BackgroundFew empirical studies support a bio-psycho-social conceptualization of frailty. In addition to physical frailty (PF), we explored mental (MF) and social (SF) frailty and studied the associations between multidimensional frailty and various adverse health outcomes.MethodsCross-sectional and longitudinal analyses were conducted using data from a population-based cohort (SLAS-1) of 2387 community-dwelling Singaporean Chinese older adults. Outcomes examined were functional and severe disability, nursing home referral and mortality. PF was defined by shrinking, weakness, slowness, exhaustion and physical inactivity, 1–2 = pre-frail, 3–5 = frail; MF was defined by ≥1 of cognitive impairment, low mood and poor self-reported health; SF was defined by ≥2 of living alone, no education, no confidant, infrequent social contact or help, infrequent social activities, financial difficulty and living in low-end public housing.ResultsThe prevalence of any frailty dimension was 63.0%, dominated by PF (26.2%) and multidimensional frailty (24.2%); 7.0% had all three frailty dimensions. With a few exceptions, frailty dimensions share similar associations with many socio-demographic, lifestyle, health and behavioral factors. Each frailty dimension varied in showing independent associations with functional (Odds Ratios [ORs] = 1.3–1.8) and severe disability prevalence at baseline (ORs = 2.2–7.3), incident functional disability (ORs = 1.1–1.5), nursing home referral (ORs = 1.5–3.4) and mortality (Hazard Ratios = 1.3–1.5) after adjusting for age, gender, medical comorbidity and the two other frailty dimensions. The addition of MF and SF to PF incrementally increased risk estimates by more than 2 folds.ConclusionsThis study highlights the relevance and utility of PF, MF and SF individually and together. Multidimensional frailty can better inform policies and promote the use of targeted multi-domain interventions tailored to older adults’ frailty statuses.

MTED is a clinically appropriate and psychometrically valid scale to evaluate music therapy engagement in PWDs.

Background Cognitive training can improve cognition in healthy older adults. Objective The objectives are to evaluate the implementation of community-based computerized cognitive training (CCT) and its effectiveness on cognition, gait, and balance in healthy older adults. Methods A single-blind randomized controlled trial with baseline and follow-up assessments was conducted at two community centers in Singapore. Healthy community-dwelling adults aged 55 years and older participated in a 10-week CCT program with 2-hour instructor-led group classes twice a week. Participants used a mobile app to play games targeting attention, memory, decision making, visuospatial abilities, and cognitive flexibility. Implementation was assessed at the participant, provider, and community level (eg, reach, implementation, and facilitators and barriers). Effectiveness measures were the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Color Trails Test 2 (CTT-2), Berg Balance Scale, and GAITRite walkway measures (single and dual task gait speed, dual task cost, and single and dual task gait variability index [GVI]). Results A total of 94 healthy community-dwelling adults participated in the CCT program (mean age 68.8 [SD 6.3] years). Implementation measures revealed high reach (125/155, 80.6%) and moderate adherence but poor penetration of sedentary older adults (43/125, 34.4%). The effectiveness data were based on intention-to-treat (ITT) and per-protocol (PP) analysis. In the ITT analysis, single task GVI increased ( b =2.32, P =.02, 95% CI [0.30 to 4.35]) and RBANS list recognition subtest deteriorated ( b =–0.57, P =.01, 95% CI [–1.00 to –0.14]) in both groups. In the PP analysis, time taken to complete CTT-2 ( b =–13.5, P =.01, 95% CI [–23.95 to –3.14]; Cohen d effect size = 0.285) was faster in the intervention group. Single task gait speed was not statistically significantly maintained in the intervention group ( b =5.38, P =.06, 95% CI [–0.30 to 11.36]) and declined in the control group (Cohen d effect size = 0.414). PP analyses also showed interaction terms for RBANS list recall subtest ( b =–0.36, P =.08, 95% CI [–0.75 to 0.04]) and visuospatial domain ( b =0.46, P =.08, 95% CI [–0.05 to 0.96]) that were not statistically significant. Conclusions CCT can be implemented in community settings to improve attention and executive function among healthy older adults. Findings help to identify suitable healthy aging programs that can be implemented on a larger scale within communities. T...

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BACKGROUND Cognitive training can improve cognition in healthy older adults OBJECTIVE The objectives are to evaluate the implementation of a community-based computerized cognitive training (CCT) and its effectiveness on cognition, gait, and balance in healthy older adults. METHODS A single-blind randomized controlled trial with baseline and follow-up assessments was conducted in two community centers (CCs) in Singapore. A total of 94 healthy community-dwelling adults aged 55 and above participated in a ten-week CCT program with two-hour instructor-led group classes conducted twice a week. Participants used a mobile application to play games targeting attention, memory, decision making, visuospatial abilities, and cognitive flexibility. Implementation was assessed at the participant-, provider-, and community-level (e.g., reach, implementation, and facilitators & barriers). Effectiveness measures were the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Color Trails Test Part 2 (CTT2), Berg Balance Scale, and GAITRite® walkway measures (single & dual task gait speed, dual task cost, and single & dual task gait variability index (GVI)). RESULTS The data was based on Intention-to-treat (ITT) and Per-protocol (PP) analysis. In the ITT group, single task GVI increased (b = 2.32, P = .02, 95% CI [0.30, 4.35]) and RBANS List Recognition subtest deteriorated (b = -0.57, P = .01, 95% CI [-1.00, -0.14]) in both groups. In the PP group, time taken to complete CCT2 (b = -13.5, P = .01, 95% CI [-23.95, -3.14]) was faster in the intervention group. Single task gait speed was also marginally significantly maintained in the intervention group (b = 5.38, P = .063, 95% CI [-0.30, 11.36]) but declined in the control group. For RBANS subtests, Picture Naming (b = 0.43, P = .04, 95% CI [0.01, 0.85]) improved significantly in both groups while List Recognition subtests (b = -0.54, P = .02, 95% CI [-1.00, -0.08]) performance deteriorated. CONCLUSIONS CCT can be successfully implemented in community settings to improve attention, executive function, and visuospatial abilities while maintaining gait speed amongst healthy older adults. Findings help to identify suitable healthy ageing programs that can be implemented on a larger scale within communities. CLINICALTRIAL ClinicalTrials.gov Identifier NCT04439591