ORIGINAL ARTICLE

Acta Med Indones - Indones J Intern Med • Vol 52 • Number 1 • January 2020

Sarcopenia and Frailty Profile in the Elderly Community of
Surabaya: A Descriptive Study

Novira Widajanti1, Jusri Ichwani1, Rwahita S. Dharmanta2, Hadiq Firdausi1,
Yudha Haryono3, Erikavitri Yulianti4, Stefanus G. Kandinata5, Meilia Wulandari5,
Rastita Widyasari5, Viranti A. Adyanita5, Nuri I. Hapsanti5, Diar M. Wardana5,
Titin Kr i sti ana 5, D r iy arkara 5, He mma Wahy u d a 5, S arah Yunara 5,
Kholidatul Husna5

1 Department of Internal Medicine, Faculty of Medicine Universitas Airlangga - Dr. Soetomo Hospital, Surabaya,
Indonesia.
2 Department of Physical Medicine and Rehabilitation, Faculty of Medicine Universitas Airlangga - Dr. Soetomo
Hospital, Surabaya, Indonesia.
3 Department of Neurology, Faculty of Medicine Universitas Airlangga - Dr. Soetomo Hospital, Surabaya, Indonesia.
4 Department of Psychiatry, Faculty of Medicine Universitas Airlangga - Dr. Soetomo Hospital, Surabaya, Indonesia.
5 Faculty of Medicine Universitas Airlangga, Surabaya, Indonesia.

Corresponding Author:
Novira Widajanti, MD. Department of Internal Medicine, Faculty of Medicine Universitas Airlangga – Dr. Soetomo
Hospital, Surabaya. Jl. Mayjen Prof. Dr. Moestopo 47, Surabaya 60131, Indonesia. email: novirawidajanti@fk.unair.
ac.id.

ABSTRAK
Latar belakang: sarkopenia dan frailty merupakan salah satu penyebab hilangnya mobilitas, disabilitas,

gangguan neuromuskular, dan sindroma kegagalan homeostatik dengan kelainan gaya berjalan dan keseimbangan
pada usia lanjut. Hal ini berkontribusi terhadap peningkatan angka jatuh dan patah (fall and fractures) sekaligus
meningkatan hospitalisasi, imobilisasi, bahkan mortalitas. Jumlah populasi usia lanjut dengan sarkopenia dan frailty
diperkirakan meningkat di seluruh dunia, sehingga studi mengenai angka prevalensi sarkopenia dan frailty secara
nasional sangat penting dilakukan sebagai dasar studi selanjutnya. Metode: penelitian ini merupakan penelitian
deskriptif dengan menggunakan data primer dari komunitas usia lanjut di Surabaya melalui posyandu lanjut usia.
Data biopsikososial, penurunan berat badan, kelelahan, dan aktivitas fisik didapat melalui wawancara, sedangkan
kekuatan genggam tangan, massa otot, dan performa fisik (kecepatan berjalan) diukur melalui instrumen. Hasil:
tiga ratus delapan subjek terkualifikasi untuk penelitian. Rerata usia subjek adalah 63 (60–100) tahun dengan
74,7% subjek berjenis kelamin perempuan. Prevalensi sarkopenia pada usia lanjut di Surabaya sebesar 41,8%
(laki-laki 13,9%, perempuan 27,9%). Prevalensi frailty secara umum adalah 36,7% (laki-laki 5,2%, perempuan
31,5%). Kesimpulan: prevalensi sarkopenia dan frailty pada populasi usia lanjut di komunitas tergolong tinggi.
Hasil penelitian ini diharapkan dapat menjadi awal dari penelitian berikutnya, terutama dalam menentukan cut-
off sarkopenia yang sesuai dengan sosiodemografi Indonesia.

Kata kunci: sarkopenia, frailty, usia lanjut, komunitas, profil.

