Chad Yixian Han, Yogesh Sharma, Alison Yaxley, Claire Baldwin, Richard Woodman, Michelle Miller
Journal: Clinical interventions in aging 2023;18():809-825
PMID: 37220521
As the global population ages, the incidence of frailty is expected to increase. Frailty has been associated with higher dependency and an increased risk of death. Research has shown that exercise and nutrition have been shown to be effective at treating and preventing frailty, however this is open to criticism as most of the research has been performed in healthy older adults, and not those who are at risk or suffering from frailty. This pilot randomised control trial aimed to determine the effectiveness of an individualised exercise and nutrition programme on frailty and its complications in 32 individuals with pre frailty and frailty. The nutrition programme focused on ensuring diet quality and that individuals were receiving 100% of their energy requirements, adequate protein, and at an ideal body weight. The exercise programme focused on resistance exercise at least 3 times per week. The results showed that an individualised diet and exercise programme improved the degree of pre-frailty and frailty after 3 and 6 months. Brain function and mood were also improved in individuals on the diet and exercise programme. Interestingly there was an indication that the number of well-nourished individuals was slightly higher in these individuals, however this was not significantly greater than those who were not undergoing the diet and exercise regime. It was concluded that adherence to a self-managed nutrition and exercise programme can slow and even reverse frailty and pre-frailty. This study could be used by healthcare professionals to recommend an individualised diet and exercise programme that focuses on ensuring 100% of daily energy requirements are met, adequate protein levels and resistance exercise to older adults with pre-frailty and frailty.
PURPOSE
Pre-frailty and frailty in older adults are associated with poor health outcomes and increase health-care costs, and further worsening during hospitalization. This study aimed to examine the effect of an individualized hospital to home, exercise-nutrition self-managed intervention for pre-frail and frail hospitalized older adults.
PATIENTS AND METHODS
Older adults admitted to an acute medical unit of a tertiary hospital in South Australia who were pre-frail or frail were recruited from September 2020 to June 2021, randomized to either control or intervention group and followed up at 3 and 6 months. The outcome variables were program adherence, frailty status by the Edmonton Frail Scale (EFS) score, lower extremity physical function, handgrip strength, nutritional status, cognition, mood, health-related quality of life, risk of functional decline, unplanned readmissions.
RESULTS
Participants were 79.2 ±6.6 years old, 63% female, mostly frail (67%), with EFS of 8.6±1.9. Adherence to the inpatient and home visits/telehealth intervention were high (91±13% and 92±21%, respectively). Intention-to-treat analysis using linear regression models showed that participants in the intervention group had significantly greater reduction in EFS at 3 (-3.0; 95% CI: -4.8 to -3.0) and 6 months (-2.5; 95% CI: -3.8 to -1.0, <0.001 for both) compared to the control group; particularly the functional performance component. There were also improvements in overall Short Physical Performance Battery score at 3 (4.0; 95% CI: 1.3 to 6.6) and 6 months (3.9; 95% CI: 1.0 to 6.9, <0.05 for both), mini-mental state examination (2.6; 95% 0.3-4.8, =0.029) at 3 months and handgrip strength (3.7; 95% CI: 0.2-7.1, =0.039) and Geriatric Depression Scale, at 6 months (-2.2; 95% CI: -4.1 to -0.30, =0.026) in the intervention group as compared to control.
CONCLUSION
This study provided evidence of acceptability to a patient self-managed exercise-nutrition program that may benefit and alleviate pre-frailty and frailty in hospitalised older adults.
© 2023 Han et al.
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