Exploratory Study on the Prevalence of Sarcopenia-Promoting Medicines in Patients With Sarcopenia and Falls
Conditions: Sarcopenia in Elderly, Falls
Sponsor: Medway NHS Foundation Trust

 
 
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Research Study Protocol Template 
 
 
 
 
1. Researcher details 
1.1 Applicant details  
Name  
Kamaldeep Sahota 
Department  
Pharmacy 
Phone number 
01634 976610 
Email  
Kamaldeep.sahota1@nhs.net 
1.2 Co-applicants/external partner details 
Name  
 
Department/company   
Phone number 
 
Email  
 
1.3 Other applicants/applicant information  
 
2. Study Information and overview 
2.1 Study details 
Study title  
Exploratory Study on the Prevalence of Sarcopenia-Causing 
Medicines in Patients with Sarcopenia and Falls 
 
Study classification  
(i.e. Research/Service Evaluation) 
Research 
Department  
(Please state where the study will be 
conducted & the name of the 
departmental manager) 
Falls clinic  
 
Lead Falls Clinician: Dr V Paranjyothi 
Protocol Version Number  
(Please state version number e.g. 1, 2) 
4 
Protocol Version Date  
(Please date protocol) 
20/7/25 
IRAS ID: 354863.  Approved: 31/7/25 
2.2 lay overview of the project 
Please provide an overview of the project in lay (non-scientific/no jargon) language. This overview 
should be understandable to most people. 

 
 
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Sarcopenia, characterised by the loss of muscle mass and function, is a prevalent condition among the 
elderly and is often associated with increased risk of falls. Certain medications, such as glucocorticoids, 
statins, and some antipsychotics, may exacerbate sarcopenia, leading to a higher incidence of falls. This 
study aims to explore the prevalence of such medicines in patients diagnosed with sarcopenia who have 
experienced falls. Understanding the impact of these medications on sarcopenia and fall risk can inform 
clinical guidelines and improve patient outcomes 
 
2.3 Background/Literature review                                                                                                
Please provide any relevant background information to support the research area/disease. The 
subtitles below are to help guide you on what is required within this section. Please include published 
findings, Add full reference to the Reference List (Section 11). The Knowledge and Library Services 
can assist with completing a literature search and horizon scan please by visiting Request a Search - 
Medway NHS KLS  
 
Overview of General Area  
 
Sarcopenia, defined as the progressive loss of skeletal muscle mass and strength, is a significant 
contributor to adverse outcomes in older adults, including falls, frailty, functional decline, 
institutionalisation, and mortality (Cruz-Jentoft et al., 2019). The European Working Group on 
Sarcopenia in Older People (EWGSOP2) recognises low muscle strength as the primary indicator of 
sarcopenia. The prevalence of sarcopenia increases with age, affecting 10–27% of adults over 60 years 
and over 50% of those aged 80 and above (Shafiee et al., 2017). Similarly, falls affect one in three 
individuals aged 65 and over annually (WHO, 2021), and are a serious complication of sarcopenia. 
Evidence shows that sarcopenic individuals are 1.5 to 2.3 times more likely to fall (Landi et al., 2012). 
Both sarcopenia and falls share multiple risk factors, one of the most important being medication use. 
Polypharmacy is prevalent among older adults and is associated with both increased fall risk and 
sarcopenia (Landi et al., 2019; Zia et al., 2017). Several classes of medications - including 
glucocorticoids, statins, loop diuretics, antidiabetic agents, and centrally acting drugs are known to 
exacerbate muscle loss, impair physical performance, or reduce mobility (Schakman et al., 2013; Scott 
et al., 2016; Fox et al., 2014). Despite this, the prevalence of such medications in older adults who have 
both sarcopenia and a history of falls has not been well defined. This gap limits targeted medication 
reviews and deprescribing strategies in high-risk individuals. 
Prior research has established links between polypharmacy and adverse musculoskeletal outcomes, and 
systematic reviews have reinforced these findings (Tanskanen et al., 2015; Veronese et al., 2020). 
However, few studies have investigated the intersection of medication use, sarcopenia, and falls within 
clinical settings such as falls clinics. While falls services often focus on fall-risk-increasing drugs 
(FRIDs), little attention has been given to medicines that may worsen muscle health. Given that falls 
clinics routinely assess high-risk older adults and conduct comprehensive geriatric assessments, they 
offer a unique and practical setting for studying the prevalence and potential impact of sarcopenia-
promoting medications. 
This study aims to address this critical gap by evaluating the prevalence of medications associated with 
sarcopenia in older adults attending a falls clinic who have a diagnosis of sarcopenia and/or a history of 
falls. It will identify the most frequently prescribed drug classes with known muscle-impairing 