ABSTRACT
Background: sarcopenia and frailty cause immobility, disability, neuromuscular disorders, and homeostatic

balance failure syndrome, characterized by gait and balance abnormalities in the elderly, and an increasing

Novira Widajanti Acta Med Indones-Indones J Intern Med

prevalence worldwide. This further contributes to the elevated incidence of falls and fractures, hospitalization,
immobilization, and even mortality, hence, a national-level study was conducted on the prevalence rates of
sarcopenia and frailty in the elderly. Methods: this descriptive study used primary data of elderly people (n =
308) in Surabaya, Indonesia. Furthermore, the biopsychosocial data, weight loss, fatigue, and physical activity
measurements were obtained through interviews, while handgrip strength, muscle mass, and physical performance
(walking speed) were evaluated using instruments. Results: the median age of the subjects was 63 years (60–100
years), and 230 (74.7%) were women. In addition the prevalence rate of sarcopenia was 41.8% (in 86 [27.9%]
women), while the prevalence rate of frailty was 36.7% (in 16 [5.2%] men and 97 [31.5%] women). Conclusion:
the prevalence of sarcopenia and frailty in the elderly is significantly high, thus, it is expected that this study results
are used as a basis for subsequent research, especially to determine the sarcopenia cut-off, in accordance with
Indonesian sociodemography.

Keywords: sarcopenia, frailty, elderly, community, profile.

INTRODUCTION
Sarcopenia is more often used as the subject

of research compared to frailty, despite of the
fact that they have been studied together for a
long time.1 Meanwhile, the absence of optimal
treatment is known to cause loss of muscle
strength, which further contributes to immobility,
neuromuscular disorders, homeostatic balance
failure syndrome,2 as well as walking and
stability disturbance.3 These occurrences tend
to increase the risk of fall and fractures in the
elderly,4-6 which ultimately leads to sarcopenia
and frailty.

According to the European Working Group
on Sarcopenia in Older People (EWGSOP)
and the Asian Working Group for Sarcopenia
(AWGS), the prevalence of sarcopenia in healthy
adults aged ≥60 years is approximately 10%
(95% confidence interval [CI] = 8%–12%) in
men and 11% (95% CI = 8%–13%) in women.7
A 2016 study in Bandung, West Java, Indonesia,
on 229 participants showed a 7.4% prevalence in
men and 1.7% in women on the basis of AWGS
parameters.7 A systematic review8 of 31 studies
on people aged ≥65 years showed a frailty
incidence of 4%–17% (9.9% on average), while
a study by Setiati et al.9 (2013) on 270 elderly
people in the outpatient department of Dr. Cipto
Mangunkusumo Hospital, Jakarta recorded
27.4%. In addition, women are two times more
likely to be frail, and the prevalence significantly
increases in people aged >80 years.10

Currently, there is a lack of national data
regarding the prevalence of sarcopenia and

frailty in Indonesia, especially in Surabaya.
Also, agreements have not been investigated
on the instruments and cut-offs of sarcopenia.
Therefore, the aim of this study is to determine
the prevalence of sarcopenia and frailty as a basis
for subsequent research.

METHODS
This is a cross-sectional, observational,

descriptive study, where primary data were
obtained using interviews and questionnaires.
Also, specific instruments were used to measure
sarcopenia and frailty amongst the elderly in
Posyandu Lansia in Surabaya.

Study Setting
Data were collected between December

2017 and March 2018 from five clinics, part
of five health centers in Surabaya, which were
Puskesmas Tambak Rejo, Sememi, Menur, Perak
Timur, and Putat Jaya.

Study Population and Sampling Method
The study population comprised the elderly

aged ≥60 years. Cluster random sampling was
used. One health center from each of the five
administrative regions in Surabaya was randomly
selected for data collection. The elderly selected
for the study encompassed those who were
recorded in the clinics, were willing and able
to fill out information on the informed consent
sheets, cooperative and capable of undergoing
several tests. Furthermore, those with severe
cardiovascular or respiration problems, a
history of pacemakers utility, and incomplete

Vol 52 • Number 1 • January 2020 Sarcopenia and frailty profile in the elderly community of Surabaya

checkpoints were excluded.
The study was conducted under ethical

clearance no. 273/EC/KEPK/FKUA/2017.

