Comprehensive geriatric intervention in community‐dwelling older adults: a cluster‐randomized controlled trial

Abstract

Background In longevity societies, one of the most serious social issues is sarcopenia and/or frailty. Preventing them is important for maintaining independence and quality of life in the older population. This study investigated the effect of a self‐monitoring comprehensive geriatric intervention programme (CGIP) on physical function and muscle size in community‐dwelling older adults. We compared the effects of a CGIP using weekly class‐styled (CS) sessions and a home‐based (HB) programme. Methods The 526 participants were randomized into one of two groups (CS 251, HB 275) based on their residential districts. We conducted a 12 week CGIP, which consisted of low‐load resistance exercise, physical activity increments, oral function improvements, and a nutritional guide. All participants were encouraged to attend two 90 min lectures that included instructions on the CGIP. They were provided with exercise materials (triaxial‐accelerometers/pedometers, ankle weights, and elastic bands) and diary logs. The CS group attended 90 min weekly sessions and independently executed the programme on other days, whereas the HB group only received instructions on how to execute the programme. Physical functions, such as knee extension strength (KES), normal and maximum walking speed, the timed up‐and‐go test, and anterior thigh muscle thickness (MT), were measured and analysed using intention‐to‐treat analysis before and after the 12 week intervention. Results Of the 526 participants identified, 517 (CS 243 age 74.0 ± 5.4 women 57.2%, HB 274 age 74.0 ± 5.6 women 58.8%) were enrolled. Nine (CS 8, HB 1) were excluded from the analysis because they did not participate in the pre‐intervention measurements. Both interventions significantly improved KES (CS 18.5%, HB 10.6%), normal walking speed (CS 3.7%, HB 2.8%), and MT (CS 3.2%, HB 3.5%). Greater improvement of KES was observed in the CS group (P = 0.003). Maximum walking speed (CS 4.7%, HB 1.8%; P = 0.001) and timed up‐and‐go (CS −4.7%, HB −0.2%; P < 0.001) significantly improved in the CS group only. Conclusions The intervention was effective in preventing sarcopenia and/or frailty. Most physical functions and MT improved after both interventions. The HB intervention is cost‐effective and may help prevent sarcopenia and/or frailty in the large older population.

Objectively Measured Daily Step Counts and Prevalence of Frailty in 3,616 Older Adults

“…Our previous study demonstrated that adding approximately 1,000 steps per day is a viable strategy for large-scale population-based intervention. 23 The strengths of this study are that we verified the association between daily step counts assessed by accelerometers in a large-scale cohort study of older adults living in a region and the prevalence of frailty as defined by two validated evaluation tools. The results for their association are robust, and our results may have potential for further generalization.…”

“…Therefore, our results indicate the possibility that the effect of increasing daily step count may be greater in people with lower daily step counts, suggesting that the “+10” (approximately 1,000 more steps than now), with the objective of a small increase in step count, may be effective for shut‐in or sedentary older adults with low step counts. Our previous study demonstrated that adding approximately 1,000 steps per day is a viable strategy for large‐scale population‐based intervention 23 …”

Nutrition in the spotlight in cachexia, sarcopenia and muscle: avoiding the wildfire

“…We selected articles investigating nutrition interventions, macronutrient intake below recommended, and micronutrient deficiency. We found 26 articles: 10 clinical trials, 3,25–33 five cross‐sectional studies, 34–38 three experimental animal studies 39–41 (one of which also included a human cross‐sectional analysis 38 ), three narrative reviews, 6,42,43 two retrospective studies, 44,45 two systematic reviews or meta‐analyses, 46,47 and one questionnaire survey 48 . Within the 320 original and review articles published in 2018, 2019, and 2020 in JCSM , the 26 articles on nutrition that we found comprise approximately 8%.…”

“…Of the nutrition studies that we found, one explored the role of protein, 31 three explored the role of vitamin D, 26,38,39 two explored the role of several nutrients, 3,41 and one explored the role of natural product (astaxanthin) supplements 40 . Seven studies 25,27–30,32,33 investigated the effects of multimodal interventions (defined as two or more approaches) on muscle mass. Articles also explored the associations of protein intake, 46,47 iron deficiency, 37,42 micronutrients, 35 calorie restriction, 43 nitrate dietary intake, 36 retrospective evaluation of early dietary supplementation, 44 and overall dietary intake and patterns 34 with several clinical outcomes and/or biomarkers of sarcopenia or cachexia.…”

The Effectiveness of an Active Learning Program in Promoting a Healthy Lifestyle among Older Adults with Low Health Literacy: A Randomized Controlled Trial

“…The accelerometer displays were masked to prevent participants from checking their step counts. In addition to step counts (i.e., number of steps/day), moderate-to-vigorous physical activity (i.e., ≥3 metabolic equivalents; MET) was measured in terms of MET h/week [29].…”