Effects of an Oral Nutritional Supplementation Plus Physical Exercise Intervention on the Physical Function, Nutritional Status, and Quality of Life in Frail Institutionalized Older Adults: The ACTIVNES Study

Effectiveness of Protein-enriched oral nutritional supplements on muscle function in middle-aged and elderly women: A randomized controlled trial

OBJECTIVES

This study evaluated the effects of protein-enriched oral nutritional supplementation (ONS) consumption for 12 weeks on muscle mass, muscular strength, and function in middle-aged and elderly women.

DESIGN

A single-center, double-blind, randomized controlled trial PARTICIPANTS: This study was conducted with 70 healthy female participants aged 50-80.

INTERVENTION AND MEASUREMENTS

Participants were instructed to incorporate two daily packs of either the test ONS (Nucare Active, Daesang Wellife Corp., Seoul, Republic of Korea; 200 kcal/pack, 23 g carbohydrate, 6 g fat, and 15 g protein including branched chain amino acids or placebo ONS (200 kcal/pack, 33 g carbohydrate, 8 g fat, and 1 g protein) into their routine for 12 weeks while maintaining their regular lifestyle. The primary outcome was lean body mass (LBM), while secondary outcomes included muscular strength, physical performance ability, inflammatory markers, and body fat mass (FM).

RESULTS

Sixty-four participants (33 in the test group, 31 in the placebo group; mean ± SD age, [test] 63.06 ± 5.51 years, [placebo] 63.29 ± 3.28 years, p = 0.839) completed the 12-week protocol. The test group exhibited a higher percentage change in LBM than the placebo group (0.26 % [95%CI: -0.27, 0.78] vs. -0.47 % [95%CI: -0.81, -0.13]; p = 0.020). The placebo group experienced a significant increase in FM (38.15 % [95%CI: 36.62, 39.69] to 38.67 % [95%CI: 37.14, 40.21]; p < 0.01). The difference in the changes in LBM/BMI and FM/BMI between the two groups was also visually distinct. There were no significant differences between the two groups in terms of muscular strength, physical performance ability, or inflammatory markers.

CONCLUSIONS

Protein-enriched ONS helped maintain LBM and prevent FM gain in middle-aged and elderly females. This suggests its potential role in preventing frailty and musculoskeletal disorders associated with female aging.

Association of Reversible Frailty with All-Cause Mortality Risk in Community-Dwelling Older Adults and Analysis of Factors Affecting Frailty Reversal in Older Adults

OBJECTIVES

Although frailty can increase the risk of premature death, whether reversal of frailty reduces the risk of premature death and what factors contribute to the reversal of frailty have not been thoroughly investigated. This study aimed to investigate the link between frailty reversal and all-cause mortality and the factors affecting frailty reversal.

DESIGN

A combination of the nested case-control study and the prospective cohort study.

SETTING AND PARTICIPANTS

Pre-frail and frail older adults in the community follow-up cohort of Dalang Town, Dongguan City.

METHODS

We used a nested case-control study to enroll pre-frail and frail older individuals. After follow-up, we determined frailty-reversible and -irreversible groups. In a prospective cohort study with these 2 groups, all-cause death was set as the endpoint. We analyzed the link between frailty reversibility and all-cause mortality risk via incidence density ratios and Cox regression. Logistic regression was used to analyze factors affecting frailty reversibility.

RESULTS

There were 637 (33.3%) participants who had a reversal of frailty status. Compared with the irreversible group, the reversible group had a 53.9% lower risk of all-cause mortality. Age, illiteracy, cigarette smoking, and daily sedentary time were negatively associated with the reversal of frailty in older adults. Hemoglobin concentration and having an exercise habit were positively associated with frailty reversal.

CONCLUSIONS AND IMPLICATIONS

The risk of all-cause mortality declined among older adults with a reversal of frailty. Hemoglobin concentration and exercise contributed to the reversal of frailty among older adults. In contrast, aging, long daily sedentary time, cigarette smoking, and illiteracy were risk factors for the reversal of frailty. These findings may provide better strategies for frailty intervention.

How to Assess Health Gains

Background/Objectives: As life expectancy rises and the epidemiological landscape of chronic diseases evolves, the necessity to assess and improve the overall health status of the population becomes increasingly fundamental. Therefore, evaluating health gains is a crucial challenge for modern health systems, particularly in the context of limited resources and increasing demand for services. The aim of this study is to assess health gains and their costs, with data provided by a private Italian clinic. Methods: We conducted a retrospective study on 129 patients admitted between June 2020 and August 2023 in a solvent ward for short-term planned hospitalization. The patients completed the EQ-5D-5L questionnaire at both admission and discharge. Quality-Adjusted Life Years (QALYs) were estimated based on the difference in EQ-5D-5L scores between discharge and admission, assuming that health gains persist up to two years post-discharge. Through QALYs value and hospitalization cost, a cost-utility analysis was performed. Descriptive and statistical analyses were carried out using STATA SE/14.0 software. Results: Of the studied sample, 55% was female, the median age was 81 [11] years old, and the median length of stay (LoS) was 16 [16] days. The patients gained, in median, 0.33 [0.38] in QALY, which was higher for males (0.35 [0.34]) than females (0.29 [0.45]). The QALY gained was greater for the non-geriatric patients (0.41 [0.42]) than geriatric ones (0.32 [0.38]) (p > 0.05). Those with a longer LoS showed a higher gain in QALY (0.35 [0.42]) than those with a shorter one (0.23 [0.29]) (p < 0.05). The cost per QALY gained was, in median, EUR 14,337, which was lower in males (EUR 13,803), in non-geriatric patients (EUR 13,743), and in patients with a shorter LoS (EUR 10,670) (p > 0.05). Conclusions: Although QALY gains differed among the groups, the median cost per QALY remained consistent. These results highlight the need for targeted interventions to optimize resource allocation, both by integrating data into allocation strategies and by employing a multidisciplinary approach to tailor interventions.

Impact of adherence to oral nutritional supplements on nutrition status and muscle strength in patients with gastrointestinal cancer: A prospective observational longitudinal study

BACKGROUND

Given the lack of evidence regarding the effects of adherence to oral nutritional supplements (ONS) and the types of formulas used in clinical practice, we aimed to assess the impact of adherence to ONS and the high-protein formula on the nutrition status and muscle strength in patients with gastrointestinal cancer.

METHODS

This study evaluated newly diagnosed outpatients with esophageal, gastric, pancreatic, and colorectal cancer prescribed ONS. Nutrition status was assessed using the Patient-Generated Subjective Global Assessment (PG-SGA), and muscle strength was assessed using handgrip strength (HGS) dynamometry. ONS adherence was calculated as the ratio of self-reported intake to the prescribed amount and categorized as ≥80% or <80%.

RESULTS

A total of 54 patients were included. Most patients were ≥60 years of age (63%), were diagnosed with colorectal cancer (63%), were classified as stage III and IV (83%), and exhibited nutrition risk or malnutrition according to PG-SGA (89%). Patients with adherence ≥80% to ONS exhibited less weight loss and HGS reduction compared with patients with adherence <80% (P < 0.05). Although patients consuming a high-protein formula maintained HGS and those on a standard formula experienced a reduction, formula type did not predict HGS change in the multivariate analysis. ONS protein intake, adjusted for adherence, was a predictor of weight change (β: 0.09; 95% CI: 0.02-0.2; P = 0.011).

CONCLUSION

Patients with adherence ≥80% to ONS experienced less reduction in both weight and HGS, whereas those consuming a high-protein formula maintained HGS. Notably, ONS protein intake, adjusted for adherence, was an independent predictor of weight change.

Advances in pathophysiology and assessment methods of chronic obstructive pulmonary disease with frailty

Frailty, a multidimensional syndrome characterized by decreased physiological reserves and vulnerability to stressors, presents significant challenges in the management of chronic obstructive pulmonary disease (COPD). COPD and frailty share common risk factors and pathophysiological pathways, such as muscle wasting, chronic inflammation, and malnutrition. Both COPD and frailty lead to a significant reduction in patients' physical functionality and quality of life. Consequently, early screening for frailty and proactive interventions for patients with COPD are increasingly considered essential. There are several methods for screening and assessing frailty in patients with COPD, such as the Fried Frailty Phenotype and the Frailty Index, each with its own advantages and limitations. However, there is currently no unified standard, nor a method specifically tailored to the Chinese population. The treatment of patients with COPD and concurrent frailty currently favors exercise interventions, nutritional interventions, or a combination of both. Further treatment approaches, including pharmacological interventions, are still being explored. Therefore, the development of frailty screening and assessment tools tailored to the Chinese population, along with the exploration of reasonable and effective new intervention measures, represents a crucial direction in China's efforts to prevent and treat frailty.