Study Instruments
T h e g e n e r a l c h a r a c t e r i s t i c s o f t h e

subjects were obtained using questionnaires.
Biopsychosocial profiles, including the
comorbidity index, nutritional status, cognitive
status, mental status, and functional status,
were assessed using the Charlson Comorbidity
Index (CCI), the Cumulative Illness Rating
Scale (CIRS), the Mini Nutritional Assessment
(MNA) questionnaire, the Abbreviated Mental
Test (AMT), the Mini-Mental State Examination
(MMSE), the Geriatric Depression Scale (GDS),
the Barthel Activity of Daily Living (ADL)
scale, and Lawton’s Instrumental Activity of
Daily Living (IADL). In addition, sarcopenia
was measured on the basis of the following
AWGS11 parameters: (i) muscle mass, which
was evaluated using the Bioelectrical Impedance
Analysis Omron Karada scan model HBF-362
(Omron Corporation, Kyoto, Japan) by adopting
the cut-off 2SD-derived from 40 subjects of
non-sarcopenic young adults as controls12 (men,
6.1 kg/m2; women, 3.05 kg/m2); (ii) hand grip
strength was measured using the TKK 5001 Grip
A hand dynamometer in triplicate, and the best
value was collected; and (iii) walking speed was
calculated using the gait speed test, where each
subject was requested to walk in a straight line
for 6 meters, and the time was recorded using a
stopwatch.

To determine the degree of sarcopenia, the
subjects were divided into the following groups:
severe sarcopenia on instances of low muscle
mass, hand grip strength, and gait speed; and
sarcopenia if the muscle mass was low and
the hand grip strength or gait speed was low;
presarcopenia if only the muscle mass was low;
and normal if all parameters were normal.13

Based on the Cardiovascular Health Study
(CHS) scale3 the measurement for frailty
involved using the following items: unintentional
weight loss, weakness with cut-off according to
the body mass index, fatigue, slow gait speed,
and low physical activity (measured using
the Physical Activity Scale for the Elderly).
Furthermore, the subjects were divided into

groups as follows: frailty if three of five criteria
were met, prefrailty if one or two were attained,
and fit if none was met.

Statistical Analysis
Data collected were processed using SPSS

Statistics ver. 17.0 (IBM Corporation, Armonk,
NY, USA) for Windows (Microsoft Corporation
Redmond, WA, USA). The categorical variables
were presented in frequencies and percentages,
while the continuous variables were presented
according to their distributions. Furthermore,

Table 1. General characteristics of the subjects in this
study

Characteristics n (%)

Sex

- Male 78 (25.3)

- Female 230 (74.7)

Marital status

- Married 178 (57.8)

- Widow/widower 117 (38.0)

- Divorced 7 (2.3)

- Single 6 (1.9)

Education

- No schooling 48 (15.6)

- Some primary 42 (13.6)

- Completed primary 98 (31.8)

- Junior high school 63 (20.5)

- High school 42 (13.6)

- Associate’s Degree 7 (2.3)

- Bachelor’s Degree 8 (2.6)

Monthly income (in millions Rupiahs)

- <1.5 234 (75.9)

- 1.5–3 55 (17.9)

- >3 19 (6.2)

Financial dependency

- Independent 69 (22.4)

- Partially dependent 55 (17.9)

- Wholly dependent 160 (51.9)

- Pension 24 (7.8)

Walker use

- No 295 (95.8)

- Yes 13 (4.2)

Regular exercise

- No 106 (34.4)

- Yes 202 (65.6)

History of falls in the last year

- No 270 (87.7)

- Yes 38 (12.3)

Novira Widajanti Acta Med Indones-Indones J Intern Med

continuous variables with normal distributions
were presented as mean (standard deviation),
while those without were displayed as median
(minimum-maximum).

