The effects of interventions to enhance cognitive and physical functions in older people with cognitive frailty: a systematic review and meta-analysis

Abstract

Introduction Cognitive frailty is the co-existence of mild cognitive impairment and physical frailty that increases the risk of adverse health outcomes. The existing systematic reviews on cognitive frailty in the literature have focused only on identifying associated factors and adverse outcomes, and their relationship with frailty and cognition. This study aimed to examine the effects of interventions on cognitive functions, frailty, and physical functions and provide an overview of intervention components used in older people with cognitive frailty. Methods This is a systematic review and meta-analysis. Medline, PubMed, CINAHL, Embase, PsycINFO, and Cochrane were searched for publishing during 2013–2021. Studies were selected based on the following eligibility criteria: 1) older people (age ≥ 60 years), 2) cognitive frailty, 3) outcomes on frailty or cognition or physical function, and 4) randomized controlled trial with any type of intervention. The Physiotherapy Evidence Database (PEDro) scale was used to rate the quality of the included studies. The review protocol was registered with PROSPERO (CRD42021251321). Results Two thousand five hundred six studies were identified, 9 were eligible, and 8 were included in the meta-analysis. The standardized mean difference (Hedges G) between groups of cognitive functions was 0.95, frailty status was 0, physical function in walking was -1.67, and the physical function in core strength assessment was 3.39. Physical activity appeared as an essential component in all interventions for older people with cognitive frailty. Discussion All interventions include physical activity as one of the components. Other components include cognitive training, nutrition education, behavioural intervention, mind–body intervention, psychosocial support, and virtual reality. The interventions are effective to promote cognitive and physical functions, but not physical frailty.

Management of cognitive frailty: A network meta‐analysis of randomized controlled trials

“…The included studies' aerobic exercises utilized Tai Chi Chuan 53 which benefits both frailty and cognition. Research suggests that physical exercises should be an essential component of CF intervention 20 . Moreover, aerobic exercise specifically helps frail seniors with depression and anxiety 61 .…”

“…Research suggests that physical exercises should be an essential component of CF intervention. 20 Moreover, aerobic exercise specifically helps frail seniors with depression and anxiety. 61 prevention is key to avoiding irreversible dementia.…”

“…Though physical activity is considered a key component in CF management by most studies 17 , 18 , 19 there is no consensus on whether exercise can improve frailty status in older adults. While some studies have shown exercise do not ameliorate frailty, 20 others have demonstrated such benefits. A network meta‐analysis (NMA) comparing the effectiveness of exercise on mild cognitive impairment and dementia revealed multi‐faceted exercise interventions were the most effective in improving overall cognitive abilities 21 .…”

Virtual and augmented reality applications to improve older adults’ quality of life: A systematic mapping review and future directions

“…In addition, VR and AR can also be applied to other domains, such as the behavioral domain in combination with other domains or separately to offer older adults real time management and make the consequences of their behaviors more tangible to motivate them to change. 137 , 138 …”

“…In addition, VR and AR can also be applied to other domains, such as the behavioral domain in combination with other domains or separately to offer older adults real time management and make the consequences of their behaviors more tangible to motivate them to change. 137,138 From the intended purpose perspective, this review concluded that VR training and rehabilitation appeared to be a promising supplement, if not an alternative, to traditional physiotherapy techniques. However, older adults are often hesitant to adopt training or rehabilitation without assistance, this may be due to their limited familiarity with technological advances.…”