Personalized Diet With or Without Physical Exercise Improves Nutritional Status, Muscle Strength, Physical Performance, and Quality of Life in Malnourished Older Adults: A Prospective Randomized Controlled Study

Objectives: Malnutrition (MN) is prevalent in older adults and closely related to sarcopenia, frailty, morbidity, mortality, and decreased quality of life. In this study, we aimed to evaluate the effects of a personalized diet combined with planned physical exercise on nutritional status, physical performance, and quality of life (QoL) in malnourished older adult patients. Methods: In this prospective study, 20 older adults with MN risk according to the Mini Nutritional Assessment-Short Form (MNA-SF) were randomized into (i) personalized diet (PD) and (ii) personalized diet with physical exercise (PDE) groups, and followed up with for 12 weeks. The physical exercise included warm-up, strengthening, balance, and cooldown phases, with a frequency of 3-4 days per week. Anthropometric measurements, physical performance, and quality of life were assessed using standardized tools at baseline and at the 4th, 8th, and 12th weeks. QoL was measured using the EQ-5D index and EQ-5D visual analog scale (VAS) scores. Results: A total of 20 patients (55% male) participated in the study. During the study, BMIs, MNA-SF scores, and hand grip strength were increased, and the patients' average duration on the Timed Up and Go (TUG) test decreased significantly in both groups. The EQ-5D index score of the PD group and the EQ-5D VAS scores of both groups were increased. Conclusions: A personalized diet with or without physical exercise therapy was associated with improved nutritional status, physical performance, and QoL.

Perspectives on Diet and Exercise Interaction for Healthy Aging: Opportunities to Reduce Malnutrition Risk and Optimize Fitness

Nutrition and exercise play a pivotal role in counteracting the effects of aging, promoting health, and improving physical fitness in older adults. This perspective study examines their interplay, highlighting their combined potential to preserve muscle mass, cognitive function, and quality of life. The objective is to address gaps in the current understanding, such as the frequent neglect of dietary intake in exercise interventions and vice versa, which can limit their effectiveness. Through a synthesis of the existing literature, we identify key findings, emphasizing the importance of adequate nutritional intake-particularly protein, essential amino acids, and micronutrients-in supporting exercise benefits and preventing sarcopenia and malnutrition. Additionally, supplementation strategies, such as omega-3 fatty acids, creatine, and essential amino acids, are explored alongside the emerging role of the gut microbiota in mediating the benefits of nutrition and exercise. Despite these advances, challenges remain, including determining optimal dosages and timing and addressing individual variability in responses. Personalized approaches tailored to sex differences, gut microbiota diversity, and baseline health conditions are critical for maximizing intervention outcomes. Our conclusions underscore the necessity of integrated strategies that align dietary and exercise interventions to support healthy and active aging. By addressing these gaps, future research can provide actionable insights to optimize health and quality of life in older populations.

Prognostic value of nutritional changes in older patients following transcatheter aortic valve replacement

OBJECTIVES

Nutritional status, as one of the core characteristics of frailty, the impact of its changes on clinical outcomes in older patients following transcatheter aortic valve replacement (TAVR) remains unclear.

DESIGN

A retrospective cohort study.

SETTING

This study included a total of 781 patients who underwent TAVR at West China Hospital between 2012 and 2022.

METHOD

The average age of the patients was 72.6 years, with a mean follow-up period of 2.2 years. All patients were followed for at least one year, and their nutritional status was assessed using the Controlling Nutritional Status (CONUT) score both before TAVR and six months post-TAVR. Based on post-TAVR changes in nutritional status, patients with normal nutritional status pre-TAVR were categorized into Non-malnutrition and New malnutrition groups, while patients with malnutrition pre-TAVR were categorized into Malnutrition regression and Malnutrition persistence groups.

RESULT

The New malnutrition group experienced higher cumulative incidences of all-cause mortality (20.5% vs. 2.4%, P = 0.002), MACE (25.5% vs. 23.7%, P = 0.001), and readmissions for heart failure (13.1% vs. 7.3%, P = 0.027) compared to the Non-malnutrition group. Conversely, the Malnutrition regression group showed a lower cumulative incidence of all-cause mortality (3.1% vs. 18.0%, P = 0.016) compared to the Malnutrition persistence group, although no statistically significant differences were observed in MACE (14.7% vs. 28.5%, P = 0.087) and readmissions for heart failure (7.0% vs. 8.3%, P = 0.551).

CONCLUSION

Our study indicates that deterioration in nutritional status after TAVR is associated with poorer clinical outcomes, whereas improvement is associated with better outcomes.

Fecal microbiota transplantation, a tool to transfer healthy longevity

The complex gut microbiome influences host aging and plays an important role in the manifestation of age-related diseases. Restoring a healthy gut microbiome via Fecal Microbiota Transplantation (FMT) is receiving extensive consideration to therapeutically transfer healthy longevity. Herein, we comprehensively review the benefits of gut microbial rejuvenation - via FMT - to promote healthy aging, with few studies documenting life length properties. This review explores how preconditioning donors via standard - lifestyle and pharmacological - antiaging interventions reshape gut microbiome, with the resulting benefits being also FMT-transferable. Finally, we expose the current clinical uses of FMT in the context of aging therapy and address FMT challenges - regulatory landscape, protocol standardization, and health risks - that require refinement to effectively utilize microbiome interventions in the elderly.

Physical activity and sedentary behaviour interventions for people living with both frailty and multiple long-term conditions and their informal carers: a scoping review and stakeholder consultation

INTRODUCTION

This scoping review mapped evidence on physical activity (including structured exercise) and sedentary behaviour interventions (interventions to reduce sedentary behaviour) in people living with both frailty and multiple long-term conditions (MLTCs) and their informal carers.

METHODS

Ten databases and grey literature were searched from 2000 to October 2023. Two reviewers screened studies and one extracted data. Results were shared with three stakeholder groups (n = 21) in a consultation phase.

RESULTS

After screening, 155 papers from 144 studies (1 ongoing) were retained. The majority were randomised controlled trials (86, 55%). Participants' mean age was 73 ± 12 years, and 73% were of White ethnicity. MLTC and frailty measurement varied widely. Most participants were pre-to-moderately frail. Physical health conditions predominated over mental health conditions.Interventions focused on structured exercise (83 studies, 60%) or combined interventions (55 studies, 39%). Two (1%) and one (0.7%) focused solely on habitual physical activity or sedentary behaviour. Adherence was 81% (interquartile range 62%-89%) with goal setting, monitoring and support important to adherence. Carers were only involved in 15 (11%) studies. Most interventions reported positive outcomes, primarily focusing on body functions and structures.

CONCLUSIONS

A modest volume of evidence exists on multicomponent structured exercise interventions, with less focus on habitual physical activity and sedentary behaviour. Interventions report largely positive effects, but an updated systematic review is required. The field could be advanced by more rigorous characterisation of MLTCs, socioeconomic status and ethnicity, increased informal carer involvement and further evaluation of habitual physical activity and sedentary behaviour interventions.

Impact of Frailty on Inpatient Mortality and Resource Utilization for Primary Pulmonary Hypertension

Background  Frailty has been associated with inferior outcomes in patients with primary pulmonary hypertension (PPH). There is a lack of national data to assess if hospital frailty risk score (HFRS) is associated with worse inpatient outcomes in PPH. Methods  Our retrospective study used the Nationwide Readmission Database (NRD). First, we extracted all cases older than 18 years who were discharged with a principal diagnosis of PPH between January and November 2016 to 2019 to allow for a 30-day follow-up. Appropriate survey and domain analyses were applied to obtain national estimates using SAS 9.4. Results  We identified 4,555 cases. HFRS <5 was present in 56% ( n  = 2,555) of the cohort. Patients with an intermediate-to-high frailty risk score (HFRS ≥5) were older than those with a low frailty risk score (HFRS <5), with a mean age of 61 versus 54 years ( p  < 0.01), and had slightly fewer women (75 vs. 78%, p  = 0.09). Patients with HFRS >5 had a higher prevalence of dementia, depression, diabetes mellitus, malignancy, acute encephalopathy, coagulopathy, heart failure, and chronic (liver and renal) diseases ( p  < 0.01). Also, they had higher inpatient mortality during index admission (14 vs. 2%, p  < 0.001), and all-cause 30-day readmission rates (38 vs. 33%, p  = 0.01). Univariate analysis suggests a positive correlation between the degree of frailty and the odds of inpatient mortality (referenced to HFRS <5). The HFRS 5 to 10 group has an odds ratio (OR) of 5 (95% confidence interval [CI]: 3.3-8), the HFRS 10 to 15 group has an OR of 14 (95% CI: 8-23), and the HFRS >15 group has an OR of 20 (95% CI: 9-45). Even after adjusting for age, gender, and significant comorbidities, the single most important factor associated with higher odds of inpatient mortality was HFRS >5 (OR: 5.5 [95% CI: 3.7-8.3], p  < 0.001) followed by acute myocardial infarction, acute encephalopathy, heart failure, chronic liver disease, and malnutrition. Length of stay had linear trend with HFRS (mean of 6 days for HFRS <5 vs. 11 days for HFRS 5-10 vs. 19 days for HFRS >10, p  < 0.001). Conclusion  Adverse inpatient outcomes correlate with the severity of HFRS in PPH.

Effect of non-pharmacological interventions in people with cognitive frailty: a systematic review and network meta-analysis

ABSRTACT

OBJECTIVE: To evaluate the effects of various non-pharmacological interventions on patients with cognitive impairment by systematic search and network meta-analysis, and to rank the effects of the included non-pharmacological interventions.

