Nutritional, Physical, Cognitive and Combination Interventions and Frailty Reversal Among Older Adults: A Randomized Controlled Trial

T. P. Ng, L. Feng, M.S. Nyunt, L. Feng, M. Niti, B.Y. Tan, G. Chan, S.A. Khoo, S.M. Chan, P. Yap, K.B. Yap

Am J Med .2015;128(11):1225-1236.e1

This study aimed to assess the reversibility of frailty in 246 community-living pre-frail and frail older people in Singapore (mean age: 70 years). Participants were randomly assigned to 5 different 6-month interventions: nutritional supplementation, physical training, cognitive training, combination treatment and usual care control.

Frailty was measured based on the CHS criteria for 5 frailty components: unintentional weight loss, slowness, weakness, exhaustion, low activity. The primary outcomes were frailty score (continuous variable) and reduction of frailty (dichotomous variable), and measures of frailty components (BMI, fast gait speed test, knee extension, exhaustion score, and physical activity). These along with secondary outcomes (activities of daily living dependency, hospitalization and falls) were assessed at 0, 3, 6 and 12 months.

Reduction in frailty during follow-up was defined as a transition to a lower frailty category from baseline over 12 months.

Frailty score and status over 12 months were reduced in all groups, including control, but the odds of frailty reduction were significantly higher in the nutritional (OR 2.98), cognition (OR 2.89), physical (OR 4.05) and combination (OR 5.00) groups. Beneficial effects persisted at 12 months.

This is the first interventional trial evaluating concurrently the effects of nutritional, cognitive, physical, and combination interventions in reversing frailty and its physical manifestations among community-living older adults.

This study shows that single interventions can improve frailty, but it is the combined intervention that gives the best results.

Comment: Two features limit the generalizability of this results: the high compliance rate for all intervention groups that is exceptional even among rigorously conducted clinical trials, and the characteristics of the sample of Chinese older adults with relatively younger age, good physical and cognitive performance, and less frequent hospitalizations. This study shows that it is feasible to identify prefrail and frail older person in the community and primary care setting and intervene effectively to reduce their level of frailty and possibly prevent future risks of hospitalization, functional dependency, institutionalization and deaths.