Aging is often accompanied by weakness, difficulty walking, and declining cognition. This frailty results in adverse health outcomes including disability, hospitalization, and mortality.
A new study from the National University of Singapore (NUS) finds that among frail elders, good nutrition, physical training, and mental exercises can reverse many of the physical challenges associated with aging and improve cognition.
Associate Professor Ng Tze Pin, from the Department of Psychological Medicine at the NUS Yong Loo Lin School of Medicine, led the research team. The study adds to earlier findings that physically frail elderly persons are eight times as likely to be cognitive impaired at the same time compared to their robust counterparts.
And, if a physically frail individual is not cognitively impaired, they are more than five times at risk of becoming cognitively impaired on follow up three years later.
“In addition, physically frail elderly persons are two to 10 times as likely to become functionally disabled on daily living activities, hospitalized, and die earlier than their robust counterparts. When physical frailty and cognitive impairment are present together in the same individual, he or she is more than 20 times as likely to become disabled, hospitalized, or die earlier,” said Ng.
Accordingly, if it is possible to reduce or even reverse physical frailty in the elderly, we could greatly improve their quality of life, he said.
The researchers conducted a four-year trial between 2010 and 2013, involving 250 community-living older persons in Singapore who were 65 years old and above and who showed signs of frailty.
“Our study shows that it is feasible to identify pre-frail and frail older persons in the community and primary care settings and provide them with lifestyle interventions to reverse frailty. We found that better nutrition, physical training, and mental exercises can reverse frailty, enhance muscle strength and gait speed, reduce depressive symptoms, and improve cognitive functioning.
“As such, these interventions can go a long way to reducing the high prevalence of physical disability, hospitalization, and mortality in an ageing society like Singapore,” Ng added.
Participants for the trial were recruited from October 2009 to August 2012 from various senior activity centers in Singapore. They were randomly allocated to receive lifestyle interventions in one of five groups for a period of six months.
Three groups of participants were provided with either physical training, nutritional enhancement, or cognitive training, while the fourth group received a combination of all three interventions. The last group was a control group which did not receive any intervention. The trial was conducted in collaboration with Khoo Teck Puat and St Luke’s hospitals in Singapore.
Assessment of the participants’ frailty and other outcomes were made before the start of intervention. During the six-month trial, the participants’ progress were measured after three months and six months. A follow-up assessment was also conducted six months after the trial (i.e. 12 months after the start of intervention).
The NUS researchers found that the three types of intervention, as well as a combination of all three approaches, were able to reduce frailty and depressive symptoms, and improve cognitive functioning of the elderly.
Ng noted, “The important message from our studies is that frailty is not an inevitable part of ageing. There is much that older people can do for themselves to avoid becoming frail and disabled, so it is vital that they pay attention to good quality diet and nutrition, engage in physical exercise, and participate in socially and cognitively stimulating activities.”
Following the encouraging findings from the trial, the research team is working with the Geriatric Education and Research Institute (GERI) and social service organizations to develop and implement pilot frailty screening and multi-domain lifestyle intervention community programs.
They hope that such programs when successfully scaled up for mass intervention can help improve the physical, psychological, and cognitive well-being of large numbers of senior citizens.
Source: National University of Singapore
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