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

TLDR

Frailty in older adults may be reversible with nutritional, physical, or cognitive interventions, alone or combined. The study compared six‑month nutritional, physical, cognitive, and combined interventions versus usual care to reduce frailty in prefrail and frail older adults. A parallel‑group RCT enrolled 151 community‑dwelling older adults (mean age 70) who received one of five 6‑month interventions—nutritional, cognitive, physical, combined, or usual care—and were evaluated on frailty, strength, gait, and activity at baseline, 3, 6, and 12 months. All groups, including control, showed frailty reduction, but intervention groups had significantly higher odds of reversal (OR 2.9–5.0), with benefits evident at 3, 6, and 12 months across strength, activity, gait, and energy domains, and no major differences in secondary outcomes.

Abstract

BackgroundIt is important to establish whether frailty among older individuals is reversible with nutritional, physical, or cognitive interventions, singly or in combination. We compared the effects of 6-month-duration interventions with nutritional supplementation, physical training, cognitive training, and combination treatment vs control in reducing frailty among community-dwelling prefrail and frail older persons.MethodsWe conducted a parallel group, randomized controlled trial in community-living prefrail and frail old adults in Singapore. The participants' mean age was 70.0 years, and 61.4% (n = 151) were female. Five different 6-month interventions included 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.ResultsFrailty score and status over 12 months were reduced in all groups, including control (15%), but were significantly higher (35.6% to 47.8%) in the nutritional (odds ratio [OR] 2.98), cognition (OR 2.89), and 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). There were no major differences with respect to the small numbers of secondary outcomes.ConclusionsPhysical, nutritional, and cognitive interventional approaches were effective in reversing frailty among community-living older persons.