quick screening tool, asks about five features and consequences of sarcopenia: difficulty lifting and carrying, needing assistance to walk, difficulty rising from a chair or bed, difficulty climbing a flight of 10 stairs, and falls. Each is scored 0, 1 or 2, giving a total from 0 (no difficulties) to 10 (severe difficulties).

The NHS says falls services check for problems such as muscle weakness, weak bones and eyesight problems, and review medicines, so unexplained weakness is worth raising with a GP rather than putting down to age.

• Difficulty lifting and carrying things.

• Needing help to walk.

• Difficulty getting up from a chair or bed.

• Difficulty climbing a flight of stairs.

• Falls.

Strength exercise is the main approach in the sources used here. The NHS physical activity guidelines for adults aged 65 and over say to be physically active every day, even if only light activity; do activities that improve strength, balance and flexibility on at least 2 days a week; do at least 150 minutes of moderate intensity activity a week or 75 minutes of vigorous activity if already active; and break up long periods of sitting or lying down.

The NHS lists lifting weights, resistance bands, body-weight exercises, yoga, pilates, tai chi, carrying heavy shopping and heavy gardening as muscle-strengthening activities. To get the benefit, it says to work to the point where you need a short rest before repeating the activity.

The NHS says to speak to a GP first if you have not exercised for some time or have medical conditions, and to make sure the intensity suits your fitness. If you have fallen or are worried about falling, it says exercises to improve strength, balance and flexibility will help make you stronger and feel more confident on your feet.

The sources used for this page point to two clear drivers. The first is age: the NHS lists muscles getting weaker as you get older among the causes of falls. The second is illness. A British Geriatrics Society abstract states that acute illness and hospitalisation accelerate muscle loss, which further increases the risk of falls.

Other health problems can also reduce strength or steadiness and make it harder to tell sarcopenia from something else. The NHS lists conditions that affect mobility or balance (arthritis, stroke, Parkinson's disease), low blood pressure, side effects of some medicines, eyesight or hearing problems and dementia as causes of falls. This is why a GP will usually look at the whole picture rather than assuming that weakness is simply age.

The same abstract describes sarcopenia as a major modifiable risk factor for falls, which means it can be improved. That is why exercise and nutrition are the focus of treatment.

A British Geriatrics Society conference abstract states that adequate protein intake and resistance exercise are central to maintaining muscle mass and function. In a systematic review of 30 trials of hospitalised or recently discharged older adults (mean age about 80), supplements enriched with HMB improved handgrip strength, though the finding was strongly influenced by one large study, and results for muscle mass were inconsistent.

The authors conclude that large, high-quality trials are still needed to refine dose, timing and combination with exercise. The abstract is a poster presented at a conference and the Society does not endorse its content, so treat it as early evidence rather than advice to buy supplements.

The NHS falls advice also says that not eating and drinking enough can make you feel lightheaded or faint, and suggests eating foods containing calcium and getting enough vitamin D to look after your bone health. If you are eating poorly or losing weight without meaning to, raise it with a GP, who can refer you for dietary advice.

The Newcastle study describes the usual pathway. SARC-F is used to find people with likely sarcopenia; its creators suggested a cut-point of 4 or more to flag probable sarcopenia, after which objective measures of muscle strength and quantity are recommended. Grip strength, measured with a hand-held dynamometer, is a standard test, with weakness classified as less than 27 kg for men and less than 16 kg for women under the European Working Group on Sarcopenia in Older People (EWGSOP2) criteria.

A 2021 meta-analysis of 29 studies found SARC-F had low to moderate sensitivity (28.9 to 55.3%), so it can miss people with sarcopenia, and its authors suggested assessing high-risk groups directly. In the Newcastle clinic sample, lower cut-points improved sensitivity, for example 81% at a cut-point of 4 or more compared with 97% at 2 or more in women. A normal questionnaire result therefore does not rule out weakness.

The Newcastle data came from an Older People's Medicine Day Unit, a specialist hospital service. In that group, 86.8% of men and 82.6% of women had muscle weakness by grip strength, so these figures describe a selected clinic population rather than older people in general.

The NHS says to call 999 if you or someone else has fallen and may have injured the head, back, neck or hip, or cannot get up. Do not try to lift someone yourself. Get help from NHS 111 if you have fallen and may be in pain, injured or unwell.

See a GP if you are worried about your balance or mobility, or if you have had a fall. The NHS says a falls service can check for muscle weakness, weak bones and eyesight problems, offer strength and balance training, check that your home is safe and review your medicines.

Weakness that comes on suddenly is different from slow muscle loss. The NHS lists weakness or numbness down one side of the body, a drooping face, slurred speech and sudden confusion among the signs of a stroke, and says to call 999 straight away, even if the symptoms stop after a short time.

• Wear well-fitting shoes or slippers with a good grip.

• Carry a mobile phone or wear a personal alarm.

• Use a non-slip mat in the bath or shower and consider grab rails.

• Ask a GP or pharmacist whether any of your medicines could affect balance.

On the NHS, the usual starting point is a GP. The NHS says a GP who thinks you are at risk of falls will check your balance and may refer you to a specialist falls service. It also says that if you have had a fall you might be able to refer yourself directly to services that can help, and suggests asking your GP surgery reception, checking the surgery website or contacting your local integrated care board (ICB).

Private physiotherapists, exercise professionals, dietitians and geriatricians also see older adults for strength and mobility. Whichever route you use, ask what each test or scan will change about your plan. The questionnaire and grip-strength pathway described in the Newcastle study does not depend on scans.