METHODS

The databases of PubMed, Cochrane Library, EMbase, Web of Science, CNKI, VIP, WANFANG, and SinoMed were searched by computer. All randomized controlled trials (RCTs) of non-pharmacological interventions for people with cognitive frailty were collected. The search was conducted from 2000 to February 2024. Two reviewers independently screened the studies, extracted data, and assessed the risk of bias of the included studies, and then used Stata15 and R4.3.1 software to conduct network meta-analysis, with physical function and cognitive function as the main outcome indicators.

RESULTS

A total of 19 randomized controlled trials involving 1738 patients were included. The results of network meta-analysis showed that among the non-pharmacological interventions, nutritional support had the best effect on improving frailty scores and cognitive function scores in patients with cognitive frailty. Aerobic training combined with resistance training is best for improving grip strength. For improving the patient's motor status, cognitive training had the best effect on improving TUG test scores. High-speed resistance training is best for improving walking speed.

CONCLUSION

This review analyses the current study of non-pharmacological interventions to improve physical performance in patients with cognitive frailty. Current evidence suggests that nutritional support is most effective at improving physical frailty and cognitive decline in patients with cognitive frailty, and that exercise and cognitive training interventions significantly improve grip strength and motor ability.

TRIAL REGISTRATION

This meta-analysis was prospectively registered with PROSPERO (registration number: CRD42023486881).

Nutritional Interventions in Older Persons with Type 2 Diabetes and Frailty: A Scoping Systematic Review

In the elderly, the coexistence of type 2 diabetes mellitus (T2DM) and frailty is frequent. Much has been described about pharmacological management and glycemic control goals. However, there is a knowledge gap in terms of the objectives and characteristics of interventions, especially nutritional ones, for this population. A scoping review was performed to document the objectives, characteristics, and results of nutritional interventions in older people with T2DM and frailty. The five-stage framework of Arksey and O'Malley was used, as was the PRISMA extension for scoping reviews. The results stand out for three trends, as follows: (1) experimental studies with multicomponent intervention physical exercise programs and nutritional programs based on educational processes or behavioral intervention; (2) observational studies with an association of the kind of diet assessed by scales and their relation to stages of frailty; (3) a review that updates recommendations on pharmacological and non-pharmacological, diet, exercise, management, as well as glucose control goals for diabetes in frail older persons. Finally, the evidence shows that management of T2DM in older adults with frailty requires goals and interventions tailored to their functional capacity and health condition. The exercise, diet, and education programs reviewed have demonstrated their effectiveness in improving physical performance, reducing the risk of frailty or progression to more advanced stages, and achieving better glycemic control.

Frailty, Sarcopenia, Cachexia, and Malnutrition in Heart Failure

With global aging, the number of patients with heart failure has increased markedly. Heart failure is a complex condition intricately associated with aging, organ damage, frailty, and cognitive decline, resulting in a poor prognosis. The relationship among frailty, sarcopenia, cachexia, malnutrition, and heart failure has recently received considerable attention. Although these conditions are distinct, they often exhibit a remarkably close relationship. Overlapping diagnostic criteria have been observed in the recently proposed guidelines and position statements, suggesting that several of these conditions may coexist in patients with heart failure. Therefore, a comprehensive understanding of these conditions is essential, and interventions must not only target these conditions individually, but also provide comprehensive management strategies. This review article provides an overview of the epidemiology, diagnostic methods, overlap, and prognosis of frailty, sarcopenia, cachexia, and malnutrition in patients with heart failure, incorporating insights from the FRAGILE-HF study data. Additionally, based on existing literature, this article discusses the impact of these conditions on the effectiveness of guideline-directed medical therapy for patients with heart failure. While recognizing these conditions early and promptly implementing interventions may be advantageous, further data, particularly from well-powered, large-scale, randomized controlled trials, are necessary to refine personalized treatment strategies for patients with heart failure.

Enhancing physical function and activity level in malnourished older adults through oral nutrition supplements: a randomized controlled trial

BACKGROUND

Malnutrition of older individuals, leads to significant functional decline, reducing their quality of life. Lifestyle interventions; dietary improvements and supplementation are explored to enhance the physical function of older adults. The current study aimed to assess the impact of oral nutritional supplements (ONS) on the functional and activity levels of Sri Lankan older adults.

METHODS

This randomized controlled trial included; an intervention group (IG) receiving 200 mL of ONS providing 247 kcal per serving, for 12 weeks and a control group (CG) receiving an equivalent volume of water. Changes in handgrip strength, knee extension strength, gait speed, functional and activity levels were assessed.

RESULTS

The IG showed significant improvements in handgrip strength (43.96 ± 18.61 kg vs. 32.81 ± 17.92 kg; p < 0.001) and knee extension strength (23.45 ± 2.29 kg vs. 16.41 ± 2.09 kg; p < 0.001) following 12 weeks compared to the CG. The IG also exhibited significant improvements in gait speed (1.31 ± 0.52 m/s vs. 0.87 ± 0.26 m/s), Barthel index score, (0.30 ± 0.47 vs. -0.18 ± 0.66), PASE score (0.52 ± 17.79 vs. -1.60 ± 21.77) and IPAQ categories.

CONCLUSIONS

ONS was found to be effective in improving the functional and physical activity levels of malnourished older adults.

TRIAL REGISTRATION

Sri Lanka Clinical Trial Registry SLCTR/2022/021. Registered on 06/10/2022.

The mediating role of loneliness in the effect of physical activity barriers on quality of life

BACKGROUND

This study aims to examine the mediating role of loneliness in the effect of physical activity barriers on quality of life.

METHODS

The sample of the study consisted of 374 people over the age of 65 who applied to a hospital. The data collection tools used in the study are 'Personal Information Form', 'Physical Activity Barriers Questionnaire' 'World Health Organization Quality of Life Instrument-Older Adults Module' and 'Loneliness Scale for the Elderly'. The mediating effect analysis was conducted through the 'Process Macro' developed by Hayes.

RESULTS

According to the obtained results, loneliness mediates the relationship between physical activity barriers and quality of life. Individuals with high levels of loneliness and physical activity barriers have lower levels of quality of life. When the results of the regression analysis indicating the mediating effect were analyzed, it was determined that the effect of physical activity barriers on quality of life were negative and significant. As the level of physical activity barriers increases, the level of quality of life decreases.

CONCLUSION

In conclusion, it was determined that loneliness plays a mediating role in the relationship between physical activity barriers and the level of quality of life. The study results suggest that adopting a physically active lifestyle is important to reduce adverse health outcomes in the elderly.

Protein and Exercise to Reverse Frailty in Older Men and Women Undergoing Transcatheter Aortic Valve Replacement: Design of the PERFORM-TAVR Trial

Despite the high procedural success of transcatheter aortic valve replacement (TAVR), 2 out of 5 older adults report poor physical performance and health-related quality of life (HRQOL) in the ensuing months, particularly those with frailty. There has yet to be a trial examining the synergistic effects of exercise and protein supplementation to counteract frailty and improve patient-centred outcomes following TAVR. The PERFORM-TAVR trial is a multicentre parallel-group randomised clinical trial that is enrolling 200 frail older adults ≥ 70 years of age undergoing TAVR. Patients will be randomly allocated to 1 of 2 treatment groups: standard-of-care lifestyle education (control group) or protein-rich oral nutritional supplement for 4 weeks before TAVR with the addition of home-based supervised exercise sessions for 12 weeks after TAVR (intervention group). The primary outcome will be physical performance as measured by a blinded observer using the Short Physical Performance Battery at 3 months. Secondary outcomes at 3, 6, and 12 months will include HRQOL, as measured by the Short-Form 36 Physical and Mental Component summary scores, and a composite safety end point. The PERFORM-TAVR trial is testing a novel frailty intervention in older adults undergoing TAVR to optimise recovery and downstream HRQOL. This represents a potential paradigm shift that highlights the value of assessing and treating patients' frailty in parallel with their underlying heart valve disease. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03522454.

How quality of life is measured in studies of nutritional intervention: a systematic review

BACKGROUND

Nutrition care can positively affect multiple aspects of patient's health; outcomes are commonly evaluated on the basis of their impact on a patient's (i) illness-specific conditions and (ii) health-related quality of life (HRQoL). Our systematic review examined how HRQoL was measured in studies of nutritional interventions. To help future researchers select appropriate Quality of Life Questionnaires (QoLQ), we identified commonly-used instruments and their uses across populations in different regions, of different ages, and with different diseases.

METHODS

We searched EMCare, EMBASE, and Medline databases for studies that had HRQoL and nutrition intervention terms in the title, the abstract, or the MeSH term classifications "quality of life" and any of "nutrition therapy", "diet therapy", or "dietary supplements" and identified 1,113 studies for possible inclusion.We then reviewed titles, abstracts, and full texts to identify studies for final inclusion.

RESULTS

Our review of titles, abstracts, and full texts resulted in the inclusion of 116 relevant studies in our final analysis. Our review identified 14 general and 25 disease-specific QoLQ. The most-used general QoLQ were the Short-Form 36-Item Health Survey (SF-36) in 27 studies and EuroQol 5-Dimension, (EQ-5D) in 26 studies. The European Organization for Research and Treatment of Cancer Quality of life Questionnaire (EORTC-QLQ), a cancer-specific QoLQ, was the most frequently used disease-specific QoLQ (28 studies). Disease-specific QoLQ were also identified for nutrition-related diseases such as diabetes, obesity, and dysphagia. Sixteen studies used multiple QoLQ, of which eight studies included both general and disease-specific measures of HRQoL. The most studied diseases were cancer (36 studies) and malnutrition (24 studies). There were few studies focused on specific age-group populations, with only 38 studies (33%) focused on adults 65 years and older and only 4 studies focused on pediatric patients. Regional variation in QoLQ use was observed, with EQ-5D used more frequently in Europe and SF-36 more commonly used in North America.