 
 
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properties and examine any associations between these medications and the severity of sarcopenia or 
falls risk. The results will contribute to the evidence base informing deprescribing strategies, medication 
review protocols, and falls prevention efforts in older adults. 
Ultimately, this study has the potential to improve clinical outcomes and prescribing safety. It will offer 
practical applications for clinicians, including developing personalised deprescribing plans, enhancing 
clinical guidelines, and supporting safer prescribing in geriatric and falls services. On a broader level, 
it aligns with public health goals to reduce healthcare costs, support independent living, and improve 
the quality of life for older populations through optimised medication use. 
 
2.4 Aims & Objectives                                                                                                                             
• Please insert a detailed description of the objectives and the purpose of the study.  
• Please include a specific statement of the primary endpoints and the secondary endpoints, if any, to 
be measured during the study. 
Objectives must be SMART 
S: Specific 
M: Measurable 
A: Achievable 
R: Relevant 
T: Time bound 
 
Aim: To determine the prevalence and types of medications associated with increased risk of sarcopenia 
among patients attending a falls clinic over a 6-month period. 
Objectives:  
1. To describe the proportion of older adults (aged ≥65) attending a falls clinic over a 6-month 
period that are prescribed one or more medications known to increase the risk of sarcopenia 
(e.g., glucocorticoids, statins, sedatives, anticholinergics). 
2. To describe which sarcopenia-associated medication classes are most frequently prescribed in 
this cohort, and how many medications per patient fall into this category. 
3. To assess the association between the number of sarcopenia-promoting medications prescribed 
and sarcopenia (as defined by clinical criteria such as grip strength, gait speed, or SARC-F score) 
in this population during the 6-month study period. 
4. To describe the demographic and clinical characteristics of patients with sarcopenia and falls 
history who are on these medications including age, sex, ethnicity, history of previous falls 
and medical history.  
 
2. Methodology                                                                                                                               Please 
provide information as to how the study will be conducted; to include where/how and by who the data 
will be collected and analysed, the proposed duration of the study etc. The subtitles below are to help 
guide you on what is required in this section.   
Study Design:  
This study will employ a cross-sectional observational design to determine the prevalence and patterns 
of medications known to increase sarcopenia risk among older adults attending a falls clinic over a 6-

 
 
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month period. Cross-sectional studies are well suited for estimating prevalence and exploring 
associations at a single point in time, particularly in clinical populations (Levin, 2006). 
 
Study Setting:  
The study will be conducted in a multidisciplinary falls clinic at Medway NHS Foundation Trust, based 
in Gillingham, Kent. This secondary care setting receives referrals primarily from inpatient hospital 
teams and primary care practitioners.  The clinic routinely assesses older adults who have experienced 
falls or are at high risk of falling, and conducts comprehensive geriatric assessments, including 
medication reviews, functional status evaluations, and frailty assessments (NICE, 2013). This makes 
them an appropriate setting for identifying medication-related contributors to sarcopenia and fall risk. 
 
Study Period:  
Data will be collected over a 6-month period (August 2025 to January 2026), enabling a sufficient 
sample while ensuring feasibility within available resources. 
 
Study Population:  
The study will include adults aged 65 years and older who attend the falls clinic during the 6-month 
data collection period.  Sarcopenia will be assessed using validated tools such as the SARC-F 
questionnaire and physical performance measures (Cruz-Jentoft et al., 2019). 
 
Inclusion criteria: 
• Aged ≥65 years 
• Attendance at the falls clinic for a new assessment 
• Diagnosed with sarcopenia (based on the EWGSOP2 criteria)  
• History of falls in the past 12 months 
 
Exclusion criteria: 
• Cognitive impairment preventing consent  
• Acute medical instability  
• Enrolled in on other clinical trials. 
 