RESULTS
From December 2017 to March 2018, a

total of 320 elderly were screened for the study,
where none exhibited severe cardiovascular or
respiration problems, and history of utilizing
pacemakers. However, about 12 participants
were unable to complete the checkpoints, and
thus excluded from the study. Out of the 308
total subjects, 230 (74.7%) were women, with a
median age of 63 (60–100) years, and Table 1
shows other general characteristics.

The median comorbidity score based on
the CCI was 4.00 (2–10). The median 10-year
survival rate was 0.53 (0.00–0.90). Based on
the CIRS, the three most frequent comorbidities
were musculoskeletal disorders (mild: n = 187
[60.7%]; moderate: n = 23 [7.5%]), hypertension,
and sensory system disorders. Based on the
Lawton’s IADL tool, the median functional

status score was 6.00 (1–8) for men and 8.00
(0–8) for women, and Table 2 shows other
biopsychosocial profiles of the subjects.

The median value for hand grip strength
was 29.00 kg (15.00–44.00 kg) and 18.50 kg
(6.00–29.00 kg) for men and women. The median
gait speed for men was 0.78 m/s (0.30–1.32
m/s); whereas the mean gait speed for women
was 0.70 (SD 0.20) m/s. In addition, the mean
muscle mass for men was 4.89 (SD 1.30) kg/
m2; while the median muscle mass for women
was 3.08 (1.33–5.52) kg/m2. Table 3 shows the
distribution of all three sarcopenia parameters.

Table 2. Biopsychosocial profile of the subjects in this study

Variables n (%)

AMT

- Severe mental impairment 5 (1.6)

- Mild-moderate mental impairment 22 (7.1)

- Normal 281 (91.2)

MMSE

- Severe cognitive impairment 12 (3.9)

- Mild cognitive impairment 53 (17.2)

- Normal 243 (78.9)

GDS

- Normal 305 (99.0)

- Depressive 3 (1.0)

Nutritional status

- Normal 216 (70.1)

- At risk of malnutrition 81 (26.3)

- Malnourished 11 (3.6)

Barthel ADL

- Partially dependent 4 (1.3)

- Minimally dependent 94 (30.5)

- Totally independent 210 (68.2)

AMT, abbreviated mental test; MMSE, Mini-Mental State
Examination; GDS, geriatric depression scale; ADL,
activity of daily living.

Table 3. Distribution of sarcopenia parameters

Variables Male - n (%) Female - n (%)

Hand grip strength

- Low 27 (8.8) 101 (32.8)

- Normal 51 (16.6) 129 (41.9)

Gait speed

- Low 42 (13.6) 162 (52.6)

- Normal 36 (11.7) 68 (22)

Muscle mass

- Low 66 (21.4) 109 (35.4)

- Normal 12 (3.9) 121 (39.3)

The prevalence rate was 41.8%, where 43
(13.9%) men and 86 (27.9%) women were
sarcopenic, and 63 (20.4%) of the subjects
exhibited severe symptoms.

On the basis of the CHS scale, the prevalence
rate of frailty was 36.7%, of which 16 (5.2%)
were men and 97 (31.5%) were women, with
details shown in Table 4.

DISCUSSION
Sarcopenia is defined as low muscle mass

with low hand grip strength or low gait speed.11
Furthermore, its prevalence rate in Asia (2008)14
was 6%–23% and 8%–22% in men and women,
respectively, with the lowest prevalence was
found in Hong Kong (12.3% in men and 7.6%
in women) and Korea (6.3% in men and 4.1% in
women).15 Conversely, the highest incidence is
recorded in Taiwan (23.6% in men and 18.6% in
women)14 and Japan (21.8% in men and 22.1%
in women).16

Vol 52 • Number 1 • January 2020 Sarcopenia and frailty profile in the elderly community of Surabaya

Specifically, this study records a prevalence
of 13.9% in men and 27.9% in women, which
is much higher than the studies conducted
in Bandung, reported based on the cut-off
recommended by the AWGS of 9.1% (7.4% in
men and 1.7% in women) and 40.6% (20.1% in
men and 20.5% in women) based on the cut-off
from Taiwan’s population.7 The subjects in this
study had a much lower mean muscle mass for
both men and women, compared to the research
in Bandung, with the women in both exhibiting
relatively lower values.

