Ng TP, Feng L, Nyunt MS, et al.
Am J Med 2015;128:1225-1236 e1221
Publication date: November 1, 2015
The objective of the Singapore Frailty Intervention Trial was to assess whether frailty among older individuals is reversible with nutritional, physical or cognitive interventions, singly or in combination.
The authors conducted a parallel group, randomized controlled trial in community-living prefrail and frail older adults in Singapore. Mean age was 70 years and 61.4% of the participants were female. Study participants (n = 246) were randomly assigned to five 6-month interventions: nutritional supplementation (n = 49), cognitive training (n = 50), physical training (n = 48), combination treatment (n = 49) and usual care control (n = 50).
Frailty score, body mass index, knee extension strength, gait speed, energy/vitality, and physical activity levels and secondary outcomes (activities of daily living dependency, hospitalization, and falls) were assessed at 0 months, 3 months, 6 months, and 12 months.
Frailty score and status over 12 months were reduced in all groups, including control (15%), but the odds of frailty reduction were significantly higher (35.6% to 47.8%) in the nutritional (odds ratio [OR] 2.98), cognition (OR 2.89), physical (OR 4.05) and combination (OR 5.00) intervention groups.
Beneficial effects were observed at 3 months and 6 months, and persisted at 12 months. Improvements in physical frailty domains (associated with interventions) were most evident for knee strength (physical, cognitive, and combination treatment), physical activity (nutritional intervention), gait speed (physical intervention), and energy (combination intervention). No major differences between groups were observed with respect to secondary, low-frequency outcomes (IADL-ADL dependency, hospitalization, and falls).
Whereas previous studies have evaluated either single or dual combinations of nutritional, cognitive or physical interventions, or an integrated multidomains intervention without differentiating the individual effects of specific interventions, 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.
The results of the trial demonstrate that it is feasible to identify prefrail and frail older persons in the community and primary care setting and to intervene effectively to reduce their level of frailty and possibly prevent future risks of hospitalization, functional dependency, institutionalization and deaths.