At least in Paula’s imagination. Metaphorically. Change of old air for fresh air is vital, she thinks, for memory, cognition and imagination. Air exchange is the function of the respiratory muscles, especially the diaphragm.
The risk for respiratory complications and infections is substantially increased in old age, which may be due, in part, to sarcopenia (aging-related weakness and atrophy) of the diaphragm muscle (DIAm), reducing its force generating capacity and impairing the ability to perform expulsive non-ventilatory motor behaviors critical for airway clearance. The aging-related reduction in DIAm force generating capacity is due to selective atrophy of higher force generating type IIx and/or IIb muscle fibers, whereas lower force generating type I and IIa muscle fiber sizes are preserved. Fiber type specific DIAm atrophy is also seen following unilateral phrenic nerve denervation and in other neurodegenerative disorders. Accordingly, the effect of aging on DIAm function resembles that of neurodegeneration and suggests possible common mechanisms, such as the involvement of several neurotrophic factors in mediating DIAm sarcopenia. Respir Physiol Neurobiol. 2016 Jun;226:137-46. doi: 10.1016/j.resp.2015.10.001. Epub 2015 Oct 20. Functional impact of sarcopenia in respiratory muscles Jonathan E Elliott 1, Sarah M Greising 1, Carlos B Mantilla 2, Gary C Sieck
The diaphragm muscle is the most important contractile district used for breathing. Like other muscles in the human body, it is subject to ageing and sarcopenia. Sarcopenia can be classified as primary (or age-related) when there are no local or systemic pathologies that cause a functional and morphological detriment of skeletal musculature. Secondary sarcopenia occurs when there is a cause or more pathological causes (illness, malnutrition, immobility) related or unrelated to ageing. In the elderly population, transdiaphragmatic pressure (Pdi) decreases by 20-41%, with a decline in the overall strength of 30% (the strength of the expiratory muscles also decreases). The article discusses the adaptation of the diaphragm muscle to ageing and some other ailments and co-morbidities, such as back pain, emotional alterations, motor incoordination, and cognitive disorders, which are related to breathing…………….Sarcopenia can be classified as primary (or age-related) when there are no local or systemic pathologies that cause a functional and morphological detriment of skeletal musculature . Secondary sarcopenia occurs when there is a cause or more pathological causes (illness, malnutrition, immobility) related or not to ageing . Ageing of the Diaphragm Muscle Bruno Bordoni,1Bruno Morabito,2 and Marta Simonelli3 Cureus. 2020 Jan; 12(1): e6645. doi: 10.7759/cureus.6645
Sarcopenia: revised European consensus on definition and diagnosis 2019
Sarcopenia is a muscle disease (muscle failure) rooted in adverse muscle changes that accrue across a lifetime; sarcopenia is common among adults of older age but can also occur earlier in life. In this updated consensus paper on sarcopenia, EWGSOP2: (1) focuses on low muscle strength as a key characteristic of sarcopenia, uses detection of low muscle quantity and quality to confirm the sarcopenia diagnosis, and identifies poor physical performance as indicative of severe sarcopenia; (2) updates the clinical algorithm that can be used for sarcopenia case-finding, diagnosis and confirmation, and severity determination and (3) provides clear cut-off points for measurements of variables that identify and characterise sarcopenia………
Health and healthcare costs of untreated sarcopenia
Optimal care for people with sarcopenia is essential because the condition has high personal, social and economic burdens when untreated . In terms of human health, sarcopenia increases risk of falls and fractures [10, 11]; impairs ability to perform activities of daily living ; is associated with cardiac disease , respiratory disease  and cognitive impairment ; leads to mobility disorders ; and contributes to lowered quality of life , loss of independence or need for long-term care placement [17–19], and death .
Filling the gaps for sarcopenia awareness, care and research design
Many aspects of the epidemiology and pathophysiology of sarcopenia are better understood today than 10 years ago. Researchers have identified links between muscle pathology and adverse health outcomes, and studies have also provided evidence that certain treatment strategies can help prevent or delay adverse consequences.
Such new insights led EWGSOP2 to review, ‘What is new?’ and ‘How can we use this knowledge to improve care for people with sarcopenia and to guide future research studies?’ These insights include:
- First, sarcopenia has long been associated with ageing and older people, but the development of sarcopenia is now recognised to begin earlier in life , and the sarcopenia phenotype has many contributing causes beyond ageing [26, 27]. These insights have implications for interventions that prevent or delay development of sarcopenia.
- Second, sarcopenia is now considered a muscle disease (muscle failure), with low muscle strength overtaking the role of low muscle mass as a principal determinant [11, 28–30]. This change is expected to facilitate prompt identification of sarcopenia in practice.
- Third, sarcopenia is associated with low muscle quantity and quality, but these parameters are now used mainly in research rather than in clinical practice. Muscle mass and muscle quality are technically difficult to measure accurately [31–34].
- Fourth, sarcopenia has been overlooked and undertreated in mainstream practice , apparently due to the complexity of determining what variables to measure, how to measure them, what cut-off points best guide diagnosis and treatment, and how to best evaluate effects of therapeutic interventions . To this end, EWGSOP2 aims to provide clear rationale for selection of diagnostic measures and cut-off points relevant to clinical practice.
To enhance awareness and care for sarcopenia, the EWGSOP2 has updated its definition and diagnostic strategies in 2018. Specific goals for the updates were to: (1) build a sarcopenia definition that reflects recent advances in scientific, epidemiological, and clinical knowledge about skeletal muscle, (2) identify variables that best detect sarcopenia and predict outcomes, and determine best tools for measuring each variable, (3) advise cut-off points for measured variables and (4) recommend an updated screening and assessment pathway that is easy to use in clinical practice. Sarcopenia: revised European consensus on definition and diagnosis Alfonso J Cruz-Jentoft,1Gülistan Bahat,2Jürgen Bauer,3Yves Boirie,4Olivier Bruyère,5Tommy Cederholm,6Cyrus Cooper,7Francesco Landi,8Yves Rolland,9Avan Aihie Sayer,10Stéphane M Schneider,11Cornel C Sieber,12Eva Topinkova,13Maurits Vandewoude,14Marjolein Visser,15Mauro Zamboni,16 and Writing Group for the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), and the Extended Group for EWGSOP2 Age Ageing. 2019 Jan; 48(1): 16–31. Published online 2018 Sep 24. doi: 10.1093/ageing/afy169
Breathing is a motor act involving much more than the lungs. ………..still working on this.