Although more specific surveys needs to be performed, there is sufficient evidence to state that gait speed identifies autonomous community-dwelling older people at risk of adverse outcomes and can be used as a single-item assessment tool. The assessment at usual pace over 4 meters was the most often used method in literature and might represent a quick, safe, inexpensive and highly reliable instrument to be implemented.

Abstract:The frailty syndrome has recently attracted attention of the scientific community and public health organizations as precursor and contributor of age-related conditions (particularly disability) in older persons. In parallel, dementia and cognitive disorders also represent major healthcare and social priorities. Although physical frailty and cognitive impairment have shown to be related in epidemiological studies, their pathophysiological mechanisms have been usually studied separately. An International Consensus Group on "Cognitive Specific aim of this approach was to facilitate the design of future personalized preventive interventions in older persons. Finally, the Group discussed the use of multidomain interventions focused on the physical, nutritional, cognitive and psychological domains for improving the well-being and quality of life in the elderly. The consensus panel proposed the identification of the so-called "cognitive frailty" as an heterogeneous clinical manifestation characterized by the simultaneous presence of both physical frailty and cognitive impairment. In particular, the key factors defining such a condition include: 1) presence of physical frailty and cognitive impairment (CDR=0.5); and 2) exclusion of concurrent AD dementia or other dementias. Under different circumstances, cognitive frailty may represent a precursor of neurodegenerative processes. A potential for reversibility may also characterize this entity. A psychological component of the condition is evident and concurs at increasing the vulnerability of the individual to stressors.

These results will allow a better understanding of the clinical stage previous to malnutrition. An adequate diagnosis and treatment of identified modifiable factors like functional impairment, eating behaviours and depression could delay or avoid malnutrition.

The NutriAlz program had no effect on functional decline in Alzheimer disease patients living at home over one year, but reduced the risk for malnutrition, as recommendations concerning diet and exercise were provided.

The transition from independence to disability in older adults is characterized by detectable changes in body composition and physical function. Epidemiologic studies have shown that weight loss, reduced caloric intake and the reduced intake of specific nutrients are associated with such changes. The mechanisms underlying these associations remain unclear, and different hypotheses have been suggested, including the reduction of the antioxidant effects of some nutrients. Changes in muscle mass and quality might play a central role in the pathway linking malnutrition, its biological and molecular consequences, and function. A different approach aims at assessing diets by dietary patterns, which capture intercorrelations of nutrients within a diet, rather than by selective foods or nutrients: epidemiologic evidence suggests that some types of diet, such as the Mediterranean diet, might prevent negative functional outcomes in older adults. However, despite a theoretical and empirical basis, intervention studies using nutritional supplementation have shown inconclusive results in preventing functional impairment and disability. The present work is the result of a review and consensus effort of a European task force on nutrition in the elderly, promoted by the International Association of Gerontology and Geriatrics (IAGG) European Region. After the critical review of different aspects related to the role of nutrition in the transition from independence to disability, we propose future lines for research, including the determination of levels of inadequacy and target doses of supplements, the study of interactions (between nutrients within a diet and with other lifestyle aspects), and the association with functional outcomes.