A study by Pongchaiyakul et al17 in Thailand
showed a higher prevalence of sarcopenia,
based on the assessment of low relative skeletal
muscle mass only, both in men and women,
which were 35.33% and 34.74% respectively.
In addition, living in the city had the strongest
association with low skeletal muscle index with
an odds ratio (OR) of 17.26 (SD 7.12) in men
and 8.62 (SD 2.74) in women. Living in the
biggest metropolitan city in the province, the
people of Surabaya tend to have a more sedentary
lifestyle. This contributes to the development
of sarcopenia, asides from the factor associated
with age, which were from the factors associated
with activities and nutrition.17-18 Similar results
were established in a study of Brazilian elderly
women conducted by Mazocco et al.19, which

demonstrated a higher vulnerability in those
living in urban areas (OR = 9.561). In addition,
less sun exposure, more diet high in fats and
refined carbohydrates, and also low fiber
intake are other possible reasons for the high
prevalence.17

About 86 (27.9%) women studied were
sarcopenic, which is much higher than in men
(13.9%). This is in line with a study of suburb-
dwelling older Chinese in 2016, recording a
higher occurrence in women than men, of 11.5%
and 6.4% respectively. According to the study, the
higher BMI in men was identified as a protective
factor against sarcopenia.20 Also, menopause
is capable of changing body composition and
fat distribution, consequently the composition
of fat-free body mass in women declines with
increasing body weight, fat mass, and central fat
deposition. This is characterized by the tendency
to exhibit decreased muscle mass,21 and a higher
incidence of sarcopenia.

Interesting results were reported for the
muscle mass values, as categorized in Table 3,
which was low for the majority of men (n = 66
[21.4%]), and normal for most women (n = 121
[39.3%]). According to Roubenoff, men tend
to experience a more significant decrease in
muscle mass as a result of the declining growth
hormone and testosterone levels.22 Hence, some
studies reported a relatively higher prevalence
in men.14-15

Malnutrition was associated with the
development of sarcopenia.18,23-25 On the basis
of the MNA questionnaire, 81 (26.3%) subjects
in this study were classified to be at risk of
malnutrition and 11 (3.6%) were malnourished.
The prevalence of malnutrition was lower (1.2%)
in Iran, where the prevalence of sarcopenia was
20.8%.23 Lower prevalence of sarcopenia was
also identified in a study among community-
dwelling elderly in Taiwan (6.8%), where the
prevalence of abnormal nutritional status (both
at risk and already malnourished) was only
5.1%.24 In addition, malnourished individuals
tend to lack nutritional factors like protein,
vitamin D, calcium, and the acid-base balance of
a diet, which plays a role in maintaining muscle
mass and muscle strength, as well as physical
performance,18 necessary in the diagnosis of

Table 4. Distribution of frailty parameters based on the
CHS scale.

Variables Male - n (%) Female - n (%)

Weight loss

- No 69 (22.4) 205 (66.6)

- Yes 9 (2.9) 25 (8.1)

Hand grip weakness

- No 75 (24.4) 128 (41.6)

- Yes 3 (1) 102 (33.1)

Fatigue

- No 57 (18.5) 159 (51.6)

- Yes 21 (6.8) 71 (23)

Slow gait speed

- No 29 (9.4) 29 (9.4)

- Yes 49 (15.9) 201 (65.3)

Low levels of physical activity

- No 35 (11.4) 95 (30.8)

- Yes 43 (14) 135 (43.8)

CHS, Cardiovascular Health Study.