CONCLUSIONS

Use of QoLQ to measure HRQoL is well established in the literature; both general and disease-specific instruments are now available for use. We advise further studies to examine potential benefits of using both general and disease-specific QoLQ to better understand the impact of nutritional interventions on HRQoL.

Frailty Prevention Care Management Program (FPCMP) on Frailty and Health Function in Community-Dwelling Older Adults: A Quasi-Experimental Trial Protocol

BACKGROUND

Frailty often results from deteriorating muscle strength and decreased physical function in older adults. Frailty includes not only physical components, but also psychological and social aspects. Previous research has shown that exercise programs, especially resistance exercises combined with nutritional care, can reduce frailty.

OBJECTIVES

This study aimed to develop a Frailty Prevention Care Management Program that prevents frailty and improves physical activity and nutrition compared to usual care for community-dwelling older adults.

METHODS

A quasi-experimental and single-blinded trial with a non-equivalent control group using a before-after design will be performed involving Frailty Prevention Care Management Program interventions, taking place both at the communities. Participants will be divided into two different intervention groups and two control groups. All groups will be assessed three times: at baseline, immediately after the intervention, and 3 months post intervention. A total of 72 community-dwelling older adults are recruited. This intervention includes an exercise program (design TRX program) and nutritional education. The control group will not receive any specific exercise training. The primary outcome shall comprise the effect of the Frailty Prevention Care Management Program on frailty using the Taiwanese version of the Tilburg frailty indicator. Secondary outcomes include the effect of physical activity using the Senior Fitness Test and nutrition measures using the Mini Nutritional Assessment-Short Form. A generalized estimating equation is constructed to analyze the effects of the intervention.

CONCLUSIONS

This trial will provide vital information to guide interventions to improve outcomes (frailty, physical activity, and nutrition) and inform the integration of nutrition and TRX exercises in community-dwelling older adults.

Reversing frailty in older adults: a scoping review

BACKGROUND

Individuals 65 years or older are presumably more susceptible to becoming frail, which increases their risk of multiple adverse health outcomes. Reversing frailty has received recent attention; however, little is understood about what it means and how to achieve it. Thus, the purpose of this scoping review is to synthesize the evidence regarding the impact of frail-related interventions on older adults living with frailty, identify what interventions resulted in frailty reversal and clarify the concept of reverse frailty.

METHODS

We followed Arksey and O'Malley's five-stage scoping review approach and conducted searches in CINAHL, EMBASE, PubMed, and Web of Science. We hand-searched the reference list of included studies and conducted a grey literature search. Two independent reviewers completed the title, abstract screenings, and full-text review using the eligibility criteria, and independently extracted approximately 10% of the studies. We critically appraised studies using Joanna Briggs critical appraisal checklist/tool, and we used a descriptive and narrative method to synthesize and analyze data.

RESULTS

Of 7499 articles, thirty met the criteria and three studies were identified in the references of included studies. Seventeen studies (56.7%) framed frailty as a reversible condition, with 11 studies (36.7%) selecting it as their primary outcome. Reversing frailty varied from either frail to pre-frail, frail to non-frail, and severe to mild frailty. We identified different types of single and multi-component interventions each targeting various domains of frailty. The physical domain was most frequently targeted (n = 32, 97%). Interventions also varied in their frequencies of delivery, intensities, and durations, and targeted participants from different settings, most commonly from community dwellings (n = 23; 69.7%).

CONCLUSION

Some studies indicated that it is possible to reverse frailty. However, this depended on how the researchers assessed or measured frailty. The current understanding of reverse frailty is a shift from a frail or severely frail state to at least a pre-frail or mildly frail state. To gain further insight into reversing frailty, we recommend a concept analysis. Furthermore, we recommend more primary studies considering the participant's lived experiences to guide intervention delivery.

Diet Is Associated with Frailty in Lung Cancer: A Possible Role of Gut Microbiota

This study investigated the associations between diet and frailty in lung cancer patients and the potential role of the gut microbiota involved. We assessed dietary intake and frailty status in 231 lung cancer patients by 3-day, 24-h dietary recalls and Fried frailty criteria, respectively, and collected 50 fecal samples for next-generation sequencing. A total of 75 (32.5%) patients were frail, which might be related to significantly lower intake of energy, protein, carbohydrate, dietary fiber, niacin, leucine, some minerals, and a poorer dietary quality as indicated by the Chinese Healthy Eating Index (p < 0.05). Among these, carbohydrate (OR = 0.98; 95% CI 0.96-0.99; p = 0.010), calcium (OR = 0.99; 95% CI 0.99-1.00; p = 0.025), and selenium (OR = 1.03; 95% CI 1.00-1.06; p = 0.022) were all significantly associated with frailty. A multivariate logistic regression analysis showed that the mean risk of frailty was 0.94 times lower (95% CI 0.90-0.99; p = 0.009) among participants with higher CHEI scores. Additionally, the frail patients demonstrated significantly lower gut microbiota β diversity (p = 0.001) and higher relative abundance of Actinobacteriota (p = 0.033). Frailty in lung cancer patients might be associated with insufficient nutrients intake and a poor dietary quality through gut microbiota regulation.

Vitamin D deficiency in nursing home residents: a systematic review

CONTEXT

Vitamin D deficiency is a global public health issue, particularly in nursing home residents.

OBJECTIVE

This review critically summarizes the prevalence of vitamin D deficiency in nursing home residents worldwide. In addition, it outlines the effect of vitamin D intervention, alone or in combination with other nutrients or therapies, on improving vitamin D status and associated health outcomes in nursing home residents.

DATA SOURCES, EXTRACTION, AND ANALYSIS

Searches were conducted of electronic databases for articles published from 2010 to May 2021. After screening of the 366 papers initially identified, 58 articles were included.

CONCLUSIONS

A paucity of observational studies in nursing homes suggests a high prevalence of vitamin D deficiency ranging from 8% [25(OH)D <25 nmol/L], up to 94% [25(OH)D <50 nmol/L] in some cohorts where supplement use was low. Reported factors associated with deficiency and suboptimal vitamin D status include lack of sunlight exposure, poor dietary intake of vitamin D, limited vitamin D food fortification, frailty, poor renal function, and low use of vitamin D supplements. Residents who are severely deficient, deficient, or insufficient in vitamin D require remedial vitamin D supplementation prior to maintenance supplementation at doses >800 IU/day. High-dose vitamin D supplementation may reduce respiratory illness; however, supportive data are limited. Oral nutritional supplements, in combination with exercise, may benefit physical function and performance, whereas supplementation with vitamin D- and calcium-fortified foods has been associated with improved quality of life and reduced bone resorption. Globally, vitamin D deficiency is highly prevalent in nursing home residents. There is an urgent need for standardized dietary and supplementation guidelines to prevent deficiency in this vulnerable group.

Effect of Curcumin Consumption on Inflammation and Oxidative Stress in Patients on Hemodialysis: A Literature Review

Advanced chronic kidney disease (CKD) stages lead to exacerbated inflammation and oxidative stress. Patients with CKD in stage 5 need renal hemodialysis (HD) to remove toxins and waste products. However, this renal replacement therapy is inefficient in controlling inflammation. Regular curcumin consumption has been shown to reduce inflammation and oxidative stress in subjects with chronic pathologies, suggesting that the daily intake of curcumin may alleviate these conditions in HD patients. This review analyzes the available scientific evidence regarding the effect of curcumin intake on oxidative stress and inflammation in HD patients, focusing on the mechanisms and consequences of HD and curcumin consumption. The inclusion of curcumin as a dietary therapeutic supplement in HD patients has shown to control the inflammation status. However, the optimal dose and oral vehicle for curcumin administration are yet to be determined. It is important to consider studies on curcumin bioaccessibility to design effective oral administration vehicles. This information will contribute to the achievement of future nutritional interventions that validate the efficacy of curcumin supplementation as part of diet therapy in HD.

Efficacy of Dietary Intervention with Group Activities on Dietary Intakes, Frailty Status, and Working Memory: A Cluster-Randomized Controlled Trial in Community Strongholds

Geriatric community centers often offer nutrition lectures to older adults. In order to make learning more interesting and pragmatic, we developed group activity sessions. This undertaking was tested for its efficacy in changes of frailty status and several other geriatric health parameters. A cluster-randomized controlled trial was conducted between September 2018 and December 2019 at 13 luncheon-providing community strongholds in Taipei, Taiwan. During the 3-month intervention period, 6 experimental strongholds received a weekly 1 h exercise workout and 1 h nutrition activities aiming at achieving the recommendations of the Taiwanese Daily Food Guide for elderlies; the other 7 received a weekly 1 h exercise workout and 1 h other activities. Dietary intakes and frailty status were the primary outcomes. Secondary outcomes included working memory and depression. The measurements were performed at baseline, 3 months, and 6 months. The nutrition intervention significantly reduced the intake of refined grains and roots (p = 0.003) and increased that of non-refined grains and roots (p = 0.008), dairy products (p < 0.0001), and seeds and nuts (at borderline, p = 0.080) at 3 months. Some, but not all, of these changes were maintained at 6 months. Performance improvements included the frailty status score (p = 0.036) and forward digit span (p = 0.004), a working memory parameter, at 3 months. Only the forward digit span remained improved (p = 0.007) at 6 months. The 3-month nutrition group activities combined with exercise sessions improved the frailty status and working memory more than exercise alone. The dietary and frailty improvements were accompanied by improved dietary intakes and advanced behavioral stages. However, the improved frailty status backslid after intervention ceased, suggesting that boosting activities are needed for maintaining the intervention effect.

