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

Han, Chad Yixian; Miller, Michelle; Yaxley, Alison; Baldwin, Claire; Woodman, Richard; Sharma, Yogesh

doi:10.1136/bmjopen-2020-040146

Cited by 38 publications

(39 citation statements)

References 70 publications

(337 reference statements)

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“…A review of existing literature indicates that nutritional improvement by assessing nutritional status and individual needs and programmed physical exercise can improve frailty status. 29 …”

Section: Discussionmentioning

confidence: 99%

Risk of Falls in HIV-Infected Patients on Antiretroviral Therapy and Its Associated Factors

Wahyudi¹,

Putri²,

Yunihastuti³

et al. 2022

HIV

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Purpose Fall is one of the geriatric syndromes and a significant public health concern, which causes potentially severe consequences among the elderly. Geriatric syndromes are common among PLHIV and affect younger age than the general population. This study attempted to identify the risk of falls in PLHIV on antiretroviral therapy (ART) and its related factors among older adults with HIV infection. Methods This cross-sectional study was conducted from December 2019 to May 2020 among PLHIV aged ≥40 years who received ART for at least 6 months in HIV Integrated Clinic, Cipto Mangunkusumo Hospital, Jakarta. Bivariate and multivariate analyses were performed using Poisson regression with robust estimator using STATA version 12.0. Results A total of 102 participants mainly consisted of males (83.3%) with a median age of 45 (IQR 5) years. The risk of fall was detected in 52% of these participants. PLHIV who have history of falls, current CD4 below 200 cells/mm 3 , and pre-frail–frail status were associated with an increased risk of falls in the future. An LPV/r-based regimen was found to be a protective factors of risk of falls among PLHIV. Conclusion History of falls, current CD4 below 200 cells/mm 3 , and pre-frail and frail status were identified as factors associated with a greater risk of fall among PLHIV.

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Section: Discussionmentioning

confidence: 99%

Risk of Falls in HIV-Infected Patients on Antiretroviral Therapy and Its Associated Factors

Wahyudi¹,

Putri²,

Yunihastuti³

et al. 2022

HIV

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“…There is a paucity of high-quality studies on combined exercise-nutrition interventions of frail older adult populations [ 58 ]. A recent review of exercise and nutrition in managing hip fracture in older adults concluded that there are still few large, long term RCTs that involve multicomponent exercise and nutrition therapy interventions [ 59 ].…”

Section: Discussionmentioning

confidence: 99%

Effect of Individual Nutrition Therapy and Exercise Regime on Gait Speed, Physical Function, Strength and Balance, Body Composition, Energy and Protein, in Injured, Vulnerable Elderly: A Multisite Randomized Controlled Trial (INTERACTIVE)

et al. 2021

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It is imperative that the surgical treatment of hip fractures is followed up with rehabilitation to enhance recovery and quality of life. This randomized controlled trial aimed to determine if an individualised, combined exercise–nutrition intervention significantly improved health outcomes in older adults, after proximal femoral fracture. We commenced the community extended therapy while in hospital, within two weeks post-surgery. The primary outcome was gait speed and secondary outcomes included physical function, strength and balance, body composition, energy and protein intake. Eighty-six and 89 participants were randomized into six months individualised exercise and nutrition intervention and attention-control groups, respectively. There were no statistically significant differences in gait speed between the groups at six and 12 months. There were no major differences between groups with respect to the secondary outcomes, except estimated energy and protein intake. This may be explained by the sample size achieved. Participants in the intervention group had greater increment in energy (235 kcal; 95% CI, 95 to 375; p = 0.01) and protein intake (9.1 g; 95% CI, 1.5 to 16.8; p = 0.02), compared with those in the control group at six months but not significant at 12 months. This study has demonstrated that providing early, combined exercise and nutrition therapy can improve dietary energy and protein intake in older adults with hip fractures.

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“…Hence, the healthcare professional may be required to tackle nutritional issues related to pre-frailty and frailty concurrently, when treating malnutrition (38), and refer to other members of the multidisciplinary team to support comprehensive frailty management. For example, working with a multidisciplinary team using combined nutrition-exercise components as part of multidisciplinary frailty management (39).…”

Section: Discussionmentioning

confidence: 99%

Use of the Patient-Generated Subjective Global Assessment to Identify Pre-Frailty and Frailty in Hospitalized Older Adults

Han

Sharma

Yaxley

et al. 2021

The Journal of nutrition, health and aging

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OBJECTIVES: The Scored Patient-Generated Subjective Global Assessment (PG-SGA) and Edmonton Frail Scale (EFS) are widely used in acute care settings to assess nutritional and frailty status, respectively. We aimed to determine whether the scored PG-SGA can identify pre-frailty and frailty status, to simultaneously evaluate malnutrition and frailty in clinical practice. DESIGN: Cross-sectional study. SETTINGS AND PARTICIPANTS: A convenience sample of 329 consecutive patients admitted to an acute medical unit in South Australia. MEASUREMENTS: Nutritional and frailty status were ascertained with scored PG-SGA and EFS, respectively. Optimal cut-off scores to identify pre-frailty and frailty were determined by calculating the Scored PG-SGA's sensitivity, specificity, positive and negative predictive values, Youden Index (YI), Liu index, Receiver Operator Curves (ROC) and Area Under Curve (AUC). Nutritional status and patient characteristics were analysed according to frailty categories. RESULTS: The optimal cut-off PG-SGA score as determined by the highest YI, to identify both pre-frailty and frailty was >3, with a sensitivity of 0.711 and specificity of 0.746. The AUC was 0.782 (95% CI 0.731-0.833). In this cohort, 64% of the patients were wellnourished, 26% were moderately malnourished and 10% were severely malnourished. Forty-three percent, 24% and 33% of the patients were classified as robust, pre-frail and frail, respectively. Bivariate analysis showed that those robust were significantly younger than those who were pre-frail (-2.8, 95% CI -5.5 to -0.1, p=0.036) or frail (-3.4, 95% CI -5.9 to -1.0, p=0.002). Robust patients had significantly lower Scored PG-SGA than those who were pre-frail (-2.5, 95%CI -3.8 to -1.1, p<0.001) or frail (-4.9, 95% CI -6.1 to -3.7, p<0.001). CONCLUSION: The Scored PG-SGA is moderately sensitive in identifying pre-frailty/frailty in older hospitalized adults and can be useful in identifying both conditions concurrently.

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

Cited by 38 publications

References 70 publications

Risk of Falls in HIV-Infected Patients on Antiretroviral Therapy and Its Associated Factors

Risk of Falls in HIV-Infected Patients on Antiretroviral Therapy and Its Associated Factors

Effect of Individual Nutrition Therapy and Exercise Regime on Gait Speed, Physical Function, Strength and Balance, Body Composition, Energy and Protein, in Injured, Vulnerable Elderly: A Multisite Randomized Controlled Trial (INTERACTIVE)

Use of the Patient-Generated Subjective Global Assessment to Identify Pre-Frailty and Frailty in Hospitalized Older Adults

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