A multifactorial interdisciplinary intervention reduces frailty in older people: randomized trial

Abstract

BackgroundFrailty is a well known and accepted term to clinicians working with older people. The study aim was to determine whether an intervention could reduce frailty and improve mobility.MethodsWe conducted a single center, randomized, controlled trial among older people who were frail in Sydney, Australia. One group received an intervention targeting the identified characteristics of frailty, whereas the comparison group received the usual health care and support services. Outcomes were assessed by raters masked to treatment allocation at 3 and 12 months after study entry. The primary outcomes were frailty as assessed by the Cardiovascular Health Study criteria, and mobility as assessed by the Short Physical Performance Battery. Secondary outcome measures included disability, depressive symptoms and health-related quality of life.ResultsA total of 216 participants (90%) completed the study. Overall, 68% of participants were women and the mean age was 83.3 years (standard deviation, 5.9). In the intention-to-treat analysis, the between-group difference in frailty was 14.7% at 12 months (95% confidence interval: 2.4%, 27.0%; P = 0.02). The score on the Short Physical Performance Battery, in which higher scores indicate better physical status, was stable in the intervention group and had declined in the control group; with the mean difference between groups being 1.44 (95% confidence interval, 0.80, 2.07; P <0.001) at 12 months. There were no major differences between the groups with respect to secondary outcomes. The few adverse events that occurred were exercise-associated musculoskeletal symptoms.ConclusionsFrailty and mobility disability can be successfully treated using an interdisciplinary multifaceted treatment program.Trial registrationAustralia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12608000250336

Síndrome da fragilidade em idosos com diabetes mellitus tipo 2

“…This fact was observed in other studies, which revealed prevalence of white people among the subjects who participated in the analysis. (13) The reason for the prevalence of frail elderly of white ethnicity can be because the evaluations were carried out at various locations in order to cover different socioeconomic and demographic classes.…”

Multicomponent exercises including muscle power training enhance muscle mass, power output, and functional outcomes in institutionalized frail nonagenarians

“…Along with sarcopenia, skeletal muscle fat infiltration, which is assessed through muscle tissue attenuation, is associated with an increased risk of mobility loss in older men and women (Visser et al 2005). As a consequence of impaired muscle function, the diagnosis of frailty includes physical impairments, such as low gait speed, fatigue, and low grip strength (Fried et al 2001;Bandeen-Roche et al 2006;Garcia-Garcia et al 2011;Cameron et al 2013). Due to the physical domains that are related to frailty, physical activity is one of the most important components in the prevention and treatment of this syndrome.…”

Musculoskeletal health, frailty and functional decline

“…Comprehensive geriatric assessment followed by an individualised multicomponent treatment has a strong evidence base and so not surprisingly is effective when applied to frail older adults. Recent frailty focused trials utilize a range of treatments, including nutritional therapy, psychiatrist or psychologist input, interventions to reduce social isolation, and exercise therapy and show effects [110,111]. One recent trial however showed that the effects take time to accrue so interventions need to be long term.…”