An Integrated Approach to Skeletal Muscle Health in Aging

A decline in muscle mass and function represents one of the most problematic changes associated with aging, and has dramatic effects on autonomy and quality of life. Several factors contribute to the inexorable process of sarcopenia, such as mitochondrial and autophagy dysfunction, and the lack of regeneration capacity of satellite cells. The physiologic decline in muscle mass and in motoneuron functionality associated with aging is exacerbated by the sedentary lifestyle that accompanies elderly people. Regular physical activity is beneficial to most people, but the elderly need well-designed and carefully administered training programs that improve muscle mass and, consequently, both functional ability and quality of life. Aging also causes alteration in the gut microbiota composition associated with sarcopenia, and some advances in research have elucidated that interventions via the gut microbiota-muscle axis have the potential to ameliorate the sarcopenic phenotype. Several mechanisms are involved in vitamin D muscle atrophy protection, as demonstrated by the decreased muscular function related to vitamin D deficiency. Malnutrition, chronic inflammation, vitamin deficiencies, and an imbalance in the muscle-gut axis are just a few of the factors that can lead to sarcopenia. Supplementing the diet with antioxidants, polyunsaturated fatty acids, vitamins, probiotics, prebiotics, proteins, kefir, and short-chain fatty acids could be potential nutritional therapies against sarcopenia. Finally, a personalized integrated strategy to counteract sarcopenia and maintain the health of skeletal muscles is suggested in this review.

Nutritional Status Is Associated with Health-Related Quality of Life, Physical Activity, and Sleep Quality: A Cross-Sectional Study in an Elderly Greek Population

This study aims to explore the associations between nutritional status and health-related quality of life, physical activity, and sleep quality in older exclusively Caucasian adults from Greec who were free of any severe disease. This is a cross-sectional study. Mini Nutritional Assessment was used to assess nutritional status, health-related quality of life was assessed using the Short Form Healthy Survey questionnaire, sleep quality was assessed using the Pittsburgh Sleep Quality Index, and physical activity levels were assessed via the International Physical Activity Questionnaire. 3405 community-dwelling men and women, over 65 years old from14 different Greek regions were enrolled. Ten-point four percent (10.4%) of the participants were classified as malnourished, while 35.6% were "at risk of malnutrition". A better nutritional status was significantly and independently associated with higher physical activity levels (p = 0.0011) and better quality of life (p = 0.0135), as well as better sleep quality (p = 0.0202). In conclusion, our study highlights the interrelationships between a good nutritional status, a high-quality sleep, active lifestyle, and good quality of life. Further interventional studies are needed to clarify the associations, and test the feasibility of improving the nutritional status, physical activity levels and sleep quality of the elderly, and the impact of these changes on quality of life, and healthy ageing in races beyond Caucasian populations. Public health strategies and policies should be recommended to inform older adults for the necessity to improve their nutritional status and lifestyle habits to improve their health status and to obtain better life expectancy.

Adherence to Mediterranean Diet and Response to an Exercise Program to Prevent Hospitalization-Associated Disability in Older Adults: A Secondary Analysis from a Randomized Controlled Trial

OBJECTIVES

To investigate the relationship between Mediterranean diet (MedDiet) adherence and response to an exercise and health education program to prevent hospitalization-associated disability (HAD) in acutely hospitalized older adults.

DESIGN

Randomized controlled trial.

SETTING AND PARTICIPANTS

Secondary analysis of a subset of 109 participants from AGECAR-PLUS study with available data on MedDiet adherence (mean age 87, and range 75-98).

INTERVENTION

Participants were randomized into the control group (n = 46, usual care) or the intervention group (n = 63, supervised exercise and health education) at admission.

MEASUREMENTS

MedDiet adherence was measured with MEDAS and through urinary total polyphenols (UTP). Functional status was assessed with the Barthel Index.

RESULTS

At discharge, patients in the intervention group who had low levels of MedDiet or UTP showed an increase in functional status [adjusted mean (95% CI) = 77.8 (70.8-84.8) points, p = 0.005, and adjusted mean (95% CI) = 78.0 (68.3-87.7) points, p = 0.020, respectively].

CONCLUSION

Older individuals over age 75 with low MedDiet adherence were likely to benefit more from a physical exercise and health education intervention.

Chinese expert consensus on prevention and intervention for the elderly with malnutrition (2022)

Malnutrition is a state of altered body composition and body cell mass due to inadequate intake or utilization of energy or nutrients, leading to physical and mental dysfunction and impaired clinical outcomes. As one of the most common geriatric syndromes, malnutrition in the elderly is a significant risk factor for poor clinical outcomes, causing a massive burden on medical resources and society. The risk factors for malnutrition in the elderly are diverse and include demographics, chronic diseases, and psychosocial factors. Presently, recommendations for the prevention and intervention of malnutrition in the elderly are not clear or consistent in China. This consensus is based on the latest global evidence and multiregional clinical experience in China, which aims to standardize the prevention and intervention of malnutrition in the elderly in China and improve the efficacy of clinical practice and the prognosis of elderly patients.

Contribution of muscle satellite cells to sarcopenia

Sarcopenia, a disorder characterized by age-related muscle loss and reduced muscle strength, is associated with decreased individual independence and quality of life, as well as a high risk of death. Skeletal muscle houses a normally mitotically quiescent population of adult stem cells called muscle satellite cells (MuSCs) that are responsible for muscle maintenance, growth, repair, and regeneration throughout the life cycle. Patients with sarcopenia are often exhibit dysregulation of MuSCs homeostasis. In this review, we focus on the etiology, assessment, and treatment of sarcopenia. We also discuss phenotypic and regulatory mechanisms of MuSC quiescence, activation, and aging states, as well as the controversy between MuSC depletion and sarcopenia. Finally, we give a multi-dimensional treatment strategy for sarcopenia based on improving MuSC function.

Resilience is associated with frailty and older age in hospitalised patients

Background

Little is known about resilience in an internal medicine setting. We aimed to assess the relationship between resilience and frailty and other clinical and sociodemographic characteristics in a cohort of prospectively enrolled hospitalised patients.

Methods

In 2017–2019, we consecutively enrolled patients in our internal medicine wards. We selected all patients who filled in the 25-item Connor-Davidson resilience scale (CD-RISC). Mean resilience was evaluated according to baseline demographic (i.e., age, sex, marital and socioeconomic status) and clinical (i.e., Cumulative Illness Rating Scale [CIRS], Edmonton Frail Scale [EFS], Barthel index, Short Blessed test, length of stay [LOS]) data. A multivariable analysis for assessing factors affecting resilience was fitted.

Results

Overall, 143 patients (median age 69 years, interquartile range 52–79, 74 females) were included. Resilience was significantly lower in frail (p = 0.010), elderly (p = 0.021), dependent (p = 0.032), and more clinically (p = 0.028) and cognitively compromised patients (p = 0.028), and in those with a low educational status (p = 0.032). No relation between resilience and LOS was noticed (p = 0.597). Frail patients were significantly older (p < 0.001), had a greater disease burden as measured by CIRS comorbidity (p < 0.001) and severity indexes (p < 0.001), were more dependent (p < 0.001), more cognitively impaired (p < 0.001), and displayed a lower educational level (p = 0.011) compared to non-frail patients. At multivariable analysis, frailty (p = 0.022) and dependency (p = 0.031; according to the Barthel index) were associated with lower resilience in the age groups 18–64 and ≥ 65 years, respectively.

Conclusions

Low resilience was associated with frailty and dependency with an age-dependent fashion. Studies assessing the impact of this finding on important health outcomes are needed.

Trial registration

Clinical Complexity in Internal Medicine Wards. San MAtteo Complexity Study (SMAC); NCT03439410. Registered 01/11/2017.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03251-9.

Physical and Motor Fitness Tests for Older Adults Living in Nursing Homes: A Systematic Review

This systematic review aimed to identify the physical/motor fitness tests for nursing home residents and to examine their psychometric properties. Electronic databases were searched for articles published between January 2005 and October 2021 using MeSh terms and relevant keywords. Of the total of 4196 studies identified, 3914 were excluded based on title, abstracts, or because they were duplicates. The remaining 282 studies were full-text analyzed, and 41 were excluded, resulting in 241 studies included in the review. The most common physical component assessed was muscle strength; 174 (72.2%) studies assessed this component. Balance (138 studies, 57.3%) and agility (102 studies, 42.3%) were the second and third components, respectively, most widely assessed. In this review, we also describe the most used assessment tests for each physical/motor component. Some potentially relevant components such as manual dexterity and proprioception have been little considered. There are few studies assessing the psychometric properties of the tests for nursing home residents, although the data show that, in general, they are reliable. This review provides valuable information to researchers and health-care professionals regarding the physical/motor tests used in nursing home residences, helping them select the screening tools that could most closely fit their study objectives.

