Table 3.
Association Between Various Definitions of Sarcopenia and Hospitalization (N = 760) and Short-term Nursing Facility (SNF) Stay (N = 566) Over 3 Years in Older Women
| Likelihood of Hospitalization* OR (95% CI) | Rate Ratio of Inpatient Days Among Those Hospitalized* (95% CI) | Mean Rate of Inpatient Days Among All Women (d/y)* | Likelihood of SNF Stay† (OR, 95% CI) | |
|---|---|---|---|---|
| IWG summary definition | ||||
| Sarcopenia | 1.19 (0.78–1.83) | 0.89 (0.72–1.16) | 1.36 (0.96–1.78) | 0.72 (0.34–1.54) |
| No sarcopenia | 1.00 (referent) | 1.00 (referent) | 1.39 (1.17–1.58) | 1.00 (referent) |
| IWG definition components | ||||
| Slowness | 1.55 (1.08–2.21) | 1.06 (0.80–1.44) | 1.50 (1.23–1.76) | 1.81 (0.87–3.77) |
| No slowness | 1.00 (referent) | 1.00 (referent) | 1.10 (0.79–1.46) | 1.00 (referent) |
| Low lean mass | 0.94 (0.64–1.37) | 0.88 (0.71–1.11) | 1.22 (0.89–1.59) | 0.52 (0.25–1.09) |
| No low lean mass | 1.00 (referent) | 1.00 (referent) | 1.43 (1.21–1.65) | 1.00 (referent) |
| European Working Group for Sarcopenia in Older Persons (EWGSOP) summary definition | ||||
| Sarcopenia | 0.96 (0.64–1.44) | 0.92 (0.75–1.17) | 1.27 (0.91–1.70) | 0.47 (0.21–1.06) |
| No sarcopenia | 1.00 (referent) | 1.00 (referent) | 1.41 (1.19–1.61) | 1.00 (referent) |
| EWGSOP definition components | ||||
| Weakness | 0.87 (0.63–1.22) | 1.26 (0.93–1.70) | 1.47 (1.18–1.73) | 1.19 (0.67–2.13) |
| No weakness | 1.00 (referent) | 1.00 (referent) | 1.26 (0.94–1.57) | 1.00 (referent) |
| Slowness | 1.43 (1.00–2.04) | 1.27 (0.99–1.65) | 1.84 (1.37–2.36) | 2.14 (1.22–3.73) |
| No slowness | 1.00 (referent) | 1.00 (referent) | 1.20 (0.98–1.37) | 1.00 (referent) |
| Low lean mass | 0.94 (0.64–1.37) | 0.88 (0.71–1.11) | 1.22 (0.90–1.56) | 0.52 (0.25–1.09) |
| No low lean mass | 1.00 (referent) | 1.00 (referent) | 1.43 (1.19–1.65) | 1.00 (referent) |
| Foundation for the NIH (FNIH) Sarcopenia Project primary summary definition | ||||
| Weakness with low lean mass | 0.82 (0.47–1.43) | 0.93 (0.69–1.27) | 1.17 (0.72–1.69) | 0.47 (0.17–1.29) |
| No sarcopenia | 1.00 (referent) | 1.00 (referent) | 1.40 (1.19–1.59) | 1.00 (referent) |
| FNIH primary definition components | ||||
| Weakness | 0.97 (0.69–1.38) | 1.31 (1.04–1.59) | 1.64 (1.25–2.02) | 0.83 (0.47–1.49) |
| No weakness | 1.00 (referent) | 1.00 (referent) | 1.28 (1.05–1.48) | 1.00 (referent) |
| Slowness | 1.43 (1.00–2.04) | 1.27 (1.00–1.67) | 1.84 (1.37–2.36) | 2.14 (1.22–3.73) |
| No slowness | 1.00 (referent) | 1.00 (referent) | 1.20 (0.99–1.39) | 1.00 (referent) |
| Low lean mass | 0.99 (0.67–1.46) | 1.00 (0.80–1.27) | 1.37 (0.99–1.80) | 0.47 (0.23–0.96) |
| No low lean mass | 1.00 (referent) | 1.00 (referent) | 1.39 (1.15–1.60) | 1.00 (referent) |
| FNIH alternative summary definition | ||||
| Weakness with low lean mass | 0.92 (0.60–1.39) | 1.06 (0.83–1.39) | 1.40 (0.96–1.89) | 0.36 (0.16–0.80) |