Sample Size Calculation:  
The estimated prevalence of sarcopenia-promoting medications among older adults who fall, varies 
across studies due to differences in definitions, populations, and settings. Although no single study has 
reported the exact prevalence of sarcopenia-promoting medicines in older adults with both sarcopenia 
and a history of falls, multiple studies suggest a high burden of such medications in these populations. 
 
While some studies conducted in hospitalised or long-term care populations report prevalence rates 
exceeding 50% (Corsonello et al., 2019), community and outpatient falls clinic populations generally 
exhibit lower rates. For example, Rawle et al. (2018) identified anticholinergic medication use in 
approximately 24% of community-dwelling older adults, and Reeve et al. (2014) reported that 30–70% 
of older adults who fall are prescribed medications associated with increased fall risk, with the lower 
range more applicable to outpatient settings. Considering the study setting is a falls clinic, where 
patients are typically community-dwelling and potentially less frail than hospitalised cohorts, an 
estimated prevalence of 30% for sarcopenia-promoting medicines is a conservative and evidence-based 
choice. This estimate ensures an appropriate balance between statistical rigour and resource feasibility 
for the exploratory study.   

 
 
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Assuming an estimated prevalence of sarcopenia-promoting medications of 30% among older adults 
attending the falls clinic, with a 95% confidence level and a margin of error of 5%, the calculated sample 
size for an infinite population is 323 participants.  This calculation is based on Cochran’s sample size 
formula for proportions, which is appropriate for large populations (Cochran, 1977). 
 
 
 
 
 
Allowing for an estimated 10% rate of non-consent or dropout—consistent with participation rates 
reported in outpatient and community-based studies involving older adults (Toon et al., 1992) the 
effective sample size to account for this will be 359 participants.  Despite this, it is estimated that around 
500 patients will attend the falls clinic over a 6-month study period, based on current clinic throughput.  
 
The recruitment period increases the likelihood of obtaining a representative sample.  The end of the 
study is defined as the date on which the final data point is collected from the last participant or the 
completion of any follow-up data collection required, whichever occurs later. 
 
Sampling Method:  
A consecutive sampling approach will be used to include all eligible patients attending the falls clinic 
during the study period. Although non-probabilistic, this method is commonly used in clinical settings 
to ensure timely recruitment and adequate sample size (Etikan et al., 2016). 
 
 
Data Collection Methods 

 
 
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Study Instrument:  
Data will be collected using a standardised spreadsheet from routinely recorded clinical information in 
the Electronic Prescribing and Medicines Administration (EPMA) system and patient health records. 
Clinical assessments will include: 
• 
SARC-F questionnaire for sarcopenia screening, 
• 
Rockwood Clinical Frailty Scale (CFS) to assess for frailty, 
• 
Grip strength, Timed-Up and Go test (TUGT), and gait speed for objective physical 
performance, 
The European consensus on definition and diagnosis of sarcopenia (Cruz-Jentoft et al., 2019) highlights 
the above tools to diagnose sarcopenia.  SARC-F is recommended to be used because its inexpensive 
and a convenient method for sarcopenia risk screening by the self-administrations of a five-item 
questionnaire.  Grip strength is used to assess muscle strength and is a strong predictor of poor patient 
outcomes.  It is moderately associated with strength in other body compartments and so it serves as a 
reliable surrogate for measures of arm and leg strength.  Gait speed and the TUGT are commonly used 
in falls clinics to assess for functional mobility, and they have been shown to be predict adverse 
outcomes related to sarcopenia.   
Medication data will be extracted from the EPMA system and categorised using British National 
Formulary (BNF) classifications to identify drugs associated with muscle impairment. 
Study Implementation:  
Potential participants will be identified through routine clinical attendance at the falls clinic within the 
study period. Screening will be conducted by doctors in the falls clinics who will review patient records 
and medication lists to identify individuals meeting the inclusion criteria. Eligible patients will be 
approached by doctors working in the falls clinic, who will introduce the study and provide the 
participant information sheet in lay language. This approach integrates seamlessly with standard care, 
minimising additional burden. 
 