Nutritional status and quality-of-life of older adults in aged care: A systematic review and meta-analysis

The effect of malnutrition beyond morbidity and mortality has become a critical area of investigation in older people with an increased focus on quality-of-life (QoL), but as yet the relationship between malnutrition and QoL remains to be reviewed in older people from aged care settings. The current study conducted a systematic review and meta-analyses of studies published between the years 1995 and 2020 examining the relationship between nutritional status and QoL or the effects of a nutrition-based intervention on QoL in older people in residential aged care. Based on searches of the databases MEDLINE, PsycINFO, Emcare, and Embase, 21 studies were identified. Meta-analyses of the cross-sectional and quasi-experimental studies revealed a significant positive relationship between nutritional status and QoL and that nutritional intervention significantly improved QoL. By contrast, meta-analysis of randomised controlled trials revealed a non-significant but improved trend post-intervention in QoL. Although the effect sizes were small, the present findings indicate that nutrition-based interventions improve QoL in older people in residential aged care and align with previous reviews based on findings from other aged settings. Future research is needed to determine causality and to better identify and control for confounding factors which may influence both nutritional status and QoL.

What long-term care interventions have been published between 2010 and 2020? Results of a WHO scoping review identifying long-term care interventions for older people around the world

OBJECTIVE

The global population is rapidly ageing. To tackle the increasing prevalence of older adults' chronic conditions, loss of intrinsic capacity and functional ability, long-term care interventions are required. The study aim was to identify long-term care interventions reported in scientific literature from 2010 to 2020 and categorise them in relation to WHO's public health framework of healthy ageing.

DESIGN

Scoping review conducted on PubMed, CINHAL, Cochrane and Google Advanced targeting studies reporting on long-term care interventions for older and frail adults. An internal validated Excel matrix was used for charting.Setting nursing homes, assisted care homes, long-term care facilities, home, residential houses for the elderly and at the community.

INCLUSION CRITERIA

Studies published in peer-reviewed journals between 1 January 2010 to 1 February 2020 on implemented interventions with outcome measures provided in the settings mentioned above for subjects older than 60 years old in English, Spanish, German, Portuguese or French.

RESULTS

305 studies were included. Fifty clustered interventions were identified and organised into four WHO Healthy Ageing domains and 20 subdomains. All interventions delved from high-income settings; no interventions from low-resource settings were identified. The most frequently reported interventions were multimodal exercise (n=68 reports, person-centred assessment and care plan development (n=22), case management for continuum care (n=16), multicomponent interventions (n=15), psychoeducational interventions for caregivers (n=13) and interventions mitigating cognitive decline (n=13).

CONCLUSION

The identified interventions are diverse overarching multiple settings and areas seeking to prevent, treat and improve loss of functional ability and intrinsic capacity. Interventions from low-resource settings were not identified.

Emerging Evidence on the Use of Probiotics and Prebiotics to Improve the Gut Microbiota of Older Adults with Frailty Syndrome: A Narrative Review

BACKGROUND

The gut microbiota can impact older adults' health, especially in patients with frailty syndrome. Understanding the association between the gut microbiota and frailty syndrome will help to explain the etiology of age-related diseases. Low-grade systemic inflammation is a factor leading to geriatric disorders, which is known as "inflammaging". Intestinal dysbiosis has a direct relationship with low-grade systemic inflammation because when the natural gut barrier is altered by age or other factors, some microorganisms or their metabolites can cross this barrier and reach the systemic circulation.

OBJECTIVES

This review had two general goals: first, to describe the characteristics of the gut microbiota associated with age-related diseases, specifically frailty syndrome. The second aim was to identify potential interventions to improve the composition and function of intestinal microbiota, consequently lessening the burden of patients with frailty syndrome.

METHODS

A search of scientific evidence was performed in PubMed, Science Direct, and Redalyc using keywords such as "frailty", "elderly", "nutrient interventions", "probiotics", and "prebiotics". We included studies reporting the effects of nutrient supplementation on frailty syndrome and older adults. These studies were analyzed to identify novel therapeutic alternatives to improve gut microbiota characteristics as well as subclinical signs related to this condition.

RESULTS

The gut microbiota participates in many metabolic processes that have an impact on the brain, muscles, and other organs. These processes integrate feedback mechanisms, comprising their respective axis with the intestine and the gut microbiota. Alterations in these associations can lead to frailty. We report a few interventions that demonstrate that prebiotics and probiotics could modulate the gut microbiota in humans. Furthermore, other nutritional interventions could be used in patients with frailty syndrome.

CONCLUSION

Probiotics and prebiotics may potentially prevent frailty syndrome or improve the quality of life of patients with this disorder. However, there is not enough information about their appropriate doses and periods of administration. Therefore, further investigations are required to determine these factors and improve their efficacy as therapeutic approaches for frailty syndrome.

Development and validation of a prediction model for actionable aspects of frailty in the text of clinicians' encounter notes

OBJECTIVE

Frailty is a prevalent risk factor for adverse outcomes among patients with chronic lung disease. However, identifying frail patients who may benefit from interventions is challenging using standard data sources. We therefore sought to identify phrases in clinical notes in the electronic health record (EHR) that describe actionable frailty syndromes.

MATERIALS AND METHODS

We used an active learning strategy to select notes from the EHR and annotated each sentence for 4 actionable aspects of frailty: respiratory impairment, musculoskeletal problems, fall risk, and nutritional deficiencies. We compared the performance of regression, tree-based, and neural network models to predict the labels for each sentence. We evaluated performance with the scaled Brier score (SBS), where 1 is perfect and 0 is uninformative, and the positive predictive value (PPV).

RESULTS

We manually annotated 155 952 sentences from 326 patients. Elastic net regression had the best performance across all 4 frailty aspects (SBS 0.52, 95% confidence interval [CI] 0.49-0.54) followed by random forests (SBS 0.49, 95% CI 0.47-0.51), and multi-task neural networks (SBS 0.39, 95% CI 0.37-0.42). For the elastic net model, the PPV for identifying the presence of respiratory impairment was 54.8% (95% CI 53.3%-56.6%) at a sensitivity of 80%.

DISCUSSION

Classification models using EHR notes can effectively identify actionable aspects of frailty among patients living with chronic lung disease. Regression performed better than random forest and neural network models.

CONCLUSIONS

NLP-based models offer promising support to population health management programs that seek to identify and refer community-dwelling patients with frailty for evidence-based interventions.

The Nutritional Status of Long-Term Institutionalized Older Adults Is Associated with Functional Status, Physical Performance and Activity, and Frailty

Among older adults living in long-term nursing homes (LTNHs), maintaining an adequate functional status and independence is a challenge. Whilst a poor nutritional status is a potential risk factor for a decreased function in this population, its role is not fully understood. Here, using a transversal multicenter study of 105 older adults living in 13 LTNHs, we analyzed the associations between nutritional status, as measured by the Mini Nutritional Assessment (MNA), and the parameters of functional status, physical performance, physical activity, and frailty as well as comorbidity and body composition. The MNA scores were positively correlated with the Barthel Index, handgrip strength, Short Physical Performance Battery (SPPB) scores, absolute muscle power, and Assessment of Physical Activity in Frail Older People (APAFOP) scores and were negatively correlated with dynamic balance and frailty. In a multiple linear regression model controlling for gender and age, the APAFOP score (β = 0.386), BMI (β = 0.301), and Barthel Index (β = 0.220) explained 31% of the variance in the MNA score. Given the observed close relationship between the MNA score and functional status, physical performance and activity, and frailty, interventions should jointly target improvements in both the nutritional status and functional status of LTNH residents. Strategies designed and implemented by interdisciplinary professional teams may be the most successful in improving these parameters to lead to better health and quality of life.

Nutrition Assessment and Interventions for the Prevention and Treatment of Malnutrition in Older Adults: An Evidence Analysis Center Scoping Review

Older adults living in the community or long-term residence such as a nursing home are at increased risk for malnutrition due to factors such as depression and isolation. The purpose of this scoping review is to identify the best available research that evaluates the validity and reliability of nutrition assessment tools, and the effectiveness of nutrition interventions to prevent or treat malnutrition among older adults. A literature search was conducted in Medline, Embase, CINAHL, and Cochrane Central databases to identify clinical trials, published in the English language, evaluating assessment and intervention methods aimed to treat or prevent malnutrition among older adults living in the community or their long-term residence such as nursing homes. Articles were screened by 2 reviewers, then data were extracted and narratively synthesized. The literature search retrieved 20,937 articles and 197 articles were included in narrative synthesis. A total of 73 assessment articles were identified, 36 of which were validity and reliability trials. A total of 122 intervention articles were identified, the majority of which were randomized controlled trials. A few of the most commonly evaluated interventions were oral nutrition supplements, medical nutrition therapy, fortification and enrichment, and nutrition education. Several systematic reviews were identified, however, that did not meet the criteria of this review. There is a need to conduct systematic reviews for nutrition assessment and intervention trials to guide development of evidence-based nutrition practice recommendations for older adults living in the community or their long-term residence.