Novira Widajanti Acta Med Indones-Indones J Intern Med

sarcopenia. Meanwhile, the other possible
explanation is because malnourished people
demonstrate reduced muscle protein synthesis.25

Frailty
The prevalence rate of frailty in the present

study was 5.2% in men and 31.5% in women.
Overall, the prevalence of frailty was 36.7%. The
prevalence rate of frailty according to the CHS
in the elderly aged >=65 years is 7%, reaching
30% in those aged >=80 years.3

Lower results were found in a study by
Setiati et al.26 recording a prevalence of 25.2%,
where nutritional and functional status, as well as
age were considered as essential factors. Despite
the relatively older mean age (74.2%) recorded,26
the proportion of individuals at risk and those
already malnourished was lower than the values
reported in the present study of 24.6% and 2.5%
respectively. However, it is also noted that Setiati
et al.26 recruited the subjects from the hospital, of
which some were referred from primary health
care and smaller hospitals. This consequently
leads to differences in the prevalence of frailty
in comparison with other elderly individuals in
the Indonesian population.

Another study by Setiati et al.9 (2013),
reported on the frailty prevalence rate of 27.4%
in 270 elderly individuals of an outpatient setting,
while 71.1% was recorded for prefrailty.

Women are known to be at a two times
higher risk of being frail compared to men.10
This phenomenon is possibly explained through
various mechanisms, including the fact that
women exhibit lower hand grip strength than
men, with a mean value of 18.5 kg and 29 kg,
respectively. This is due to the fact that women
possess greater fat mass,21 and the relatively
higher vulnerable to fatigue. Specifically, fatigue
is defined on the basis of two items identified in
the Center for Epidemiologic Studies Depression
Scale (CES-D) questionnaire:
• I find it difficult to start activities as usual.
• I feel the need for extra effort to start the

activity.

Using similar definition, Vestergaard et al.27
reported a 15% and 29% prevalence rate of
fatigue in men and women, respectively in Italy.
Also, using reduced energy as the definition,

Tolea et al.28 reported the experience in 12% of
men and 22% of women. Comparably, women
tend to exhibit a slightly lower speed, due to the
variation in anthropometric size and lifestyles.28
Among the elderly, Lenardt et al.29 (2013)
reported men as more physically active.

There was higher prevalence of frailty among
women in the present study than men (31.5% vs.
5.2%). A study by Rensa et al.30 reported a 24%
proportion in women, with report of a relatively
older median age (67 years old). However, the
B-ADL was lower in the present study, which
according to Rensa et al,30 was associated with
the frailty syndrome in elderly.

The prevalence further increases significantly
in individuals >80 years of age,10 as cellular
m e t a b o l i s m a n d p h y s i o l o g i c a l f u n c t i o n
progressively decreases over time. In addition,
the musculoskeletal system is also affected by
sarcopenia, characterized by the reduced muscle
strength, mobility, balance, and tolerance for
activities, subsequently increasing the risk of
falls and physical inactivity.31

Weight loss results in reduced fat mass,
muscle mass, and bone.32 Furthermore, low
muscle mass is one of the factors associated
with the decline in gait speed and weakness of
hand grip in sarcopenia,33 hence the overlapping
relationship with frailty.34 In addition, low
muscle mass is also associated with fatigue.35

According to Newman36 (2005), about
15%–20% of the elderly experience weight loss,
which is defined as a loss of >=5 kg (or >5%)
of the initial body weight for 5–10 years. This
prevalence increases in high-risk populations,
encompassing community-dwelling elderly, and
it is also associated with advanced age, presence
of disability, comorbidity, hospital admission
history, low level of education, cognitive
impairment, smoking, death of a partner, and
low initial body weight.27

Conversely, physical activities are affected by
both physiological and external factors, including
opportunities, gender-related sociocultural values,
motivation, and choices.37 Health problems are
risk factors for a decreased functional status,
creating limitations for the elderly, which results
in complications and the emergence of new
problems.38 Therefore, the presence of physical

Vol 52 • Number 1 • January 2020 Sarcopenia and frailty profile in the elderly community of Surabaya

activity is an indicator of independence in daily
life, which contributes towards the reduction
and control of cardiovascular and ischemic heart
disease.39

There was an association between cognition
and frailty,40-41 which was better illustrated as
a cycle as frailty increases the risk of future
cognitive decline and conversely cognitive
impairment increases the risk of frailty.41 A
systematic review on 10 cross-sectional studies
and 9 longitudinal studies reported that cognitive
impairment was more prevalent in frail elderly.40
This result is in line with the present study, where
most (75%) of the elderly with severe cognitive
impairment were frail and 54.7% of those with
mild cognitive impairment were frail. (Table 5).

young adults as the reference for the diagnosis
of sarcopenia. Moreover, according to the
authors’ knowledge, the present study is the first
multicenter study in Indonesia which has nearly
complete sarcopenia and frailty profile in the
elderly. This study is expected to be a basis for
subsequent research.