Consenting will be conducted face-to-face during the same clinic visit. The falls clinicians will ensure 
that potential participants have ample opportunity to ask questions and fully understand the purpose, 
procedures, risks, and benefits of the study. Written informed consent will be obtained prior to any data 
collection. For patients who require additional time to decide, arrangements will be made to revisit 
consent at a subsequent visit or via telephone within the study period, ensuring voluntary participation 
without coercion. 
 
All study procedures, including data collection related to demographic information, clinical 
characteristics, medication use, and sarcopenia assessments, will be performed as part of or immediately 
following the routine clinical evaluation. This strategy ensures minimal disruption to patient care while 
maintaining rigorous data quality. The research team will maintain strict confidentiality and data 
protection throughout the study, in line with institutional and regulatory guidelines. 
 
Quality of Data:  
To ensure reliability and accuracy, the primary researcher will review all completed data sheets against 
source documentation. A 10% random sample will be independently audited by a second clinician to 

 
 
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confirm data accuracy and consistency. The spreadsheet will be formatted with built-in checks to 
minimise entry errors and missing data. Any discrepancies will be resolved by consensus or with senior 
clinical input.  
 
2.7 Primary Measures                                                                                                                         
The primary outcome measure is the outcome that an investigator considers to be the most important 
among the many outcomes that are to be examined in the study.  
3. Statistics 
4.1 Planned statistical analysis 
All data will be entered and analysed using Microsoft Excel. Statistical analysis will primarily involve 
descriptive statistics to summarise the prevalence and patterns of sarcopenia-associated medication 
use among older adults attending a falls clinic. 
 
1. Descriptive Analysis 
a) Categorical variables (e.g. sex, sarcopenia status, medication classes) will be summarised 
using frequencies and percentages. 
b) Continuous variables (e.g. age, number of medications) will be reported as means and 
standard deviations or medians and interquartile ranges, depending on data distribution. 
c) The primary outcome - prevalence of sarcopenia-promoting medications - will be 
calculated with proportions and 95% confidence intervals, using Excel’s statistical 
functions. 
2. Exploratory Multivariate Analysis (if feasible) 
a) Python may be used to explore relationships between medication use and factors such as 
sarcopenia status, age, or number of falls. 
b) Any such analysis will be exploratory and interpreted with caution due to software 
limitations. 
 
4.2 Person performing the statistical analysis?  
The data will be anonymised, stored securely, and analysed by the principal investigator and the Senior 
Research and Innovation Project Facilitator at Medway hospital using password-protected Excel files 
and Python. A second reviewer will verify a random sample of the data for accuracy and consistency.  
 
4. Risks and benefits 
5.1 Risks of study participation  
This study poses minimal risk to participants as it involves secondary analysis of data collected during 
routine clinical care. No additional procedures, tests, or interventions will be introduced. The primary 
risk pertains to data confidentiality. All data will be effectively anonymised and securely stored in 
accordance with NHS Trust data governance policies to mitigate any potential breaches of privacy. 
 
5.2 Benefits of study participation  
There are no direct benefits to individual participants. However, the findings from this study may inform 
future prescribing practices and improve medication safety for older adults at risk of sarcopenia and 

 
 
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falls. The results could also contribute to more targeted medication reviews and deprescribing strategies 
within falls services. 
 
