Management of Frailty: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials

Negm, Ahmed; Kennedy, Courtney; Thabane, Lehana; Veroniki, Areti-Angeliki; Adachi, Jonathan; Richardson, Julie; Cameron, Ian D.; Giangregorio, Aidan; Πετροπούλου, Μαρία; Alsaad, Saad M; Al-Zahrani, Jamaan; Maaz, Muhammad; Ahmed, Muhammad Muneeb; Kim, Eileen; Tehfe, Hadi; Dima, Robert; Sabanayagam, Kalyani; Hewston, Patricia; Alrob, Hajar Abu; Παπαϊωάννου, Αλεξάνδρα

doi:10.1016/j.jamda.2019.08.009

Cited by 107 publications

(77 citation statements)

References 78 publications

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“…The WHO recommends each week at least 150 min of moderate-intensity endurance exercise, two sessions of resistance exercise, and three sessions of balance exercise in people with poor mobility [53]. Recently, a meta-analysis concluded that physical activity alone and nutritional support combined to physical activity were the most effective interventions to decrease frailty [55]. Our systematic review shows similar findings.…”

Section: Discussionsupporting

confidence: 78%

Nutritional Intervention to Prevent the Functional Decline in Community-Dwelling Older Adults: A Systematic Review

et al. 2020

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Aging is a global public health concern. From the age of 50, muscle mass, muscle strength and physical performance tend to decline. Sarcopenia and frailty are frequent in community-dwelling older adults and are associated with negative outcomes such as physical disability and mortality. Therefore, the identification of therapeutic strategies to prevent and fight sarcopenia and frailty is of great interest. This systematic review aims to summarize the impact of nutritional interventions alone or combined with other treatment(s) in older community-dwelling adults on (1) the three indicators of sarcopenia, i.e., muscle mass, muscle strength and physical performance; and (2) the hospitalization and readmission rates. The literature search was performed on Medline and included studies published between January 2010 and June 2020. We included randomized controlled trials of nutritional intervention alone or combined with other treatment(s) in community-living subjects aged 65 or older. In total, 28 articles were retained in the final analysis. This systematic review highlights the importance of a multimodal approach, including at least a combined nutritional and exercise intervention, to improve muscle mass, muscle strength and physical performance, in community-dwelling older adults but especially in frail and sarcopenic subjects. Regarding hospitalization and readmission rate, data were limited and inconclusive. Future studies should continue to investigate the effects of such interventions in this population.

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Section: Discussionsupporting

confidence: 78%

Nutritional Intervention to Prevent the Functional Decline in Community-Dwelling Older Adults: A Systematic Review

et al. 2020

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“…In fact, several interventions have been proposed to prevent, delay or reverse frailty in older people, such as physical exercise, nutritional supplementation, cognitive training and combined treatment [ 26 ]. Furthermore, several studies have also established the effectiveness of tailored management programs to prevent frailty progression [ 27 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

Validation of “(fr)AGILE”: a quick tool to identify multidimensional frailty in the elderly

et al. 2020

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Background Several tools have been proposed and validated to operationally define frailty. Recently, the Italian Frailty index (IFi), an Italian modified version of Frailty index, has been validated but its use in clinical practice is limited by long time of administration. Therefore, the aim of this study was to create and validate a quick version of the IFi (AGILE). Methods Validation study was performed by administering IFi and AGILE, after a Comprehensive Geriatric Assessment (CGA) in 401 subjects aged 65 or over (77 ± 7 years). AGILE was a 10-items tool created starting from the more predictive items of the four domains of frailty investigated by IFi (mental, physical, socioeconomic and nutritional). AGILE scores were stratified in light, moderate and severe frailty. At 24 months of follow-up, death, disability (taking into account an increase in ADL lost ≥1 from the baseline) and hospitalization were considered. Area under curve (AUC) was evaluated for both IFi and AGILE. Results Administration time was 9.5 ± 3.8 min for IFi administered after a CGA, and 2.4 ± 1.2 min for AGILE, regardless of CGA (p < 0.001). With increasing degree of frailty, prevalence of mortality increased progressively from 6.5 to 41.8% and from 9.0 to 33.3%, disability from 16.1 to 64.2% and from 22.1 to 59.8% and hospitalization from 17.2 to 58.7% and from 27.0 to 52.2% with AGILE and IFi, respectively (p = NS). Relative Risk for each unit of increase in AGILE was 56, 44 and 24% for mortality, disability and hospitalization, respectively and was lower for IFi (8, 7 and 4% for mortality, disability and hospitalization, respectively). The AUC was higher in AGILE vs. IFi for mortality (0.729 vs. 0.698), disability (0.715 vs. 0.682) and hospitalization (0.645 vs. 0.630). Conclusions Our study shows that AGILE is a rapid and effective tool for screening multidimensional frailty, able to predict mortality, disability and hospitalization, especially useful in care settings that require reliable assessment instruments with short administration time.

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“…According to a recent systematic review and meta-analysis of 21 randomised controlled trials in 5262 participants, physical activity intervention, when compared to placebo and standard care, was associated with reductions in frailty. 55 Physical intervention for older people with coronary heart disease may not only help prevent frailty but also help reduce cardiovascular risk.…”

Section: Discussionmentioning

confidence: 99%

<p>Frailty in Older Patients with Acute Coronary Syndrome in Vietnam</p>

Nguyen¹,

Le²,

Tran³

et al. 2019

CIA

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Background: There has been limited evidence about frailty in older patients with acute coronary syndrome (ACS) in Vietnam. Aim: (1) To investigate the prevalence of frailty in older patients hospitalised with ACS and its associated factors; (2) To investigate the impact of frailty on percutaneous coronary intervention (PCI) and adverse outcomes in this population. Methods: Patients aged ≥60 with ACS admitted to two teaching hospitals in Vietnam were recruited from 9/2017 to 4/2018. Frailty was defined by the Reported Edmonton Frail Scale. Multivariate logistic regression was applied to investigate the associated factors of frailty and the impact of frailty on PCI and adverse outcomes. Results: There were 324 participants, mean age 73.5±8.3, 39.2% female. The prevalence of frailty was 48.1%. Advanced age, female gender, history of hypertension, heart failure, stroke and chronic kidney disease were significantly associated with a frailty status. Overall, 50.3% of the participants received PCI (58.3% in the non-frail vs 41.7% in the frail, p=0.003). However, frailty did not have an independent impact on PCI (adjusted OR 0.66, 95% CI 0.41-1.08). Frailty was significantly associated with increased risk of having arrhythmia during hospitalisation (adjusted OR 2.24, 95% CI 1.32-3.80), hospital-acquired pneumonia (adjusted OR 2.27, 95% CI 1.24-4.17), in-hospital mortality (adjusted OR 3.02, 95% CI 1.35-6.75), 30-day mortality (adjusted OR 3.28, 95% CI 1.59-6.76), and 30-day readmission (adjusted OR 2.53, 95% CI 1.38-4.63). Conclusion: In this study, frailty was present in nearly half of older patients with ACS and was associated with increased adverse outcomes. These findings suggest that frailty screening should be performed in older patients with ACS in Vietnam.

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Management of Frailty: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials

Cited by 107 publications

References 78 publications

Nutritional Intervention to Prevent the Functional Decline in Community-Dwelling Older Adults: A Systematic Review

Nutritional Intervention to Prevent the Functional Decline in Community-Dwelling Older Adults: A Systematic Review

Validation of “(fr)AGILE”: a quick tool to identify multidimensional frailty in the elderly

<p>Frailty in Older Patients with Acute Coronary Syndrome in Vietnam</p>

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