New Clinical Practice Guidelines for Sarcopenia Screening and Diagnosis in Korean Older Adults: A Step Forward.

Abstract

Sarcopenia, the age-related loss of muscle mass, strength, and function, has become an increasingly prevalent condition as the global population ages. It is associated with a wide range of negative health outcomes including falls, disability, and mortality. In response to this growing problem, researchers and healthcare professionals have developed various guidelines and assessment tools for the diagnosis and management of sarcopenia. In Korea, the Korean Working Group on Sarcopenia (KWGS) has established new clinical practice guidelines for sarcopenia screening and diagnosis. As Korea is one of the fastest-aging countries worldwide, preventing and treating sarcopenia in older adults to prevent further frailty and disabilities has become an overarching healthcare issue. Although international guidelines for sarcopenia have been previously established, several issues support country-specific guidelines for this condition. First, different populations may have varying characteristics that could affect the diagnosis of sarcopenia based on body composition and functional parameters. Second, healthcare systems vary among countries, which can affect sarcopenia diagnosis and management. For example, in Korea, the healthcare system is disease-oriented and specialty-centered, and the concepts of frailty and intrinsic capacity have been relatively less adopted by both the healthcare and welfare sectors. Finally, the regulatory conditions may differ among countries. Specifically, sarcopenia has been considered a disease since 2021, and diagnostic procedures for this condition have become eligible for medical reimbursement. The KWGS guidelines incorporate a diverse range of screening tools, including questionnaires and physical examinations, for easier case-finding in different research and clinical settings. The guidelines also simplify the classification flow by combining the two existing steps suggested in other guidelines into one step to reduce confusion in the selection of diagnostic tools and increase the clinical uptake of sarcopenia diagnosis. Apart from existing sarcopenia guidelines that consider muscle mass a pivotal parameter for defining sarcopenia, the KWGS experts determined that having low muscle strength with low physical performance also has clinical relevance, even in the absence of decreased muscle mass. Thus, the KWGS defines a state of “functional sarcopenia.” This expanded conceptual definition of sarcopenia as a state with complex pathophysiology is consistent with the concept of frailty. The KWGS guidelines emphasize sarcopenia as a geriatric mobility condition with a complex pathophysiology rather than a single disease entity. Despite efforts to develop guidelines and assessment tools for sarcopenia, healthcare practitioners in Korea remain unfamiliar with diagnosing and setting up evaluation tools for sarcopenia in routine clinical practice, with inconsistencies in understanding the biological or clinical constructs of sarcopenia. Additionally, the geriatric domains of multimorbidity, polypharmacy, cognitive decline, depression, and social care needs are often overlooked in sarcopenia assessments and interventions. To address these problems, the KWGS’s new clinical guidelines aim to facilitate the early detection of sarcopenia by permitting diverse screening tools using a unified process. The KWGS recommendation expands the conceptual definition of sarcopenia and emphasizes the importance of designing holistic, personalized intervention plans based on comprehensive geriatric assessment (CGA), which embraces multiple domains. Hence, the KWGS recommends CGA to reveal the underlying and associated conditions of sarcopenia after making a diagnosis based on the diagnostic flow. This approach aims to ensure that healthcare professionals design holistic, personalized intervention plans based on CGA, embracing multiple domains, including not only nutrition and physical activity but also disability, medications, cognition, mood, and social support. As the published guidelines in this issue mainly focus on sarcopenia screening and diagnosis, a separate guideline on intervention will soon be developed.