Elsevier

The American Journal of Medicine

Volume 128, Issue 11, November 2015, Pages 1225-1236.e1
The American Journal of Medicine

Clinical research study
Nutritional, Physical, Cognitive, and Combination Interventions and Frailty Reversal Among Older Adults: A Randomized Controlled Trial

https://doi.org/10.1016/j.amjmed.2015.06.017Get rights and content
Under a Creative Commons license
open access

Abstract

Background

It is important to establish whether frailty among older individuals is reversible with nutritional, physical, or cognitive interventions, singly or in combination. We compared the effects of 6-month-duration interventions with nutritional supplementation, physical training, cognitive training, and combination treatment vs control in reducing frailty among community-dwelling prefrail and frail older persons.

Methods

We conducted a parallel group, randomized controlled trial in community-living prefrail and frail old adults in Singapore. The participants' mean age was 70.0 years, and 61.4% (n = 151) were female. Five different 6-month interventions included nutritional supplementation (n = 49), cognitive training (n = 50), physical training (n = 48), combination treatment (n = 49), and usual care control (n = 50). Frailty score, body mass index, knee extension strength, gait speed, energy/vitality, and physical activity levels and secondary outcomes (activities of daily living dependency, hospitalization, and falls) were assessed at 0 months, 3 months, 6 months, and 12 months.

Results

Frailty score and status over 12 months were reduced in all groups, including control (15%), but were significantly higher (35.6% to 47.8%) in the nutritional (odds ratio [OR] 2.98), cognition (OR 2.89), and physical (OR 4.05) and combination (OR 5.00) intervention groups. Beneficial effects were observed at 3 months and 6 months, and persisted at 12 months. Improvements in physical frailty domains (associated with interventions) were most evident for knee strength (physical, cognitive, and combination treatment), physical activity (nutritional intervention), gait speed (physical intervention), and energy (combination intervention). There were no major differences with respect to the small numbers of secondary outcomes.

Conclusions

Physical, nutritional, and cognitive interventional approaches were effective in reversing frailty among community-living older persons.

Keywords

Cognitive training
Frailty
Nutritional supplementation
Physical exercise

Cited by (0)

Trial Registration: clinicaltrials.gov; Identifier: NCT00973258.

Funding: The study was supported by a research grant NMRC/1108/2007 from the National Medical Research Council.

Conflict of Interest: None reported.

Authorship: TPN had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. He formulated the hypothesis, performed literature review, designed the study, reviewed the data, and drafted and reviewed the manuscript. Liang Feng reviewed the literature, analyzed the data and drafted and reviewed the manuscript. MN, MSZN, Lei Feng, GC, SAK, SMC, PY and KBY participated in the review of the literature, study design, and data collection, and the review of the data and manuscript drafts.