Impact of Rehabilitation Dose on Nutritional Status at Discharge from a Convalescent Rehabilitation Ward in Malnourished Patients with Hip Fracture

The object of this study is to determine the impact of the rehabilitation dose on the nutritional status at discharge from a convalescent rehabilitation ward in malnourished patients with hip fracture. This retrospective case-control study involved malnourished patients with hip fracture aged 65 years or older who had been admitted to a convalescent rehabilitation ward and whose data were registered in the Japan Rehabilitation Nutrition Database. The primary outcome was nutritional status at discharge. Patients were classified according to whether nutritional status was improved or not at discharge, according to the Mini Nutritional Assessment-Short Form^® (MNA-SF) score. The association between improved nutritional status and rehabilitation dose was assessed by a logistic regression analysis. Data were available for 145 patients (27 men, 118 women; mean age 85.1 ± 7.9 years). Daily rehabilitation dose was 109.5 (median 94.6–116.2) min and the MNA-SF score at admission was 5 (median 4–6). Nutritional status was improved in 97 patients and not improved in 48. Logistic regression analysis showed the following factors to be independently associated with nutritional status at discharge: Functional Independence Measure score (OR 1.042, 95% CI 1.016–1.068), energy intake (OR 1.002 CI 1.000–1.004), daily rehabilitation dose (OR 1.023, 95% CI 1.002–1.045), and length of hospital stay (OR 1.026, 95% CI 1.003–1.049). The daily rehabilitation dose in malnourished patients with hip fracture may positively impact nutritional status at discharge.

Response and Adherence of Nursing Home Residents to a Nutrition/Exercise Intervention

OBJECTIVES

Interindividual response variability to nutrition and exercise interventions is extensive in older adults. A group of nursing home (NH) residents participated in a combined intervention. The objective of this post-hoc analysis was to identify factors associated with intervention response measured by change in physical function and body composition.

DESIGN

Post-hoc analyses in the Older Person's Exercise and Nutrition study, a 2-arm randomized trial. The primary outcomes were 30-second Chair Stand Test and composite scores combining physical function and fat-free mass. A secondary outcome was intervention adherence. A 12-week intervention of sit-to-stand exercises and protein-rich nutritional supplements did not improve chair-stand capacity vs control on intention-to-treat basis.

SETTING AND PARTICIPANTS

Residents ≥75 years of age from dementia and somatic units in eight NHs in Sweden.

METHODS

Logistic regressions were performed to define factors associated with response (maintenance/improvement) or nonresponse (deterioration) in 30-second Chair Stand Test, and with intervention adherence. Linear regressions were performed to explore factors associated with response in composite scores.

RESULTS

Mean age of participants (n = 52 intervention, n = 49 control) was 85.8 years. Sarcopenia was occurring in 74%. Sarcopenia at baseline (P = .005) and high adherence to nutritional supplements (P = .002) increased the odds of response. Higher independence in daily activities increased the odds of adherence to sit-to-stand exercises (P = .027) and the combined intervention (P = .020). Allocation to the intervention group and higher self-perceived health were associated with higher composite scores.

CONCLUSIONS AND IMPLICATIONS

NH residents with baseline sarcopenia, better self-perceived health, and high adherence to nutritional supplements benefitted most from a combined nutrition and exercise intervention regarding chair-stand capacity and composite scores of function and fat-free mass. Adherence was related to higher grade of independence. Understanding factors associated with response and adherence to an intervention will help target susceptible residents in most need of support and to optimize the outcome.

Interactions of the microbiome with pharmacological and non-pharmacological approaches for the management of ageing-related musculoskeletal diseases

Despite major progress in the understanding of the pathophysiology and therapeutic options for common ageing-related musculoskeletal conditions (i.e. osteoporosis and associated fractures, sarcopenia and osteoarthritis), there is still a considerable proportion of patients who respond sub optimally to available treatments or experience adverse effects. Emerging microbiome research suggests that perturbations in microbial composition, functional and metabolic capacity (i.e. dysbiosis) are associated with intestinal and extra-intestinal disorders including musculoskeletal diseases. Besides its contributions to disease pathogenesis, the role of the microbiome is further extended to shaping individuals' responses to disease therapeutics (i.e. pharmacomicrobiomics). In this review, we focus on the reciprocal interactions between the microbiome and therapeutics for osteoporosis, sarcopenia and osteoarthritis. Specifically, we identify the effects of therapeutics on microbiome's configurations, functions and metabolic output, intestinal integrity and immune function, but also the effects of the microbiome on the metabolism of these therapeutics, which in turn, may influence their bioavailability, efficacy and side-effect profile contributing to variable treatment responses in clinical practice. We further discuss emerging strategies for microbiota manipulation as preventive or therapeutic (alone or complementary to available treatments) approaches for improving outcomes of musculoskeletal health and disease.

Effect of Training-Detraining Phases of Multicomponent Exercises and BCAA Supplementation on Inflammatory Markers and Albumin Levels in Frail Older Persons

Nowadays, it is accepted that the regular practice of exercise and branched-chain amino acids supplementation (BCAAs) can benefit the immune responses in older persons, prevent the occurrence of physical frailty (PF), cognitive decline, and aging-related comorbidities. However, the impact of their combination (as non-pharmacological interventions) in albumin and the inflammatory markers is not fully understood. Therefore, we investigated the effect of a 40-week multifactorial intervention [MIP, multicomponent exercise (ME) associated or not with BCAAs] on plasma levels of inflammatory markers and albumin in frail older persons (≥75 years old) living at residential care homes (RCH). This study consisted of a prospective, naturalistic, controlled clinical trial with four arms of multifactorial and experimental (interventions-wahshout-interventions) design. The intervention groups were ME + BCAAs (n = 8), ME (n = 7), BCAAs (n = 7), and control group (n = 13). Lower limb muscle-strength, cognitive profile, and PF tests were concomitantly evaluated with plasma levels of albumin, anti- and pro-inflammatory cytokines [Interleukin-10 (IL-10) and Tumor Necrosis Factor-alpha (TNF-α) respectively], TNF-α/IL-10 ratio, and myeloperoxidase (MPO) activity at four different time-points: Baseline (T1), after 16 weeks of multifactorial intervention (T2), then after a subsequent 8 weeks washout period (T3) and finally, after an additional 16 weeks of multifactorial intervention (T4). Improvement of cognitive profile and muscle strength-related albumin levels, as well as reduction in the TNF-α levels were found particularly in ME plus BCAAs group. No significant variations were observed over time for TNF-α/IL-10 ratio or MPO activity. Overall, the study showed that MIP triggered slight alterations in the inflammatory and physical function of the frail older participants, which could provide independence and higher quality of life for this population.

Evaluation of Oral Nutritional Supplementation in the Management of Frailty among the Elderly at Facilities of Community Care for the Elderly

Adequate nutritional intake in elderly individuals improves frailty. Elderly individuals may exhibit improvements in frailty with the use of community care facilities. Therefore, this study evaluated the effects of nutritional intervention in elderly subjects at community care facilities receiving oral nutritional supplements (ONSs) and determined their nutritional status. Sixty-two elderly individuals using community care facilities were divided into the experimental group (EG) (before [n = 31]/after [n = 28]) and control group (CG) (before [n = 31]/after [n = 25]). Subjects in both groups were treated with ONSs (200 mL/200 kcal) for 90 days. However, those in the EG received the product with increased protein; vitamins A, C, D, and E; phosphorus; calcium; and zinc. The data collected included anthropometric data, dietary assessment findings, frailty status (Korean version of the Fatigue, Resistance, Ambulation, Illnesses, and Loss of weight questionnaire), and nutritional status (Mini Nutritional Assessment, MNA). The changes in the two groups were analyzed using the Mann-Whitney U Wilcoxon signed-rank test. Nutritional intervention increased the weight, body mass index, and lean body mass in the EG (p < 0.05). Protein, calcium, and iron levels increased only in the EG (p < 0.05). The MNA score increased and sum of frailty indicators improved in the EG, and the increase in the MNA score in the EG was greater than that in the CG. This study verified the improved anthropometric data and dietary intake in the EG. Thus, the higher number of pre-frailty elderly individuals at facilities of community care indicates the need for adequate nutritional supplementation for frailty management.

Frailty, sarcopenia and cachexia in heart failure patients: Different clinical entities of the same painting

Heart Failure (HF) in elderly patients is a systemic syndrome where advanced age, comorbidities with organ system deterioration, frailty and impaired cognition significantly impact outcome. Cardiac cachexia, sarcopenia and frailty despite overlap in definitions are different clinical entities that frequently coexist in HF patients. However, these co-factors often remain unaddressed, resulting in poor quality-of-life, prolonged physical disability and exercise intolerance and finally with higher rehospitalization rates and mortality. Strategy aim to increase muscle mass and muscle strength and delay the occurrence of frailty state appear essential in this regard. Common HF drugs therapy (b-blockers, angiotensin-converting enzyme inhibitors) and prescription of physical exercise program remain the cornerstone of therapeutic approach in HF patients with new promising data regarding nutritional supplementation. However, the treatment of all these conditions still remain debated and only a profound knowledge of the specific mechanisms and patterns of disease progression will allow to use the appropriate therapy in a given clinical setting. For all these reasons we briefly review current knowledge on frailty, sarcopenia and cachexia in HF patients with the attempt to define clinically significant degrees of multiorgan dysfunction, specific "red alert" thresholds in clinical practice and therapeutic approach.