5.3 Risk Assessment performed? 
A risk assessment will be undertaken as part of the set-up of this project and submitted to the Medway 
R&I team. 
5. Data protection                                                                 
Please describe how the data will be collected per the General Data Protection Regulation (GDPR). 
Include details of procedures for data handling, record keeping and archiving arrangements both 
during and post-study, including the location of data, accessibility rights and security provisions. 
Data Handling and Anonymisation 
Data will be extracted from routinely collected clinical records, including the Electronic Prescribing 
and Medicines Administration (EPMA) system and patient health records, as part of standard falls 
clinic assessments. This will include information on medications, frailty scores, physical performance 
measures (e.g., grip strength, gait speed), and adjusted BMI. 
All data collected during the study will be handled in accordance with the Data Protection Act 2018 
and General Data Protection Regulation (GDPR) to ensure participants’ privacy and confidentiality. 
Personal identifiable information (PII) will be collected only as necessary for recruitment, consent, 
and linkage of clinical data. 
Upon collection, identifiable data will be securely stored on encrypted NHS Trust computers 
accessible only to authorised members of the research team. Each participant will be assigned a 
unique study ID number, and all subsequent data analysis will use these anonymised ID codes to 
prevent identification of individuals. 
Hard copies of consent forms and any paper records will be stored in locked filing cabinets within 
secure NHS facilities. Electronic data will be password protected with access restricted to study 
personnel. Data transfer, if required, will be conducted using secure, encrypted methods. 
Anonymised datasets used for analysis and publication will contain no direct identifiers. Only 
aggregated data will be reported, ensuring individual participants cannot be identified. Data retention 
will comply with institutional policies, storing research data securely for at least 5 years post-study 
completion. 
Data Storage and Accessibility 
During the study, all data will be stored on Trust-approved encrypted systems within Medway NHS 
Foundation Trust's secure IT environment.  Only the primary researcher and supervising clinicians 
with data access approval will be permitted to view the study dataset. Data will not be transferred 
outside the Trust’s systems without appropriate approvals. 
Archiving and Retention 
Upon study completion, anonymised research data will be archived securely for a minimum of 5 years 
in accordance with Medway NHS Foundation Trust research governance policy and Good Clinical 

 
 
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Practice (GCP) standards. Identifiable data (if retained for audit purposes) will be securely destroyed 
following the retention period, in line with Trust data destruction protocols. 
Security Provisions 
• 
Data will be stored on encrypted drives with multifactor authentication. 
• 
Regular backups will be performed on secure Trust servers. 
• 
No data will be saved to personal devices or removed from NHS premises. 
Ethical and Governance Oversight 
This study will be conducted in accordance with the principles of the Declaration of Helsinki and 
applicable national regulations governing research involving human participants. Ethical approval will 
be sought and obtained from a Research Ethics Committee (REC) prior to study commencement. The 
study will also be reviewed and approved by the relevant Health Research Authority (HRA) and 
Medway NHS Trust research and innovation (R&I) departments to ensure compliance with 
governance standards.   
All research personnel involved in the study will have completed appropriate Good Clinical Practice 
(GCP) training and will adhere to institutional policies for patient safety, confidentiality, and data 
protection. Regular monitoring by the Medway R& I team, and audit activities will be implemented to 
ensure adherence to the approved protocol, regulatory requirements, and quality standards.  
6. Funding  
7.1 Does this project require funding? 
No 
7.2 Has funding been secured  
n/a 
7.3 Have you completed a study budget  
 
n/a 
7. Ethical considerations  
Please list any factors of your project that may lead to ethical issues.  
This study involves the use of routinely collected clinical data from older adults attending a falls clinic 
at Medway NHS Foundation Trust. Although no additional interventions will be introduced, ethical 
approval will be sought from the Health Research Authority (HRA) and an NHS Research Ethics 
Committee (REC), given the study’s use of identifiable clinical information for research purposes. 
All participants will receive a written participant information sheet outlining the study’s purpose, the 
voluntary nature of participation, and how their data will be used and protected. Written informed 
consent will be obtained prior to inclusion. Patients will be informed that declining participation will 
not affect their current or future clinical care. 
To ensure data confidentiality, all information extracted for the study will be anonymised at the point 
of analysis. No directly identifying information will be included in the research dataset. All data will be 

 
 
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stored on encrypted NHS Trust servers, with access restricted to authorised personnel only.  All 
members of the research team will complete GCP training.  
 
8. Dissemination plans 
Please list all the ways you plan to share the findings of this project. This may include scientific 
journal publications, conference presentations etc. 
The findings of this study will be disseminated internally within Medway NHS Foundation Trust via 
clinical governance meetings, audit reports, and engagement with the falls clinic and pharmacy teams. 
Externally, results will be submitted for presentation at relevant academic and professional conferences 
such as the British Geriatrics Society (BGS) and for publication in a peer-reviewed journal (e.g. Age 
and Ageing, Drugs & Aging). A lay summary of the findings will be made available to patients and 
carers through clinic communications and the Trust’s website. The study aims to inform safer 
prescribing and medication review practices for older adults, contributing to falls prevention strategies 
and local guideline development. 
 