| No sarcopenia | 1.00 (referent) | 1.00 (referent) | 1.38 (1.16–1.55) | 1.00 (referent) |
| FNIH alternative definition components | ||||
| Weakness | 0.97 (0.69–1.38) | 1.31 (1.04–1.65) | 1.64 (1.25–2.06) | 0.83 (0.47–1.49) |
| No weakness | 1.00 (referent) | 1.00 (referent) | 1.28 (1.05–1.48) | 1.00 (referent) |
| Slowness | 1.43 (1.00–2.04) | 1.27 (0.99–1.66) | 1.84 (1.41–2.37) | 2.14 (1.22–3.73) |
| No slowness | 1.00 (referent) | 1.00 (referent) | 1.20 (0.97–1.37) | 1.00 (referent) |
| Low lean mass | 0.86 (0.62–1.20) | 1.00 (0.80–1.30) | 1.31 (0.98–1.66) | 0.37 (0.20–0.69) |
| No low lean mass | 1.00 (referent) | 1.00 (referent) | 1.42 (1.16–1.64) | 1.00 (referent) |
| Baumgartner definition | ||||
| Sarcopenia | 1.09 (0.70–1.68) | 0.87 (0.68–1.14) | 1.27 (0.90–1.70) | 0.58 (0.25–1.36) |
| No sarcopenia | 1.00 (referent) | 1.00 (referent) | 1.40 (1.18–1.61) | 1.00 (referent) |
| Newman definition | ||||
| Sarcopenia | 1.10 (0.75–1.61) | 0.80 (0.65–0.98) | 1.21 (0.91–1.50) | 0.57 (0.28–1.19) |
| No sarcopenia | 1.00 (referent) | 1.00 (referent) | 1.43 (1.19–1.67) | 1.00 (referent) |
Notes: Models adjusted for age, clinical center, functional limitations (any difficulty with activities of daily living or instrumental activities of daily living: walking 2–3 blocks, climbing up 10 steps, preparing meal, heavy housework, shopping), and comorbidity score (none, 1, or 2 or more from the list of prevalent fracture, arthritis, diabetes, chronic obstructive pulmonary disease [COPD], angina, hypertension, congestive heart failure [CHF], MI, Parkinson’s, stroke, thyroid problem). IWG: presence of slowness (gait < 1.0 m/s) and low lean mass (ALM/ht2 ≤ 5.67kg/m2). EWGSOP: presence of slowness (gait ≤0.8 m/s) plus low lean mass (ALM/ht2 ≤ 5.67kg/m2) or weakness (grip < 20kg). FNIH primary definition: Presence of both weakness (grip < 16kg) and low lean mass (ALM/BMI < 0.512); slowness defined as gait ≤0.8 m/s. FNIH alternative definition: Presence of both weakness (grip < 16kg) and low lean mass (ALM<0.15.02); slowness defined as gait ≤0.8 m/s. Baumgartner: ALM/ht2 < 5.45kg/m2. Newman: Residual of actual ALM − predicted ALM from prediction equation ≤ −1.53kg/m2.
*Calculated using Logit-Poisson Hurdle model, bootstrapped CI’s presented for annualized rate of inpatient days. Analyses limited to women with Medicare Fee-for-Service claims (all clinics) or Kaiser Encounter data (Portland clinic only). N = 760.
†Calculated using logistic regression. Analyses limited to women with Medicare Fee-for-Service claims (all clinics). N = 566.
ALM = appendicular lean mass; BMI = body mass index; CI = confidence interval; EWGSOP = European Working Group for Sarcopenia in Older Persons; FNIH = Foundation for NIH Sarcopenia Project; IWG = International Working Group; MI = myocardial infarction; NIH = National Institute of Health.