CONCLUSION
The prevalence rates of sarcopenia and

frailty in the elderly population of Surabaya are
high. However, the results obtained differ from
other previous research perfomed in several
cities of Indonesia, hence an agreement on
the instruments and cut-offs is required in the
determination of sarcopenia.

ACKNOWLEDGMENTS
The author is grateful to the Heads of the

Tambak Rejo Community, Menur, Sememi, Perak
Timur, and Putat Jaya Health Center, as well as
the supervised Posyandu, Posyandu Lansia cadres
in each, and all parties involved in ensuring the
successful completion of this research. This Study
was funded by Dr. Soetomo Hospital, Surabaya
Research Program.

REFERENCES
1. Bauer JM, Sieber CC. Sarcopenia and frailty: a

clinician’s controversial point of view. Exp Gerontol.
2008;43(7):674-8. doi: 10.1016/j.exger.2008.03.007.
PMID 18440743.

2. Vetta F, Ronzoni S, Taglieri G, et al. The impact of
malnutrition on the quality of life in the elderly. Clin
Nutr. 1999;18(5):259-67. doi: 10.1054/clnu.1999.0060.
PMID 10601532.

3. Dutta C. Significance of sarcopenia in the elderly.
J Nutr. 1997;127(5 Suppl.):992S-3S. doi: 10.1093/
jn/127.5.992S. PMID 9164281.

4. Fried LP, Tangen CM, Walston J, et al. Cardiovascular
health study Collaborative Research Group: frailty in
older adults. J Gerontol A. 2001;56(3):M146-57. doi:
10.1093/gerona/56.3.M146.

5. Moulias R, Meaume S, Raynaud-Simon A. Sarcopenia,
hypermetabolism, and aging. Z Gerontol Geriatr.
1999;32(6):425-32. doi: 10.1007/s003910050140.
PMID 10654381.

6. Vanitallie TB. Frailty in the elderly: contributions of
sarcopenia and visceral protein depletion. Metabolism.
2003;52(10 Suppl.):22-6. doi: 10.1016/s0026-
0495(03)00297-x. PMID 14577059.

7. Vitriana, Defi IR, Irawan GN, et al. Prevalensi

Table 5. Frequency of cognitive impairment among fit,
prefrail, and frail elderly.

Cognitive
Function

Fit
n (%)

Prefrail
n (%)

Frail
n (%)

Severe cognitive
impairment

0 (0) 3 (25) 9 (75)

Mild cognitive
impairment

1 (1.9) 23 (43.4) 29 (54.7)

Normal 18 (7.4) 150 (61.7) 75 (30.9)

Among other instruments, the frailty criteria
proposed by Fried et al.8, using the data from
CHS, remains the most frequently used,40,42 and
was shown to demonstrate a good predictive
validity for adverse health outcomes in various
populations.42 However, there are some studies
suggested the inclusion of cognition as a frailty
component,41-42 as impairments in both physical
and cognitive function contribute to the risk of
functional decline in elderly.

There were some limitations in the present
study. First, the subjects were needed to undergo
several tests to measure each components of
sarcopenia and frailty. This could lead to fatigue
which could affect the outcomes. To overcome
this, all subjects were given time to eat and
do ice-breaking in the middle of the tests.
Second, all subjects despite exhibiting cognitive
impairment were included in the present study,
although some informations were collected from
the care giver, not the subjects themselves.

One of the strength in this study is the mean
muscle mass measurement of non-sarcopenic

Novira Widajanti Acta Med Indones-Indones J Intern Med

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