Improving aging-related frailty status among older adults: Results of a nutrition-focused program

Background: Healthcare professionals today aim to boost the years older people live in good health by reducing the impact of aging-related frailty. Toward healthier aging, our current analysis quantified frailty changes that occurred when poorly nourished, community-living, older adults received interventional nutrition care. Methods: We recruited outpatient study participants ≥ 60 years and malnourished or at-risk on screening (Mini Nutrition Assessment-Short Form, MNA-SF). For quasi-experimental analysis, we selected those who were prefrail or frail by Fried phenotype criteria (n=524). Each followed a comprehensive nutrition-focused Quality Improvement Program (QIP)—counseling on nutrition and physical activity, daily consumption of oral nutritional supplements for 60 days (Ensure with Hydroxymethylbutyrate® and Glucerna®, Abbott, USA), with follow-up through day 90. We quantified outcomes as changes from baseline to post-intervention for (i) overall frailty status (frail, prefrail, normal) or (ii) number of positive Fried frailty criteria of five (weight loss, exhaustion, low physical activity, slow gait speed, and muscular weakness) using change categories Worse, Same, or Better. We also measured baseline and post-intervention status of nutritional state (MNA-SF), mental state/cognitive status (Mini-Mental State Exam, MMSE), depression/psychological health (Geriatric Depression Scale, GDS), and disability (Barthel Index, BI). We applied logistic regression analyses to identify factors that predicted post-intervention improvement in frailty status. Results: At baseline, the mean age of participants was 74.2 (±8.7) years, 71% (n=372/524) of participants were prefrail, and 29% (n=152/524) were frail; 16.2% (n=85/524) were malnourished, and 83.8% (n=439/524) were at risk. By study day 90, 34.4% (180/524) of participants had a better frailty status, while 55% (n=288/524) met fewer frailty criteria. Better frailty status was also associated with significantly higher MNA-SF score (12.3 vs 9.1, P < 0.001), improved mental state/cognitive status as higher MMSE score (28.1 vs 27.7, P < 0.05), decreased depression/improved psychological health as lower GDS score (3.3 vs 4.5, P < 0.001), and greater independence as higher BI score (96.9 vs 96.1, P < 0.05). Logistic regression analyses showed that MNA-SF score improvement was predictive of frailty improvement in response to the nutrition-focused QIP intervention. Specifically, individuals who experienced improvement from prefrail or frail to normal were nearly 8-times more likely than others to have a parallel increase in MNA-SF score (Odds ratio of 7.83, 95% CI 4.3–15.2, P < 0.01). Conclusion: Healthy aging can be supported by addressing poor nutritional status, a frailty risk contributor. We found that community-living older adults achieved a better frailty status after following a nutrition-focused QIP. Notably, improved nutritional status predicted and paralleled improvement in frailty status. ClinicalTrials.gov Identifier: NCT04042987.