"GPs should prescribe protein powders and weight lifting to pensioners to help reverse frailty," The Daily Telegraph reports.
While there is no exact definition of frailty, it is usually used as an umbrella term to describe a range of linked age-related factors such as lack of energy, unintentional weight loss, slow walking speed and reduced grip strength.
Frailty among older adults is a growing problem. It can affect peoples' ability to carry out everyday activities, have a negative impact on quality of life and increase the risk of other health problems. Under UK government recommendations GPs are required to have systems in place to help identify people living with frailty. But how to provide effective care and support once people are identified is another issue.
A new review looked at 46 individual studies on the effectiveness of different interventions for frailty. The studies were highly varied with interventions ranging from different forms of physical activity to medication, education and nutrition supplements. Overall increased strength training and increased protein intake – either in the form of protein-rich foods or supplements – were the 2 interventions rated highest in terms of effectiveness and ease of implementation.
The findings are generally in-keeping with physical activity guidelines for older adults who, just like everyone else, should do strengthening exercises that work all major muscle groups on at least 2 days per week (combined with aerobic exercise). A healthy and balanced diet is also essential, and protein is a vital component necessary for growth and repair in the body.
Where did the story come from?
The study was conducted by researchers from St Vincent's University Hospital and Trinity College Dublin. One of the researchers received funding from the Irish Health Research Board for the Systematic Approach for Improving Care for Frail Older People (SAFE). It was published in the peer-reviewed British Journal of General Practice.
The Telegraph and Mail Online's coverage was accurate, with the exception that both sources suggested GPs should prescribe protein "powders", which is not strictly correct. The review did find that increased protein intake was effective. But the study's authors did not make any recommendation about how to increase protein intake, and didn't mention powders at all.
What kind of research was this?
This was a systematic review that identified trials and observational studies looking at different frailty interventions provided in general practice or the community.
Frailty is described in the review as "a state of physiological vulnerability with diminished capacity to manage external stressors" and is linked with increased risk of illness, falls, dependency, disability and death. Studies estimate frailty affects around half of people above the age of 80.
As the population ages, the number of people living with frailty is increasing. Effective prevention and management of frailty is therefore needed.
A systematic review is the best way to identify research that has looked into interventions, but the findings are only as reliable as the studies included in the review.
What did the research involve?
The study searched medical literature databases for relevant studies using a variety of terms such as "frailty", "primary care", "community", "screening" and "interventions". The researchers assessed and compared the studies, according to their design and methods, interventions and the outcomes measured.
They used a scoring system to rate the intervention's effectiveness in terms of whether it improved frailty according to given criteria. They also considered how easy the intervention would be to implement in terms of time and money, and healthcare professionals' involvement (for example, could a single professional provide an intervention or would it take a team of professionals).
The inclusion criteria were met by 46 studies and involved a total of 15,690 adults, with an average 160 participants per study. All the studies were recent with only 4 pre-dating 2010. However, only 2 studies came from the UK, with 10 from Japan, 8 the US, and others from other Western and Asian countries.
The 46 studies used 17 different screening criteria to identify people living with frailty. They also covered highly varied interventions – 23 interventions involved physical exercise, though this ranged from mixed aerobic and strength training to specific exercises such as walking or tai-chi, 1 involved a Wii games console. Ten studies involved dietary and health education, 8 involved medication management and 8 involved nutrition supplements. Other studies involved home visits or counselling.
What were the basic results?
Roughly two-thirds of all studies demonstrated that interventions improved frailty.
Interventions that included strength training and increased protein intake or supplementation were consistently rated highest in terms of effectiveness and ease of implementation.
Interventions that were similarly easy to implement but in the mid-range of effectiveness included tai-chi, health education, increased calories. Treatments such as hormone replacement or osteoporosis medicines were also in the mid-range of effectiveness, but harder to implement.
Home visits and geriatric assessments seemed to be among the less effective interventions.
How did the researchers interpret the results?
The researchers conclude their findings "suggest that a combination of strength exercises and protein supplementation is the most effective and easiest to implement intervention to delay or reverse frailty."
With the growing prevalence of frailty and increasing pressure on GPs to identify people at risk, this systematic review is highly relevant.
Essentially its findings are in-line with current government recommendations. Older adults aged over 65 are advised, just as younger adults are, to do weekly aerobic exercise combined with strengthening exercises that work all major muscle groups on at least 2 days per week. Protein is also an essential dietary component which is necessary for growth and repair in the body.
However this review can't provide specific recommendations, such as the best type of strength training or the exact amount of protein needed and whether this should come just from dietary sources (such as meat, fish and cheese) or in the form of supplements.
Nevertheless the findings support UK physical activity guidelines. They are also broadly in-keeping with recommendations on how to reduce your risk of frailty and disability:
- being more physically active
- following a healthy diet
- stopping smoking
- reducing alcohol
- maintaining a healthy weight
The earlier in life that you put these changes in place, the more likely you are to avoid frailty in older age.
Read more advice about healthy living.
Analysis by Bazian
Edited by NHS Website
Links to the headlines
The Daily Telegraph, 4 December 2018
Mail Online, 4 December 2018
Links to the science
British Journal of General Practice. Published online December 4 2018