Effects of Probiotics and Prebiotics on Frailty and Ageing: A Narrative Review

Globally, the population over the age of 60 is growing fast, but people age in different ways. Frailty, shown by the accumulation of age-related deficits, is a state of increased vulnerability to adverse outcomes among people of the same chronological age. Ageing results in a decline in diversity and homeostasis of microbiomes, and gut flora changes are related to health deficit accumulation and adverse health outcomes. In older people, health deficits including inappropriate intake, sarcopenia, physical inactivity, polypharmacy, and social vulnerability are factors associated with gut dysbiosis. The use of probiotics and prebiotics is a cost-effective and widely available intervention. Intake of probiotics and prebiotics may improve the homeostasis of gut microflora and prevent frailty and unhealthy aging. However, health effects vary among probiotics and prebiotics and among individual populations. This narrative review summarizes recent evidence about the relationship between prebiotic and probiotic consumption with health outcomes in older people.

Effectiveness of combined exercise and nutrition interventions in prefrail or frail older hospitalised patients: a systematic review and meta-analysis

OBJECTIVES

To determine the effectiveness of combined exercise-nutrition interventions in prefrail/frail hospitalised older adults on frailty, frailty-related indicators, quality of life (QoL), falls and its cost-effectiveness.

DESIGN

Randomised controlled trials (RCTs) of combined exercise-nutrition interventions on hospitalised prefrail/frail older adults ≥65 years were collated from MEDLINE, Emcare, CINAHL, Ageline, Scopus, Cochrane and PEDro on 10 October 2019. The methodological quality was appraised, and data were summarised descriptively or by meta-analysis using a fixed effects model. The standardised mean difference (SMD) or difference of means (MD) with 95% CIs was calculated.

RESULTS

Twenty articles from 11 RCTs experimenting exercise-nutrition interventions on hospitalised older adults were included. Seven articles were suitable for the meta-analyses. One study had low risk of bias and found improvements in physical performance and frailty-related biomarkers. Exercise interventions were mostly supervised by a physiotherapist, focusing on strength, ranging 2-5 times/week, of 20-90 min duration. Most nutrition interventions involved counselling and supplementation but had dietitian supervision in only three studies. The meta-analyses suggest that participants who received exercise-nutrition intervention had greater reduction in frailty scores (n=3, SMD 0.25; 95% CI 0.03 to 0.46; p=0.02) and improvement in short physical performance battery (SPPB) scores (n=3, MD 0.48; 95% CI 0.12 to 0.84; p=0.008) compared with standard care. Only the chair-stand test (n=3) out of the three SPPB components was significantly improved (MD 0.26; 95% CI 0.09 to 0.43; p=0.003). Patients were more independent in activities of daily living in intervention groups, but high heterogeneity was observed (I²=96%, p<0.001). The pooled effect for handgrip (n=3)±knee extension muscle strength (n=4) was not statistically significant. Nutritional status, cognition, biomarkers, QoL, falls and cost-effectiveness were summarised descriptively due to insufficient data.

CONCLUSIONS

There is evidence, albeit weak, showing that exercise-nutrition interventions are effective to improve frailty and frailty-related indicators in hospitalised older adults.

Associations Between Nutritional Status, Sociodemographic Characteristics, and Health-Related Variables and Health-Related Quality of Life Among Chinese Elderly Patients: A Multicenter Prospective Study

Background: Studies that explore the nutritional status, sociodemographic factors, mental health variables, and physical health variables that affect the health-related quality of life (HRQoL) of elderly patients are scarce in China. Objective: This study aimed to examine the association between health-related quality of life (HRQoL) and nutritional status, sociodemographic characteristics, and health-related variables among Chinese elderly patients. Materials and Methods: Participants were recruited from six tertiary-level hospitals in six provinces or municipalities/cities throughout China from October 2018 to February 2019: a total of 9,996 participants aged 65 years and older were enrolled. The nutritional status and HRQoL were measured using the Mini Nutritional Assessment-Short Form (MNA-SF) and the EuroQoL Five-Dimension Visual Analog Scale, respectively. BMI was taken using standard measurement protocols. Sociodemographic characteristics included age, sex, education, marital status, ethnicity, smoking, alcohol drinking, and current residence. Mental and physical health variables such as frailty and depression were assessed using validated tested instruments. Multiple linear regression analysis was used to analyze whether the nutritional status, sociodemographic characteristics, and health-related variables were associated with HRQoL. Results: According to the MNA-SF scores at the 30- and 90-day follow-up, 9.7% and 9.1% of participants were malnourished, respectively. Higher MNA-SF scores were related to higher HRQoL scores in older patients (regression coefficient; 95% confidence interval) both at the 30-day (0.660; 0.499-0.821) and 90-day (0.622; 0.434-0.809) follow-up. However, there were no significant associations between the body mass index values and HRQoL. Sociodemographic characteristics (such as age, smoking, and current residence), physical health variables (frailty, urinary function, defecation function, sleeping condition, and falling accidents in the past 12 months), and mental health variables (depression) were the main factors influencing HRQoL in this group. Conclusion: There are several factors associated with HRQoL among the population derived from this investigation of a representative sample of the Chinese hospitalized elderly population in tertiary hospitals. These findings could have major importance for the planning of "active aging" policies and programs. Trial Registration: Chinese Clinical Trial Registry, ChiCTR1800017682, registered August 9, 2018.

Physical and psychological states interfere with health-related quality of life of institutionalized elderly: a cross-sectional study

Background

Nursing home elders experience many problems that may influence their quality of life, in example of cognitive, mental, nutritional and physical disabilities. Concerning about elders’ wellbeing may help them living with dignity. This study aimed to investigate factors associated with Health-Related Quality of Life (HRQoL) of institutionalized elders in a capital city of Brazilian Northeast.

Methods

A cross-sectional study was conducted with 125 institutionalized elders living in the metropolitan region of João Pessoa (Brazil). The following variables were tested regarding their association with the elders’ HRQoL: Socio-demographic characteristics; Performance of daily-living activities, Frailty status, Cognitive status, Nutritional status, Self-perception of oral health and Depression status. Hierarchical multiple Poisson loglinear and binary logistic regressions analyses were performed in order to assess the impact of each independent variable on HRQoL, considering a significance level of 5%.

Results

The median of HRQoL of institutionalized elders was 64. Multivariate regression models showed that retirement, frailty and depression were statistically associated with poor HRQoL (p < 0.05). Not-frail elderly and less depressed were more likely to present higher HRQoL scores.

Conclusions

Lower HRQoL of institutionalized elderly is associated with decline of physical and psychological states. Institutions should be advised to plan and implement actions that would improve the HRQoL of institutionalized elderly.

Developing and Validating a Primary Care EMR-based Frailty Definition using Machine Learning

Introduction

Individuals who have been identified as frail have an increased state of vulnerability, often leading to adverse health events, increased health spending, and potentially detrimental outcomes.

Objective

The objective of this work is to develop and validate a case definition for frailty that can be used in a primary care electronic medical record database.

Methods

This is a cross-sectional validation study using data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) in Southern Alberta. 52 CPCSSN sentinels assessed a random sample of their own patients using the Rockwood Clinical Frailty scale, resulting in a total of 875 patients to be used as reference standard. Patients must be over the age of 65 and have had a clinic visit within the last 24 months. The case definition for frailty was developed using machine learning methods using CPCSSN records for the 875 patients.

Results

Of the 875 patients, 155 (17.7%) were frail and 720 (84.2%) were not frail. Validation metrics of the case definition were: sensitivity and specificity of 0.28, 95% CI (0.21 to 0.36) and 0.94, 95% CI (0.93 to 0.96), respectively; PPV and NPV of 0.53, 95% CI (0.42 to 0.64) and 0.86, 95% CI (0.83 to 0.88), respectively.

Conclusions

The low sensitivity and specificity results could be because frailty as a construct remains under-developed and relatively poorly understood due to its complex nature. These results contribute to the literature by demonstrating that case definitions for frailty require expert consensus and potentially more sophisticated algorithms to be successful.

How to Improve the Functional Capacity of Frail and Pre-Frail Elderly People? Health, Nutritional Status and Exercise Intervention. The EXERNET-Elder 3.0 Project

Aging is associated with the impairment of health and functional capacity, and physical exercise seems to be an effective tool in frailty prevention and treatment. The purpose of this study was to present the methodology used in the EXERNET-Elder 3.0 project that aims to evaluate the immediate and residual effects and of a multicomponent exercise training program called Elder-fit on frailty, fitness, body composition and quality of life, and also to analyse a possible dietary intake interaction according to health and metabolic status. A total of 110 frail and pre-frail elders participated in this study and were divided into a control group (CG = 52) and an intervention group (IG = 58). The IG performed a supervised multicomponent exercise training program of 6 months and 3 days per week, which included strength, endurance, balance, coordination and flexibility exercises, while the CG continued with their usual daily activities. Both groups received four speeches about healthy habits along the project. Four evaluations were performed: at baseline, after 3 months of training, at the end of the training program (6 months) and 4 months after the program had ended to examine the effects of detraining. Evaluating the efficacy, safety and feasibility of this program will help to develop efficacious physical interventions against frailty. Further, protocols should be described accurately to allow exercise programs to be successfully replicated.