9. Any other relevant information 
 
10. Reference List  
Please add in full references you have added into text in the above sections. Use Harvard referencing 
style (For examples see link https://www.scribbr.co.uk/referencing/harvard-style/ ). If your field has a 
selected referencing style use that one.   
 
• Cochran, W.G. (1977). Sampling Techniques. 3rd Edition. John Wiley & Sons, New York 
• Corsonello A, Pedone C, Incalzi RA (2019). Age-Related Pharmacokinetic and 
Pharmacodynamic Changes and Their Clinical Implications. Curr Med Chem.26(17):2932–44. 
https://doi.org/10.2174/0929867325666181022151633 
• Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition 
and diagnosis [published correction appears in Age Ageing. 2019 Jul 1;48(4):601. doi: 
10.1093/ageing/afz046.]. Age Ageing. 2019;48(1):16-31. doi:10.1093/ageing/afy169 
• Etikan, I., Musa, S. A., & Alkassim, R. S. (2016). Comparison of convenience sampling and 
purposive sampling. American Journal of Theoretical and Applied Statistics, 5(1), 1–4. 
• Fox, C., et al. (2014). Anticholinergic medication use and cognitive impairment in the older 
population: the MRC Cognitive Function and Ageing Study. Journal of the American 
Geriatrics Society, 62(10), 1916–1922. 
• Landi, F., et al. (2012). Sarcopenia as a risk factor for falls in elderly individuals: Results from 
the ilSIRENTE study. Clinical Nutrition, 31(5), 652–658. 
• Landi, F., et al. (2019). Polypharmacy and sarcopenia in older adults: A population-based 
study. Journal of the American Medical Directors Association, 20(5), 600–604.e7. 
• Levin, K. A. (2006). Study design III: Cross-sectional studies. Evidence-Based Dentistry, 7(1), 
24–25. 

 
 
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• NICE (2013). Falls in older people: assessing risk and prevention. NICE Clinical Guideline 
CG161. 
• Rawle MJ, Westbury LD, Russell S, et al (2018). Anticholinergic drug burden and cognitive 
function in people aged 50 years and older: the English Longitudinal Study of Ageing. Age 
Ageing; 47(4):505–11 https://doi.org/10.1093/ageing/afy026 
• Reeve E, Wiese MD, Hendrix I, et al. (2014).  The impact of deprescribing interventions on 
polypharmacy and clinical outcomes: a systematic review and meta-analysis. J Am Med Dir 
Assoc. 15(3):131–6. 
• https://doi.org/10.1016/j.jamda.2013.11.008 
• Schakman, O., et al. (2013). Mechanisms of muscle atrophy induced by glucocorticoids. 
Hormone Research in Paediatrics, 79(4), 219–227. 
• Scott, D., et al. (2016). Sarcopenia and statin use: A potential link? Drugs & Aging, 33(1), 1–
9. 
• Shafiee, G., et al. (2017). Prevalence of sarcopenia in the world: A systematic review and 
meta-analysis. Journal of Diabetes and Metabolic Disorders, 16, 21. 
• Tanskanen, A., et al. (2015). Anticholinergic burden and physical functioning in older people: 
A systematic review. Drugs & Aging, 32(10), 741–750. 
• Toon, P. D., Watson, R., & Seers, H. E. (1992). Participation rates in general practice research: 
A review. Family Practice, 9(4), 373–381. https://doi.org/10.1093/fampra/9.4.373 
• Veronese, N., et al. (2020). Polypharmacy is associated with higher frailty risk in older people: 
A systematic review and meta-analysis. Journal of the American Medical Directors 
Association, 21(2), 181–187. 
• WHO. (2021). Falls. https://www.who.int/news-room/fact-sheets/detail/falls 
• Zia, A., Kamaruzzaman, S. B., & Tan, M. P. (2017). Polypharmacy and falls in older people: 
Balancing evidence-based medicine against falls risk. Postgraduate Medical Journal, 93(1102), 
18–22